District of Columbia Administrative Code

5800 PURPOSE 5800.1 This chapter establishes the reimbursement rate for the Independent Mental Health Community Residence Facility Supportive Services. Establishment of a reimbursement rate will allow the Department of Mental Health (Department) to contract with independent Menta…

5801 REIMBURSEMENT RATE 5801.1 The Independent MHCRF Supportive Services rate is as set forth below: SERVICE RATE UNIT Supportive Services (Independent MHCRF) $10.00 Daily SOURCE: Final Rulemaking published at 59 DCR 8546, 8547 (July 20, 2012). AUTHORITY: DC-DCMR The Director of …

5802 ELIGIBILITY 5802.1 Only a licensed independent MHCRF operator who has entered into a HCA with the Department to provide services to individuals who require a higher level of care, as determined by an assessment and treatment plan, will be eligible for reimbursement in accord…

5803 SUBMISSION OF CLAIM; PAYMENT OF VOUCHER 5803.1 The licensed independent MHCRF operator shall submit all Supportive Services claims under the HCA by invoice, pursuant to this chapter and the terms of the HCA between the Department and the licensed independent MHCRF operator. …

5804 AUDITS 5804.1 A licensed independent MHCRF operator shall, upon the request of the Department, cooperate in any audit or investigation concerning the Independent MHCRF Supportive Services program. SOURCE: Final Rulemaking published at 59 DCR 8546, 8547 (July 20, 2012). AUTHO…

5899 DEFINITIONS 5899.1 When used in this chapter, the following terms shall have the meaning ascribed: Mental Health Community Residence Facility (MHCRF) - a publicly or privately owned residence licensed in accordance with 22 DCMR B38, that houses individuals, eighteen (18) or …

6200 PURPOSE 6200.1 This chapter establishes the reimbursement rate for services provided to eligible District residents by Department of Behavioral Health (Department) certified substance abuse providers, as this term is defined in Chapter 23 (Certification Standards for Substan…

6201 REIMBURSEMENT RATE 6201.1 Reimbursement for substance abuse services shall be as follows: SERVICE CODE RATE per UNIT Urinalysis (Laboratory) H0003 15.00 Breathalyzer Collection H0048 8.80 Urinalysis Collection H0048 LR 8.80 Case Management H0006 20.02 Case Management (HIV) H…

GENERAL PROVISIONS The Department of Behavioral Health (“Department”) is the Single State Agency (“SSA”) responsible for the development and promulgation of rules, regulations, and certification standards for prevention and treatment services related to the abuse of alcohol, toba…

ELIGIBILITY FOR SUBSTANCE USE DISORDER SERVICES SUD is a chronic relapsing disease characterized by a cluster of cognitive, behavioral, and psychological symptoms indicating that the client continues using the substance despite significant substance-related problems. A diagnosis …

6302 SERVICES FOR PEOPLE WITH CO-OCCURRING MENTAL ILLNESSES A provider shall not decline to provide SUD services because of a person’s co-occurring mental illness. All SUD treatment providers shall screen each client for SUD and mental illness during the Initial or Comprehensive …

PROVIDER CERTIFICATION PROCESS The Department utilizes the certification process to thoroughly evaluate an applicant’s capacity to provide high quality SUD services in accordance with this regulation and the needs of the District’s behavioral health system. Each applicant seeking…

6304 CERTIFICATION: EXEMPTIONS FROM STANDARDS Upon good cause shown, including but not limited to a conflict between a certification standard and a provider’s third-party contract or agreement, the Department may exempt a provider from a certification standard if the exemption do…

6305 DENIAL OR DECERTIFICATION PROCESS The Director may deny initial certification if the applicant fails to comply with any certification standard or the application fails to demonstrate the applicant’s capacity to deliver high quality SUD services on a sustained and regular bas…

6306 NOTICES OF INFRACTION The fine amount for any NOI issued under this chapter shall be as follows: For the first offense $500.00; For the second offense $1,000.00; For the third offense $2,000.00; For the fourth and subsequent offenses $4,000.00. The administrative procedure f…

6307 CLOSURES AND CONTINUITY OF CLIENT CARE A provider shall provide written notification to the Department at least ninety (90) calendar days prior to its impending closure, or immediately upon knowledge of an impending closure less than ninety (90) calendar days in the future. …

6308 GENERAL MANAGEMENT AND ADMINISTRATION STANDARDS Each provider shall be established as a recognized legal entity in the District of Columbia and qualified to conduct business in the District. Evidence of qualification to conduct business includes a certificate of good standin…

6309 EMPLOYEE CONDUCT All staff shall adhere to ethical standards of behavior in their relationships with clients as follows: Staff shall maintain an ethical and professional relationship with clients at all times; Licensed or certified staff must adhere to their professional cod…

QUALITY IMPROVEMENT Each provider shall establish and adhere to policies and procedures governing quality improvement (“Quality Improvement Policy”). The Quality Improvement Policy shall require the provider to adopt a written quality improvement (“QI”) plan describing the object…

6311 FISCAL MANAGEMENT STANDARDS Applicants or providers that are in financial distress and at risk of imminent closure represent a risk both to the Department’s clients and the behavioral health system. The Department shall not certify any applicant or re-certify any provider wi…

6312 ADMINISTRATIVE PRACTICE ETHICS All providers shall operate in an ethical manner, including but not limited to complying with the provisions of this section. A provider shall not offer or imply to offer services not authorized on the certification issued by the Department. A …

6313 PROGRAM POLICIES AND PROCEDURES Each program must document the following: Organization and program mission statement, philosophy, purpose, and values; Organizational structure; Leadership structure; Program relationships; Staffing; Relationships with parent organizations, af…

6314 EMERGENCY PREPAREDNESS PLAN Each provider shall establish and adhere to a written disaster evacuation and continuity of operations plan in accordance with the Department policy on Disaster Evacuation/Continuity of Operations Plans. A provider shall immediately notify the Dep…

FACILITIES MANAGEMENT A provider shall establish and maintain a safe environment for its operation, including adhering to the following provisions: Each provider’s service site(s) shall be located and designed to provide adequate and appropriate facilities for private, confidenti…

6316 MEDICATION STORAGE AND ADMINISTRATION STANDARDS Controlled substances shall be maintained in accordance with applicable Federal and District laws and regulations. An SUD treatment program shall implement written policies and procedures to govern the acquisition, safe storage…

6317 VEHICLE ENVIRONMENTAL AND SAFETY STANDARDS A provider shall implement measures to ensure the safe operation of its transportation service, if applicable. These measures shall include, but are not limited to: Automobile insurance with adequate liability coverage; Regular insp…

FOOD AND NUTRITION STANDARDS The provisions of this section apply to any provider that prepares or serves food. All programs that prepare food shall have a current Certified Food Protection Manager (“CFPM”) certification from the District of Columbia Department of Health, and the…

6319 PERSONNEL TRAINING STANDARDS Provider staff shall have annual training that meets the Occupational Safety & Health Administration (“OSHA”) regulations that govern behavioral health facilities and any other applicable infection control guidelines, including use of universal p…

6320 CLIENT RIGHTS AND PRIVILEGES, INCLUDING GRIEVANCES A program shall protect the following rights and privileges of each client: Right to be admitted and receive services in accordance with the Human Rights Act of 1977, effective December 13, 1977 (D.C. Law 2-38; D.C. Code §§ …

CLIENT CHOICE Each provider shall establish and adhere to policies and procedures governing the means by which clients shall be informed of the full choices of providers and how to access these services (“Client Choice Policy”). The Department shall review and approve each provid…

CLIENT RECORDS MANAGEMENT AND CONFIDENTIALITY A program shall create and maintain an organized record for each client receiving services. Providers shall utilize an EHR system certified by the Department of Health and Human Services Office of the National Coordinator for Health I…

STORAGE AND RETENTION OF CLIENT RECORDS A provider shall retain client records (either original or accurate reproductions) until all litigation, adverse audit findings, or both, are resolved. If no such conditions exist, a provider shall retain client records for at least ten (10…

CLIENT RECORD CONTENTS At a minimum, all client records shall include: Documentation of the referral and initial screening interview and its findings; The client’s consent to SUD services; The Client’s Rights Statement; Documentation that the client received: An orientation to th…

RESIDENTIAL TREATMENT AND RECOVERY PROGRAMS The provisions of this section apply only to residential treatment programs and environmental stability programs, as defined by this chapter. Each residential provider, except providers only offering environmental stability, must obtain…

PROGRAMS SERVING PARENTS AND CHILDREN In addition to core requirements and other standards described in this chapter, a program providing SUD treatment services to parents and their children shall comply with the provisions of this section. The provider shall specify in its certi…

PROVIDER REQUIREMENTS FOR OPIOID TREATMENT PROGRAMS In accordance with 42 CFR Part 8, Certification of Opioid Treatment Programs (“OTPs”), all OTPs must be certified by the U.S. Substance Abuse and Mental Health Services Administration (“SAMHSA”), the Drug Enforcement Administrat…

LEVELS OF CARE: GENERAL REQUIREMENTS All individuals seeking SUD services must be assessed and referred to a particular LOC in accordance with the Department-approved assessment tool(s) and ASAM criteria. Each provider shall ensure that the client receives treatment in accordance…

PROVIDER REQUIREMENT: INTAKE AND ASSESSMENT Intake and Assessment is a not a LOC but a core responsibility of all certified treatment providers. All certified treatment providers, with the exception of those certified at Level R only, shall provide an initial health screening and…

LEVEL OF CARE 1: OPIOID TREATMENT PROGRAMS 6330.1 Opioid Treatment Programs (OTPs) provide MOUD and other treatment services for clients that meet diagnostic criteria for: (a) Active moderate to severe opioid use disorder (OUD); (b) Being in OUD remission; or (c) Being at high ri…

LEVEL OF CARE 1: OUTPATIENT Level 1 Outpatient providers shall have the capacity to provide up to eight (8) hours of SUD treatment services per week, per client, in accordance with this section and medical necessity based on ASAM criteria. Level 1 Outpatient is the appropriate LO…

LEVEL OF CARE 2.1: INTENSIVE OUTPATIENT PROGRAM (IOP) Level 2.1 Intensive Outpatient Program (IOP) providers shall have the capacity to provide between nine (9) and nineteen (19) hours of a mixture of SUD treatment services per week for adults and between six (6) and nineteen (19…

LEVEL OF CARE 2.5: DAY TREATMENT Level 2.5 Day Treatment providers shall have the capacity to provide a minimum of twenty (20) hours of a mixture of SUD treatment services per week, per client, in accordance with this section and medical necessity based on ASAM criteria. Day Trea…

LEVEL OF CARE 3.1: CLINICALLY MANAGED LOW-INTENSITY RESIDENTIAL Level 3.1 Clinically Managed Low-Intensity Residential providers shall have the capacity to provide a minimum of five (5) hours of a mixture of SUD treatment services per week, per client, in accordance with this sec…

LEVEL OF CARE 3.3: CLINICALLY MANAGED POPULATION-SPECIFIC HIGH-INTENSITY RESIDENTIAL Level 3.3 Clinically Managed Population-Specific High-Intensity Residential providers shall have the capacity to provide a minimum of twenty (20) hours of mixture of SUD treatment services per we…

LEVEL OF CARE 3.5: CLINICALLY MANAGED HIGH-INTENSITY RESIDENTIAL (ADULT)/ CLINICALLY MANAGED MEDIUM-INTENSITY RESIDENTIAL (YOUTH) Level 3.5 Clinically Managed High-Intensity Residential/Clinically Managed Medium-Intensity Residential providers shall have the capacity to provide a…

LEVEL OF CARE 3.7-WM: MEDICALLY MONITORED INPATIENT WITHDRAWAL MANAGEMENT (MMIWM) MMIWM is twenty-four (24) hour, medically directed evaluation and withdrawal management service. This service is for clients with sufficiently severe signs and symptoms of withdrawal from psychoacti…

LEVEL OF CARE-R: RECOVERY SUPPORT SERVICES RSS covers the provision of non-clinical services for clients in treatment or in need of supportive services to maintain their recovery. RSS providers shall provide the following core RSS: Recovery Support Evaluation; and RSS. RSS provid…

CORE SERVICE: DIAGNOSTIC ASSESSMENT AND PLAN OF CARE Diagnostic Assessment and Plan of Care services include two distinct actions: (1) the assessment and diagnosis of the client, and (2) the development of the Plan of Care. A Diagnostic Assessment and Plan of Care Service may be …

CORE SERVICE: CLINICAL CARE COORDINATION The CCC service adopts a “whole-person” approach to address the client’s needs related to physical health, behavioral health, and social determinants of health. CCC involves coordination of care between the behavioral health clinician and …

CORE SERVICE: CRISIS INTERVENTION Crisis Intervention is an immediate short-term treatment intervention, which assists a client to resolve an acute personal crisis that significantly jeopardizes the client’s treatment, recovery progress, health, or safety. Crisis Intervention doe…