994. STANDARDS FOR COLLABORATIVE CARE SERVICES REIMBURSEMENT

994 STANDARDS FOR COLLABORATIVE CARE SERVICES REIMBURSEMENT 994.1 Collaborative Care is integrated behavioral health and primary care that extends the capabilities of the primary care team to identify and treat people with less complex behavioral conditions, including but not limited to, anxiety and depression. The purpose of Collaborative Care is to assist the primary care team in meeting the unique needs of individuals with co-occurring behavioral health conditions. 994.2 The Collaborative Care team must: Meet requirements for an evidence-based model, approved by the Department of Health Care Finance; Use a registry to track clinical outcomes; Use at least one (1) validated clinical rating scale; and Develop and implement a person-centered plan of care that includes outcome goals of Collaborative Care. 994.3 Providers and/or Federally Qualified Health Centers (FQHCs) who wish to provide Collaborative Care must submit a signed DHCF attestation form to attest that they are providing Collaborative Care services that meet requirements outlined in Subsection 994.2 in their practice. This attestation form shall be re-submitted to DHCF annually. 994.4 Each member of the Collaborative Care team must be enrolled as a Medicaid provider, pursuant to Chapter 94 of Title 29 DCMR. The Collaborative Care team is multidisciplinary and must include at least one (1) team member of the provider types listed at Subsection 994.6. 994.5 The supervising practitioner must be the beneficiary’s primary care provider or FQHC, and is responsible for the following activities: Overseeing the beneficiary’s care, including prescribing medications, providing treatment for medical conditions, and referring to specialty care as necessary; Submitting the signed attestation, as described in Section 994.3; and Submitting claims to DHCF for reimbursement for Collaborative Care, that meet requirements outlined in Section 994.10. 994.6 Members of the care team other than the supervising practitioner may be one of the following provider types: Physician; Psychiatrist; APRN; Psychologist; Licensed Independent Clinical Social Worker; Licensed Independent Social Worker; Licensed Graduate Social Worker; Licensed Professional Counselor; Licensed Graduate Professional Counselor; Certified Addiction Counselor; Licensed Marriage and Family Therapists; Psychology Associates; Physician Assistants; Registered Nurses with appropriate licensure/clinical experience in behavioral health; or Individuals with a bachelor's degree and subsequent certification in the identified model. 994.7 Collaborative Care activities may include: Administering assessment and care management activities, including the administration of the validated rating scales; Completing, and revising as needed, the behavioral health care plan required by subsection 994.2; Maintaining the patient registry; Meeting regularly with other team members to discuss the beneficiary’s progress and treatment plan; and Providing brief psychosocial interventions to the beneficiary, as needed. 994.8 Collaborative Care services shall: Be reimbursed based on the amount of time a team spends providing Collaborative Care services for an individual in a given month; Be reimbursed pursuant to Subsection 995.1 of this Chapter; Not require prior authorization during the first six (6) months of Collaborative Care services; Require prior authorization for services delivered beyond the initial six (6) months and every six (6) months thereafter; and Not be billed concurrently with other care management programs. 994.9 Psychiatrists or APRNs with specialty training in psychiatry that are on the Collaborative Care team may not bill for Interprofessional Consultations, as described in Section 993 of this chapter, for individuals receiving Collaborative Care services. SOURCE: Final Rulemaking published at 50 DCR 4943(June 20, 2003); as Final Rulemaking published at 53 DCR 1696 (March 10, 2006); as Final Rulemaking published at 55 DCR 2284 (March 7, 2008); as amended by Final Rulemaking published at 61 DCR 993 (February 7, 2014); as amended by Final Rulemaking published at 72 DCR 010225 (September 19, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 994