D.C. Mun. Regs. r. 22-A3304
The Department has established a billing code - the Transitional Care Case Rate ("TCR") - to be used by the consumer's clinical home for payment of the CTV.
The total CTV payment will be provided in increments of 50% for the first claim, 25% for the second claim, and 25% for the third claim over a minimum 3 month period. Each consumer who transitions from the DCCSA to a new clinical home must remain with the new provider for a minimum of ninety (90) days from the date of enrollment in order for the new clinical home to submit all three claims for the entire amount of the CTV. If the consumer changes providers before the entire CTV can be claimed by the new provider in accordance with Sections 3304.3 - 3304.6, the remainder of the CTV will not be available to the second, or any subsequent, providers.
In order for any CTV payment to occur, an authorization request for the CTV will need to be included in the authorization plan for each transitioned consumer. A maximum of three (3) units of the CTV may be authorized between the initial enrollment and the 9th month following the consumer's intake with the new CSA.
In order for the new provider to be eligible to claim the CTV, the initial intake of the consumer by the new provider must occur within 90 days of the consumer's transfer from the DCCSA. Upon completion of the consumer's intake with the new provider, the new provider may submit a claim for the first unit of the CTV (50% of the CTV) using the appropriate billing code (T2022U1 - Initial Transitional Care Case Rate).
The new provider may submit a claim for the second unit of the CTV (25% of the CTV) during the second month of services to the consumer, using the appropriate billing code (T2022U2 - Subsequent Transitional Care Case Rate). If the consumer is not seen on a monthly basis, the provider can submit a claim for the second installment of the CTV any time services are rendered to the transitioning consumer as long as it is after the conclusion of the initial month of service with the new provider and before the sixth month following the consumer's initial intake. This claim must accompany a concurrent claim for an MHRS service to the consumer in order for the second installment to be paid.
The new provider may submit a claim for the final unit of the CTV (25% of the CTV) using the appropriate billing code (T2022U2 - Subsequent Transitional Care Case Rate) during the third month of services to the consumer. If the consumer is not seen on a monthly basis, the provider can submit a claim for the third installment of the CTV any time services are rendered to the transitioning consumer as long as it is after the conclusion of the second month of service with the new provider and before the ninth month following the consumer's initial intake. This claim must accompany a concurrent claim for an MHRS service to the consumer in order for the third installment to be paid.
Claims for the CTV are subject to DMH audit/chart review to substantiate the CTV claim.
The CTV does not affect the payment of any MHRS services provided to transitioned consumers by any MHRS provider.
D.C. Mun. Regs. r. 22-A3304