Statutes, codes, and regulations
District Of Columbia Administrative Code
Title 22 - HEALTHSubtitle 22-A - MENTAL HEALTH
Chapter 22-A39 - MENTAL HEALTH CLUBHOUSE CERTIFICATION STANDARDS
Rule 22-A3906 - DISTRICT REIMBURSEMENT LIMITATIONS

D.C. Mun. Regs. tit. 22, r. 22-A3906

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Current through Register Vol. 71, No. 52, December 27, 2024
Rule 22-A3906 - DISTRICT REIMBURSEMENT LIMITATIONS
3906.1

Clubhouse treatment duration varies but generally last up to one hundred eighty (180) days. Clubhouse treatment can continue long-term in accordance with the Plan of Care for individuals experiencing ongoing rehabilitiation needs. Clubhouse services may be reimbursed according to the consumer's Human Care Agreement (HCA) with the Department and medical necessity.

3906.2

The Department shall reimburse Clubhouse specialty providers for clubhouse services at a per diem rate. The services will only be reimbursable if the following requirements are met:

(a) The member has engaged in at least three (3) hours of Clubhouse services per day; and
(b) A daily encounter note documenting the services provided to the member was prepared per day in accordance with § 3907.3 of this chapter.
3906.3

Clubhouse services require a Plan of Care.

3906.4

Clubhouse services may not be reimbursed for the same consumer on the same day as Rehabilitation/Day Services or Intensive Day Treatment.

3906.5

The District shall only reimburse one Clubhouse on behalf of each consumer per one hundred eighty (180) day period.

3906.6

In accordance with § 3432 of this subtitle, certain services may not be reimbursed through Medicaid.

D.C. Mun. Regs. tit. 22, r. 22-A3906

Emergency and Proposed Rulemaking published at 57 DCR 4010 (May 7, 2010)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 57 DCR 7734 (August 20, 2010)[EXPIRED]; as amended by Final Rulemaking published at 57 DCR 8698, 8703 (September 24, 2010); amended by Final Rulemaking published at 66 DCR 5638 (5/3/2019); amended by Final Rulemaking published at 67 DCR 10674 (9/4/2020)
Authority: The Director of the Department of Mental Health (Department), pursuant to the authority set forth in sections 104, and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001, (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05 ).