D.C. Mun. Regs. r. 22-A8001

Current through Register Vol. 71, No. 25, June 21, 2024

Rule 22-A8001 - ELIGIBILITY FOR BEHAVIORAL HEALTH STABILIZATION SERVICES

8001.1

Providers certified under this chapter shall provide behavioral health stabilization services to any individual who presents in a behavioral health crisis, regardless of insurance status or ability to pay.

8001.2

An individual shall meet the following eligibility requirements to receive Medicaid-funded behavioral health stabilization services:

(a) Be bona fide residents of the District, as defined in D.C. Official Code § 7-1131.02(29); and

(b) Be enrolled in Medicaid, or be eligible for enrollment and have an application pending; or

(c) For new enrollees and those enrollees whose Medicaid eligibility has lapsed:

(i) There is an eligibility grace period of ninety (90) calendar days from the date of first service for new enrollees, or from the date of eligibility expiration for enrollees who have a lapse in coverage, until the date the District's Economic Security Administration ("ESA") makes an eligibility or recertification determination.

(ii) In the event an individual appeals a denial of eligibility or recertification by the ESA, the Director may extend the ninety (90) calendar day eligibility grace period until the appeal has been exhausted. The ninety (90) calendar day eligibility grace period may also be extended at the discretion of the Director for other good cause shown.

(iii) Upon expiration of the eligibility grace period, services provided to the individual are no longer reimbursable by Medicaid. Nothing in this section alters the Department's timely- filing requirements for claim submissions.

8001.3

To qualify for locally- funded services, individuals must not be eligible for Medicaid or Medicare, not be enrolled in any other third-party insurance program except the D.C. HealthCare Alliance, or be enrolled in an insurance program that does not cover medically necessary services. All individuals receiving locally- funded services must also meet the following requirements:

(a) For individuals eighteen (18) years of age and older, live in households with a countable income of less than two hundred percent (200%) of the Federal poverty level, and for individuals under eighteen (18) years of age, live in households with a countable income of less than three hundred percent (300%) of the Federal poverty level.

(b) An individual who does not meet the income limits in paragraph (a) above may receive treatment services in accordance with the following requirements:

(i) The individual must, within ninety (90) days of enrollment for services, apply to the Department of Human Services Economic Security Administration for certification to verify income; and

(ii) The individual may receive treatment services in accordance with rates determined by the Department.

D.C. Mun. Regs. r. 22-A8001

Final Rulemaking published at 68 DCR 1623 (2/5/2021)