D.C. Mun. Regs. tit. 22, r. 22-A3713

Current through Register Vol. 71, No. 52, December 27, 2024

Rule 22-A3713 - REIMBURSEMENT

3713.1

Mental Health and SUD Supported Employment providers, pursuant to their contract with RSA, shall seek reimbursement from RSA for the following services when provided to their Supported Employment consumers/clients while they are enrolled with RSA:

(a) Job Development; and

(b) Job Coaching.

3713.2

All Mental Health and SUD Supported Employment services not subject to reimbursement by RSA shall be billed by the Supported Employment provider in accordance with the remainder of this section. Reimbursement for Medicaid-funded and locally-funded Mental Health and SUD Supported Employment services described in §§ 3713.3 and 3713.4 shall be at the rate contained in the District of Columbia Medicaid fee schedule available online at www.dcmedicaid.com. All future updates to the service codes and rates will be included in the District of Columbia Medicaid fee schedule pursuant to the procedures established in 29 DCMR § 988.

3713.3

The following services shall be billed as Vocational Supported Employment:

(a) Intake;

(b) Vocational Assessment;

(c) IWP Development;

(d) Disclosure Counseling;

(e) Treatment Team Coordination;

(f) Job Development (if provided outside of time-period of RSA involvement);

(g) Job Coaching (if provided outside of time-period of RSA involvement); and

(h) Vocational Follow-Along Supports.

3713.4

The following services shall be billed as Therapeutic Supported Employment and shall be delivered by qualified practitioners or credentialed staff eligible to provide Community Support services as specified in 22-A DCMR Chapter 34:

(a) Benefits Counseling; and

(b) Therapeutic Follow-Along Supports.

3713.5

Prior authorization by the Department shall be required for Vocational and Therapeutic Supported Employment services. Initial and any subsequent authorizations for Vocational Supported Employment services shall not exceed ninety-six (96) units per one hundred and eighty (180) calendar day time period. Authorizations for Therapeutic Supported Employment services shall not exceed one hundred and eighty (180) calendar days.

3713.6

Vocational and Therapeutic Supported Employment Services shall not be billed on the same day as Intensive Day Treatment services, as defined in 22-A DCMR Chapter 34.

3713.7

Billing units are fifteen (15) minutes.

3713.8

Mental Health and SUD Supported Employment services shall only be provided:

(a) At the Supported Employment provider's service site; or

(b) In natural settings, including the consumer's/client's work site or other community setting.

3713.9

All claims seeking Medicaid or local only reimbursement under this Chapter shall include the active National Provider Identification numbers for the certified provider and the rendering provider. The rendering provider is the staff member who provided the service.

D.C. Mun. Regs. tit. 22, r. 22-A3713

Final Rulemaking published at 67 DCR 10775 (9/4/2020); amended by Final Rulemaking published at 69 DCR 13495 (11/4/2022)