D.C. Mun. Regs. tit. 29, r. 29-990

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

Rule 29-990 - INDEPENDENTLY LICENSED BEHAVIORAL HEALTH PRACTITIONERS

990.1

The following independently licensed behavioral health practitioners (individual and group) shall be eligible to enroll in the District of Columbia Medicaid Program and provide behavioral health services, regardless of program affiliation:

(a) Psychologists;

(b) Licensed independent clinical social workers;

(c) Licensed professional counselors; and

(d) Licensed marriage and family therapists.

990.2

Medicaid reimbursement shall be available for the following services, when provided to an eligible Medicaid beneficiary by an independently licensed behavioral health practitioner identified in § 990.1, practicing within the scope of their license, in accordance with requirements set forth in Title 17 of the District of Columbia Municipal Regulations (DCMR):

(a) Assessment, diagnostic, and screening services; and

(b) Psychological testing.

990.3

Medicaid reimbursement shall be available for the following services, when provided to an eligible Medicaid beneficiary diagnosed with a behavioral health condition by a licensed practitioner practicing within the scope of their license, in accordance with requirements set forth in Title 17 of the DCMR:

(a) Counseling and psychotherapy; and

(b) Treatment planning and care coordination.

990.4

Additional guidance on service delivery and provider billing shall be published on DHCF's Medicaid website at www.dc-medicaid.com.

990.5

Except for the services described in § 990.6, Medicaid reimbursement rates for fee-for-service behavioral health services shall be eighty percent (80%) of the rates paid by the Medicare program. The reimbursement rates for behavioral health services shall be posted on DHCF's Medicaid website at www.dc-medicaid.com and updated annually.

990.6

DHCF shall establish the Medicaid reimbursement rate for procedure codes that do not fall within the Medicare fee schedule by considering the following factors:

(a) Practitioner fees;

(b) Fee schedules from other states;

(c) Similar procedures with established fees; and/or

(d) Private insurance payments.

D.C. Mun. Regs. tit. 29, r. 29-990

Amended by Final Rulemaking published at 69 DCR 10987 (9/2/2022)