D.C. Mun. Regs. tit. 22, r. 22-A6401

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-A6401 - REIMBURSEMENT RATE

6401.1

The Department of Health Care Finance has published rates for Medicaid- funded services under Title 22-A District of Columbia Municipal Regulations (DCMR), Chapter 63. Those rates are contained in the District of Columbia Medicaid fee schedule available online at www.dcmedicaid.com. The Department of Behavioral Health ("the Department") shall reimburse providers for Chapter 63 services provided to non-Medicaid beneficiaries at the same rates as contained in the District of Columbia Medicaid fee schedule.

6401.2

Reimbursement for the local-only substance use services provided under Title 22- A DCMR Chapter 63,which include:

(a) Multi-systemic Therapy for Transition Age Youth and

(b) Environmental Stability, as well as Chapter 63-adjacent

(c) Residential Room and Board, are set forth in the table below. The Department shall publish notice of all future updates to these codes and rates through a Public Notice in the D.C. Register and provide for meaningful comment before implementation. The Notice shall describe the type of change, the reason for the change, the effective date of the change, and the new local only reimbursement rate.

SERVICE	CODE	RATE per UNIT ($)	UNIT
Multi-Systemic Therapy for Transition Age Youth (TAY) (ACRA) (Ages 21-24)	H2033HF	63.11	15 min.
Residential Treatment, Room & Board	H0043	101.14	Per diem
Residential Treatment, Room & Board, Woman w/1 child	H0043UN	210.00	Per diem
Residential Treatment, Room & Board, Woman w/2 children	H0043UP	215.00	Per diem
Residential Treatment, Room & Board, Woman w/3 children	H0043UQ	220.00	Per diem
Residential Treatment, Room & Board, Women w/4 or more children	H0043UR	225.00	Per diem
Environmental Stability, Supported Housing, Individual	H0044HF	849.00	Per month
Environmental Stability, Supported Housing, Woman w/children	H0044HFUN	1000.00	Per month

6401.3

Reimbursement for the following tests provided to non-Medicaid clients shall be

the rate contained in the District of Columbia Medicaid fee schedule available online at www.dcmedicaid.com:

(a) HIV-1 and HIV-2 Single Result Testing (86703);

(b) Urine Pregnancy Test (81025);

(c) Tuberculosis Test, Intradermal (86580);

(d) Hepatitis C Test (86803);

(e) Presumptive Drug Test, Optical Observation (80305);

(f) Presumptive Drug Test, Assisted Direct Optical Observation (80306); and

(g) Presumptive Test by Instrument Chemistry Analyzers (80307).

6401.4

Reimbursement for the following tests provided to non-Medicaid clients shall be the rate contained in the District of Columbia Medicaid fee schedule available online at www.dcmedicaid.com

(a) Definitive Drug Testing 1-7 Drug Classes (G0480); and

(b) Definitive Drug Testing 8-14 Drug Classes (G0481).

6401.5

All future updates to the service codes and rates will be included in the District of Columbia Medicaid fee schedule pursuant to the procedures established in Title 29 DCMR, Section 988, by providing notice and an opportunity for comment.

D.C. Mun. Regs. tit. 22, r. 22-A6401

Final Rulemaking published at 63 DCR 6936 (5/6/2016; amended by Final Rulemaking published at 66 DCR 002322 (2/22/2019); amended by Final Rulemaking published at 67 DCR 11430 (10/2/2020)