D.C. Mun. Regs. r. 29-949
Each PRTF shall be reimbursed on a prospective basis at a facility-specific per diem rate.
Each PRTF located in the District of Columbia shall be reimbursed at a rate equal to the average rate paid by the State of Maryland Medicaid Program as of July 1 each year for comparable services and provider type. The reimbursement rate calculated pursuant to this section shall become effective October 1 of each year in which the average rate was determined and shall remain in effect for a full year.
Each PRTF located outside of the District of Columbia may be reimbursed for services provided to District Medicaid beneficiaries who are residents of the District of Columbia. The reimbursement rates shall be determined as set forth in §§ 949.4 through 949.6.
If the PRTF located outside of the District of Columbia is enrolled in the Medicaid Program in the state in which the facility is located, the reimbursement rate shall be the same rate paid by the state in which the facility is located as of July 1 of each year, for comparable services rendered by a comparable provider type. The reimbursement rate shall be effective October 1 of each year and shall remain in effect for a full year. Each PRTF shall enroll in the District's Medicaid Program and provide documentation of its enrollment in the Medicaid Program in the state in which the facility is located.
If the PRTF located outside of the District of Columbia is not enrolled in the Medicaid Program in the state in which the facility is located, the reimbursement rate shall be the established payment rate for services charged to other third party payers. Each PRTF shall enroll in the District's Medicaid Program and be certified by the Department of Mental Health before accepting District Medicaid beneficiaries for services.
If the PRTF located outside of the District of Columbia is not enrolled in the Medicaid Program in the state in which the facility is located does not charge other third party payers, the reimbursement rate shall be the lowest rate charged to a self-paying recipient of services. Each PRTF shall enroll in the District's Medicaid Program and be certified by the Department of Mental Health before accepting District Medicaid beneficiaries for services.
All provider appeals shall be governed in accordance with the requirements set forth in Chapter 13 of Title 29 of the District of Columbia Municipal Regulations.
For the purposes of sections 948 and 949, the following terms shall have the meanings ascribed:
Psychiatric residential treatment facility- a psychiatric facility that is not a hospital and is accredited by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation of Services for Families and Children, or by any other accrediting organization with comparable standards that is recognized by the state in which it is located and provides inpatient psychiatric services for individuals under the age of twenty-two (22) and meets the requirements set forth in §§ 441.151 through 441.182 of Title 42 of the Code of Federal Regulations.
Psychiatrist -a person who is licensed to practice psychiatry pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 26, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1202et seq.) and implementing regulations or licensed as a psychiatrist in the jurisdiction where the services are being provided.
Psychologist - a person who is licensed to practice psychology pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1202et seq.) and implementing regulations or licensed as a psychologist in the jurisdiction where the services are being provided.
Registered nurse - a person who is licensed as a registered nurse pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1202et seq.) and implementing regulations or licensed as a registered nurse in the jurisdiction where the services are being provided.
Occupational therapist - a person who is licensed or authorized to practice occupational therapy pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1201et seq.) and implementing regulations or licensed as an occupational therapist in the jurisdiction where the services are provided.
D.C. Mun. Regs. r. 29-949