D.C. Mun. Regs. r. 22-A3432

Current through Register Vol. 71, No. 24, June 14, 2024

Rule 22-A3432 - NON-REIMBURSABLE SERVICES

3432.1

Clinical Care Coordination (CCC) adopts a "whole-person" approach to address the consumer's needs related to their physical health, behavioral health, and social determinants of health. CCC involves coordination of care between the behavioral health clinician and the clinical personnel of an external provider (e.g., primary care, another behavioral health provider, payors, behavioral health authority, hospital).

3432.2

CCC is essential to ensuring that consumers receive both the appropriate level of care and that there is continuity of care when transitioning to a different level of care or to new providers of care. The reconciliation of medications, where appropriate, is a vital component of CCC.

3432.3

CCC may be rendered by a qualified practitioner pursuant to § 3432.8 practicing within the scope of their license in person or through telehealth in accordance with 29 DCMR § 910.

3432.4

Qualified practitioners providing CCC shall:

(a) Communicate treatment needs, assessments and treatment information to healthcare providers external to the consumer's CSA or specialty provider;

(b) Facilitate appropriate linkages for the consumer with other healthcare professionals external to the consumer's CSA or specialty provider; and

(c) Provide planning and Plan of Care implementation activities separate from the diagnostic assessment service when the clinician and consumer meet face-to-face or through telehealth pursuant to 29 DCMR § 910.

3432.5

Providers must document CCC in an encounter note that meets the requirements of § 3413.19 and indicates the intended purpose of the service, the modality of communication, time spent reviewing or preparing records, the actions taken, and the result(s) achieved.

3432.6

CCC shall be provided at a site pursuant to 29 DCMR § 910.7 or § 910.8.

3432.7

The provider may only submit a claim for one (1) service if multiple practitioners participated in rendering the CCC service.

3432.8

Qualified Practitioners of CCC are:

(a) Physicians;

(b) Psychologists;

(c) LICSWs;

(d) LGSWs;

(e) APRNs;

(f) Registered Nurses;

(g) LISWs;

(h) LPCs;

(i) Physician Assistants;

(j) Psychology Associates;

(k) LMFTs; and

(l) LGPCs.

D.C. Mun. Regs. r. 22-A3432

Final Rulemaking published at 67 DCR 10674 (9/4/2020); amended by Final Rulemaking published at 70 DCR 3050 (3/10/2023), effective date corrected to 4/7/2023, by Errata Notice published at 71 DCR 4474 (4/19/2024).