D.C. Mun. Regs. tit. 29, r. 29-5220

Current through Register Vol. 71, No. 44, November 1, 2024

Rule 29-5220 - REIMBURSEMENT

5220.1

Reimbursement for MHRS shall be made according to the District of Columbia Medicaid fee schedule available online at www.dc-medicaid.com. Updates to the reimbursement rates for MHRS services shall comply with the public notice requirements set forth in 29 DCMR § 988.

5220.2

A public notice of MHRS rate changes shall be published in the D.C. Register at least thirty (30) calendar days before the change shall take effect and the public notice shall include a link to the Medicaid fee schedule.

5220.3

DBH shall be responsible for payment of the non-federal share of total expenditures under the District of Columbia Medicaid State Plan (State Plan), or the local match, for all MHRS in accordance with the terms and conditions set forth in the Memorandum of Understanding between DHCF and DBH.

5220.4

DHCF shall claim the federal share of Medicaid financial participation, or the federal match, for all MHRS services.

5220.5

MHRS providers shall not bill the Medicaid beneficiary or any member of the Medicaid beneficiary's family for MHRS services.

5220.6

In accordance with the Medicaid third-party liability requirements set forth under 42 CFR Part 433 and outlined in the State Plan, DBH shall bill all known third-party payors prior to billing the Medicaid Program.

5220.7

Medicaid reimbursement for MHRS shall not be available for:

(a) Treatment for inmates in public institutions, as defined in 42 C.F.R. § 435.1010;

(b) Room and board;

(c) Transportation services;

(d) Educational, vocational, and job training services;

(e) Services delivered as a component of human subjects research or clinical trials, unless the service is otherwise covered under the Medicaid State Plan;

(f) Screening and prevention services (other than those provided under EPSDT requirements);

(g) Services rendered by parents, guardians, or other family members or legally responsible adults including biological, step, and adopted relatives;

(h) Legal services;

(i) Services that are not provided and documented in accordance with DBH-established, service-specific standards;

(j) Social or recreational services;

(k) Services which are not medically appropriate as determined by the District Medicaid program; and

(l) Services furnished to persons other than the consumer, when those services are not directed exclusively to the well-being and benefit of the consumer.

D.C. Mun. Regs. tit. 29, r. 29-5220

Final Rulemaking published at 69 DCR 12836 (10/21/2022)