Volver a Preguntas frecuentes de CalAIM​​ 

A continuación se muestra una lista de preguntas frecuentes que se han recopilado de los seminarios web de asistencia técnica e informativos y las presentaciones al correo electrónico BHCalAIM@dhcs.ca.gov. DHCS actualizará esta lista trimestralmente.​​  

Colateral​​ 

Dado que la psicoterapia familiar sin la presencia del paciente (código CPT 90846) puede ser reportada en el Sistema de Entrega Organizada de Medicamentos de Medi-Cal (DMC), ¿también debería ser reportada en el sistema de entrega de Salud Mental Especializada (SMHS)?​​ 

No. CPT code 90846 means family psychotherapyy (without the patient present). In the DMC delivery system, the definition of family therapy in the State Plan includes the following sentence, “There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of this service…” This is why CPT code 90846 is included in the DMC-ODS delivery system. The definition of therapy in the Rehabilitative Mental Health Services (i.e., SMHS) segment of the State Plan includes the sentence “Therapy may be delivered to a beneficiary or group of beneficiaries and may include family therapy directed at improving the beneficiary’s functioning and at which the beneficiary is present.” Since the definition of therapy in the SMHS delivery system explicitly requires the member to be present, CPT code 90846 is not available in SMHS.​​ 

¿Se puede utilizar la Psicoterapia de Grupo Familiar Múltiple (código CPT 90849) para informar una sesión de terapia familiar cuando el miembro no está presente en el sistema de administración DMC-ODS?​​ 

Sí, se puede.​​ 

CPT code 90849 means multiple-family group therapy. In the DMC-ODS delivery system, it is a family therapy code. In the Specialty Mental Health delivery system it was grouped into the family therapy service category. According to the State Plan, family therapy is defined in the State Plan as “a rehabilitative service that includes family members in the treatment process, providing education about factors that are important to the member’s recovery as well as the holistic recovery of the family system. Family members can provide social support to the beneficiary and help motivate their loved one to remain in treatment. There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of this service, but the service is for the direct benefit of the beneficiary.” Since the definition of family therapy allows it, counties may report CPT code 90849 in the DMC-ODS delivery system when the member is not present.​​ 

¿Pueden los condados usar el código HCPCS H0007 (servicios de alcohol y/o drogas; intervención en crisis) para reportar contactos colaterales como parte de la intervención en crisis en el sistema de entrega DMC-ODS?​​ 

No. HCPCS code H0007 (alcohol and/or drug services, crisis intervention), has been grouped into the SUD Crisis Intervention Services category. According to the State Plan, SUD Crisis Intervention Services “consists of contacts with a beneficiary in crisis. A crisis means an actual relapse or an unforeseen event or circumstance which presents to the beneficiary an imminent threat of relapse. SUD Crisis Intervention Services shall focus on alleviating the crisis problem, be limited to the stabilization of the beneficiary’s immediate situation, and be provided in the least intensive level of care that is medically necessary for their condition.” Since the State Plan explicitly states that SUD crisis intervention must be provided to the member, HCPCS code H0007 cannot be used to claim for a collateral contact.​​ 

¿Pueden los condados usar el código H0032 de HCPCS (plan de servicios de salud mental desarrollado por personas que no son médicos) para informar un contacto colateral en el sistema de entrega de SMHS?​​ 

Yes. HCPCS Code H0032, mental health service plan development by non-physician, is used to claim reimbursement for Treatment Planning. Treatment Planning is defined in the State Plan as “a service activity to develop or update a beneficiary’s course of treatment, documentation of the recommended course of treatment, and monitoring of a beneficiary’s progress.” Nothing in this definition excludes contact with significant support persons or other collaterals if the purpose of their participation is to focus on the treatment of the member.  Therefore, counties may use HCPCS code H0032 to claim reimbursement for Treatment Planning.  ​​ 

¿Pueden los condados usar el código HCPCS H0034 (capacitación y apoyo para medicamentos) para informar contactos colaterales en los sistemas de entrega DMC-ODS y SMHS?​​ 

Los condados pueden reclamar contactos colaterales utilizando el código HCPCS H0034 en el sistema de entrega de SMHS, pero no en el sistema de entrega DMC-ODS.​​ 

HCPCS code H0034 means medication training and support. In the Specialty Mental Health System (SMHS), HCPCS code H0034 has been grouped into the medication Support service type. In the Drug Medi-Cal and the Drug Medi-Cal Organized Delivery systems (DMC and DMC-ODS), HCPCS code H0034 has been grouped into the Medication Services service type. In the State Plan, SMHS Medication Support Services are defined as services that “may include contact with significant persons or other collaterals.” However, in the DMC/DMC-ODS State Plan, the definition of Medication Services does not include contact with collaterals. Further, services that allow the member not to be present are marked with an *. Medication Services are not marked with an *.  Therefore, counties cannot report H0033 and H0034 as collateral contacts in DMC and DMC-ODS delivery systems, but can report H0033 and H0034 as collateral contacts in the SMHS delivery system.​​ 

¿Los códigos HCPCS H0038 y H0025 (Servicios de apoyo entre pares) incluyen contactos colaterales?​​ 

HCPCS H0038 means one-on-one peer support services, and HCPCS code H0025 means group support services. Peer support services have been grouped into peer support in all delivery systems. The State Plan definition of peer support in all delivery systems states that “peer support services can include contact with family members or other collaterals if the purpose of the collateral’s participation is to focus on the treatment needs of the beneficiary.” Since the State Plan definition of peer support services specifically states that it includes collateral contacts, counties may use HCPCS codes H0038 and H0025 to claim for services that include collateral contacts.​​ 

¿Rehabilitación y Recuperación incluyen contactos colaterales en los sistemas de entrega de SMHS y DMC-ODS respectivamente, y pueden los condados usar el código H2017 de HCPCS para describir esos contactos?​​ 

Yes. HCPCS code H2017 (Psychosocial Rehabilitation) has been grouped into the Recovery service category in the DMC-ODS delivery system and into the Rehabilitation service category in the SMHS delivery system. The State Plan defines Psychosocial Rehabilitation as an activity that “may include contact with significant support persons or other collaterals if the purpose of their participation is to focus on the treatment needs of the member. Recovery services in DMC-ODS include Care Coordination. Part of the State Plan’s definition of Care Coordination states that it entails “coordinating with ancillary services, including individualized connection, referral, and linkages to community-based services and supports.” Since the State Plan’s definition of Rehabilitation and Recovery includes collateral contacts, counties may use HCPCS code H2017 to claim for collateral contacts.​​ 

¿Se puede usar HCPCS H2021 (servicio envolvente basado en la comunidad) para describir contactos colaterales cuando el miembro no está presente?​​ 

Yes. HCPCS code H2021 (community-based wrap-around service) was grouped into the Rehabilitation service category in the SMHS delivery system and into Treatment Planning service category in the DMC and DMC-ODS delivery systems. The State Plan defines Psychosocial Rehabilitation as an activity that “may include contact with significant support persons or other collaterals if the purpose of their participation is to focus on the treatment needs of the member. Treatment Planning is defined in the State Plan as “a service activity to develop or update a beneficiary’s course of treatment, documentation of the recommended course of treatment, and monitoring of a beneficiary’s progress.” Since the State Plan’s definition of Rehabilitation and Treatment Planning either includes collateral contacts or does not prohibit collateral contacts, counties may use HCPCS code H2021 to claim for collateral contacts whether or not the member is present.​​ 

¿Pueden los Servicios Terapéuticos Conductuales, descritos por el código HCPCS H2019, incluir garantías para personas que no son la familia biológica del miembro?​​  

Yes. HCPCS code H2019 (therapeutic behavioral services) was grouped into the Therapeutic Behavioral Service category. Information Notice 08-38 defines therapeutic behavioral services as services that include making collateral contacts with family members, caregivers and others significant in the life of the member whether or not the member is present. Since the Information Notice’s definition of therapeutic behavioral services includes collateral contacts, counties may use HCPCS code H2019 to claim reimbursement for collateral contact.​​ 

¿Se puede informar un contacto colateral para pacientes ambulatorios además de un servicio de Cuidado de Crianza Terapéutico (TFC)?​​ 

Yes. The MHP Contract states, in part, that the Therapeutic Foster Care (TFC) “service model allows for the provision of certain specialty mental health service activities (plan development, rehabilitation and collateral) available under the EPSDT benefit as a home-based alternative to high level care in institutional settings.” Since the MHP Contract’s description of TFC states that collateral contacts that are in the plan development or rehabilitation service categories, counties may claim collateral contacts in plan development and rehabilitation service categories in addition to TFC.​​ 

¿La gestión de casos específicos (código HCPCS T1017) incluye contactos colaterales?​​ 

Yes.  HCPCS code T1017 (targeted case management) was grouped into Referral and Linkage service category. The State Plan defines referral and linkages as services that include “identifying appropriate resources, making appointments, and assisting a beneficiary with a warm handoff to obtain ongoing support.” Since the State Plan’s definition of referral and linkages services includes collateral contacts, counties may use HCPCS code T1017 to claim reimbursement for collateral contact.​​ 

¿Es necesario que el miembro esté presente cuando se proporciona la Administración de Casos Específicos (código HCPCS T1017)?​​ 

No.  HCPCS code T1017 (targeted case management) was grouped into Referral and Linkage service category. The State Plan defines referral and linkages as services that include “identifying appropriate resources, making appointments, and assisting a beneficiary with a warm handoff to obtain ongoing support.” Since the State Plan’s definition of Referral and Linkage includes services that need to be performed when the member is not present, counties can use HCPCS code T1017 to claim for services when the member is not present.​​ 

¿Puede un condado reportar H2035 (servicio de tratamiento de alcohol y/u otras drogas) y, además, reportar por separado un servicio colateral?​​ 

Yes. HCPCS code H2035 (Alcohol and/or other drug treatment program) has been grouped into the Recovery service category in the DMC-ODS delivery system. The State Plan states that “recovery can be delivered as a standalone service, or as a service delivered as part of the levels of care listed below:​​ 

• Evaluación​​ 
  • The definition of assessment in the State Plan includes the following: assessment “may include contact with family members or other collaterals if the purpose of the collateral’s participation is to focus on the treatment needs of the beneficiary.”​​ 
• Coordinación de la atención​​ 
• The State Plan definition of care coordination includes the following component: “Coordinating with ancillary services, including individualized connection, referral and linkages to community-based services and supports.”​​ 
• Asesoramiento​​ 
• The State Plan definition of individual counseling includes the following sentence: “Individual counseling can include contact with family members or other collaterals if the purpose of the collateral’s participation is to focus on the treatment needs of the beneficiary by supporting the achievement of the beneficiary’s goals.”​​ 
  • The definition of family therapy in the State Plan includes the following sentence, “There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of this service, but the service is for the direct benefit to the beneficiary.”​​ 
• Terapia Familiar​​ 

Dado que los servicios de recuperación se pueden reclamar con los servicios ambulatorios (evaluación, coordinación de atención, asesoramiento y terapia familiar) que permiten servicios colaterales, el condado puede reclamar un servicio ambulatorio colateral que se agrupó en una de esas categorías de servicios además del código HCPCS H2035.​​