Rov qab mus rau CalAIM FAQs​​ 

Hauv qab no yog cov npe ntawm cov lus nug uas nquag nug tau raug sau los ntawm kev pab cuam thiab cov ntaub ntawv webinars thiab xa mus rau BHCalAIM@dhcs.ca.gov email. DHCS yuav hloov kho cov npe no nyob rau peb lub hlis twg.​​  

DMC-ODS​​ 

Kev Sib Tham Hauv Tsev Kho Mob puas tuaj yeem tshwm sim ntawm cov neeg ua haujlwm muaj ntawv tso cai nyob hauv tib lub koom haum, lossis yuav tsum muaj kev sib tham no ntawm cov neeg ua haujlwm muaj ntawv tso cai thiab cov kws pab tswv yim sab nraud uas tau cog lus los ntawm lub nroog?​​ 

Siv BHIN 24-001 & DMC-ODS Service Table​​ 

Clinician Consultations may occur between licensed agency staff within the same agency as well as between licensed agency staff and consultants outside of their agency, given both clinicians are qualified to provide Drug Medi-Cal Organized Delivery System (DMC-ODS) services. Page 22 of Behavioral Health Information Notice (BHIN) 24-001 provides authority for Clinician Consultation under the DMC-ODS program. This includes consultations between clinicians designed to assist Drug Medi-Cal (DMC) clinicians with seeking expert advice on treatment needs for specific DMC-ODS members while also permitting DMC-ODS plans to contract with one or more physicians, clinicians, or pharmacists specializing in addiction in order to provide consultation services. Enclosure 5 of BHIN 24-001 lists the types of providers that are qualified to deliver each DMC-ODS service.​​ 

Cov Kev Pabcuam Kev Sib Tham Hauv Tsev Khomob tau them nqi li cas hauv Drug Medi-Cal Organized Delivery System (DMC-ODS)?​​ 

Reference: BHIN 24-001, BHIN 23-017, DMC-ODS Billing Manual, DMC-ODS Service Table.​​ 

Clinician Consultation tsis yog ib qho kev pabcuam ncaj qha rau DMC-ODS cov tswvcuab. Qhov kev pabcuam no tso cai rau cov kws kho mob nrhiav kev kho mob thiab cov kws tshaj lij los ntawm lwm cov kws tshaj lij uas muaj ntawv tso cai los txhawb kev saib xyuas rau cov tswv cuab DMC-ODS tshwj xeeb.​​ 

Tsuas yog cov kws kho mob DMC-ODS uas tab tom nrhiav kev pab tswv yim thiab muab kev saib xyuas ncaj qha rau tus tswv cuab tuaj yeem sau nqi rau Clinician Consultation. Tus neeg muab kev pabcuam DMC-ODS tuaj yeem siv cov txheej txheem kev sib tham hauv Clinician Consultation codes (99367, 99368, lossis 99451) los thov rau qhov haujlwm. Tus kws kho mob muab cov lus qhia tsis tuaj yeem sau nqi rau Clinician Consultation.​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing Clinician Consultation services.​​ 

Puas yog kev sib tham ntawm Tus Kws Tshaj Lij Tshaj Lij Tshaj Lij Tshaj Lij Kho Mob (LPHA) thiab Tus Kws Lij Choj Kws Kho Mob (LPCC) rau kev txiav txim siab txog kev kuaj mob thiab kev kho mob yuav tsum tau them nqi siv cov lej ntsuas?​​ 

Reference: BHIN 24-001, BHIN 23-068, DMC-ODS Billing Manual, DMC-ODS Service Table.​​ 

No. The assessment code would not be used to bill for the consultation. Consultation between an LPHA and a LPCC that occurs during a DMC-ODS member’s assessment would be billed as Clinician Consultation using a separate code.​​ 

Clinician Consultation tsis yog ib qho kev pabcuam ncaj qha rau DMC-ODS cov tswvcuab. Qhov kev pabcuam no tso cai rau cov kws kho mob nrhiav kev kho mob thiab cov kws tshaj lij los ntawm lwm cov kws tshaj lij uas muaj ntawv tso cai los txhawb kev saib xyuas rau cov tswv cuab DMC-ODS tshwj xeeb.​​ 

Tsuas yog cov kws kho mob DMC-ODS uas tab tom nrhiav kev pab tswv yim thiab muab kev saib xyuas ncaj qha rau tus tswv cuab tuaj yeem sau nqi rau Clinician Consultation. Tus neeg muab kev pabcuam DMC-ODS tuaj yeem siv cov txheej txheem kev sib tham hauv Clinician Consultation codes (99367, 99368, lossis 99451) los thov rau qhov haujlwm. Tus kws kho mob muab cov lus qhia tsis tuaj yeem sau nqi rau Clinician Consultation.​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing Clinician Consultation services.​​ 

Thaum twg tus kws kho mob hauv chaw kho mob yuav them nqi rau Cov Kev Pabcuam Rov Qab Hauv Cov Tshuaj Medi-Cal Organized Delivery System (DMC-ODS)?​​ 

Reference: BHIN 24-001, BHIN 22-005, DMC-ODS Billing Manual, DMC-ODS Service Table.​​ 

Tus nqi them txhua hnub rau Kev Pabcuam Kev Khomob Nyob Hauv Tsev muaj xws li:​​ 

• Kev soj ntsuam​​ 
• Kev sab laj (tus kheej thiab pab pawg)​​ 
• Kev Kho Mob Tsev Neeg​​ 
• Kev Pab Kho Mob​​ 
• Kev Kawm Tus Neeg Mob​​ 
• Kev Pabcuam Kev Siv Tshuaj Tsis Txaus Siab Kev Pabcuam​​ 

Members may receive Recovery Services under DMC-ODS in three ways: as a standalone service, separately but concurrently with the other DMC-ODS levels of care listed in BHIN 24-001’s “Covered DMC-ODS Services” section (including Residential Services), or as a component of these DMC-ODS levels of care.​​ 

Yog tias ib tus tswvcuab tau txais Kev Pabcuam Rov Qab los ua ib feem ntawm lawv Cov Kev Pabcuam Kev Khomob nyob hauv tsev, cov neeg muab kev pabcuam nyob hauv yuav tsum xa cov ntaub ntawv sib cais rau Cov Kev Pabcuam Rov Qab. Cov Kev Pabcuam Rov Qab tuaj yeem thov rau tib hnub raws li Kev Pabcuam Kev Khomob hauv Chaw Nyob thiab rau tib tus tswvcuab los ntawm Cov Kev Pabcuam Kev Khomob Sab Nraud thiab Cov Chaw Pabcuam Kev Khomob nyob.​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing Recovery Services.​​ 

Yuav ua li cas tus neeg muab kev pab them nqi kho mob nyob rau hauv cov kev pab cuam bundled tus nqi rau ib hnub uas tsis muaj kev pab them nqi nyob rau hauv lub hnub ntawm kev thov?​​ 

Reference MHSUDS 19-010; MHSUDS 18-058; DMC-ODS Billing Manual; SUBG Policy Manual; § 1915(c) of the Social Security Act​​ 

Cov kws kho mob tuaj yeem sau tus nqi txhua hnub rau Cov Kev Pab Kho Mob Nyob Hauv Tsev thaum tsawg kawg yog ib qho ntawm cov kev pabcuam uas suav nrog hauv tus nqi pob khoom raug muab rau tus tswvcuab rau hnub thov Medi-Cal. Tus nqi niaj hnub no suav nrog cov kev pabcuam / kev pabcuam hauv qab no:​​ 

• Kev soj ntsuam​​ 
• Kev sab laj (tus kheej thiab pab pawg)​​ 
• Kev Kho Mob Tsev Neeg​​ 
• Kev Pab Kho Mob​​ 
• Kev Kawm Tus Neeg Mob​​ 
• Kev Pabcuam Kev Siv Tshuaj Tsis Txaus Siab Kev Pabcuam​​ 

Please refer to the DMC-ODS Billing Manual and Service Table for guidance on billing for Residential Treatment Services.​​ 

Medi-Cal does not reimburse for room and board (e.g. housing and routine living expenses) in accordance with § 1915(c) of the Social Security Act. California offers separate funding streams that counties can utilize to reimburse for room and board for Residential Treatment Services, including the Substance Use Prevention, Treatment and Recovery Services Block Grant (SUBG). However, counties must develop guidelines for and monitor their use of block grant funding to ensure appropriate use. As noted in MHSUDS 18-058, SUBG funding may be used for the following services:​​ 

• Chav thiab lub rooj tsavxwm rau Kev Pabcuam Kev Khomob Nyob Hauv Tsev muaj nyob hauv DMC-ODS,​​ 
• Rov Qab Qhov Chaw Nyob¹ cov kev pab cuam hauv Drug Medi-Cal Organized Delivery System (DMC-ODS) cov phiaj xwm (txog 24 lub hlis), lossis​​ 
• Chav tsev thiab lub rooj tsavxwm rau cov tswvcuab tau txais kev pabcuam hauv Transitional Housing² hauv Lub Nroog Drug Medi-Cal (DMC) (txog 24 lub hlis).​​ 

While not a part of DMC-ODS, Children’s Crisis Residential Programs (CCRP) are California Department of Social Services licensed Short-Term Residential Therapeutic programs that are certified by DHCS to provide Medicaid covered services, primarily crisis residential treatment services. CCRPs are part of a community care delivery system that provide non-medical care for children experiencing mental health crises that can serve as an alternative to psychiatric hospitalization.​​ 

Eligible costs for crisis residential treatment services are costs for direct practitioners, medical equipment, medical supplies, and overhead; eligible costs do not include room and board. Counties are responsible to pay for the cost of room and board when a CCRP admits a Medi-Cal member. Counties may pay for the cost of room and board with funds the county receives from the State to provide community mental health services through 1991 Realignment or the Mental Health Services Act (MHSA). Counties must develop guidelines for and monitor their use of MHSA funds. As noted on page 3 and 4 of MHSUDS 19-010, Counties may use 1991 Realignment Funds or Mental Health Services Act funds to pay for the following services:​​ 

• 1991 Cov nyiaj rov qab kho dua tuaj yeem them rau cov kev kho mob hauv tsev kho mob, chav tsev thiab lub rooj tsav xwm, thiab kev saib xyuas 24-teev thiab saib xyuas rau cov neeg tsim nyog, suav nrog cov neeg tau txais txiaj ntsig Medi-Cal, hauv STRTP kev ua haujlwm raws li CCRP.​​ 

• Cov nyiaj MHSA tuaj yeem them cov nqi kho mob hauv tsev kho mob thiab chav tsev thiab pawg thawj coj saib hauv CCRP rau cov menyuam yaus nyob rau hauv Pawg Pabcuam Kev Pabcuam Tag Nrho ntawm Cov Kev Pabcuam Hauv Zej Zog thiab Kev Txhawb Nqa. General Service Development cov nyiaj yuav them rau cov nqi kho mob hauv tsev kho mob, tab sis tsis yog tus nqi ntawm chav tsev thiab lub rooj tsavxwm. Lub nroog yuav tsum siv nyiaj MHSA raws li txoj kev npaj npaj ua raws li cov txheej txheem muaj feem cuam tshuam, tau pom zoo los ntawm lawv Pawg Neeg Saib Xyuas, thiab xa mus rau DHCS thiab Pawg Saib Xyuas Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv thiab Kev Saib Xyuas Kev Ua Haujlwm.​​ 

Hauv cov ntsiab lus, tus nqi bundled rau cov kev pab kho mob hauv tsev tsuas yog muaj nyob rau hnub uas muaj kev pab them nqi kho mob. Kev thov rau DMC-ODS Cov Kev Pabcuam Kev Khomob nyob hauv tsev raug them rov qab cais los ntawm SUBG thiab MHSA cov nyiaj kwj, uas muaj rau cov nuj nqis hauv chav tsev thiab pawg thawj coj thaum kho vaj tse. Txhua lub nroog yuav tsum tsim cov lus qhia thiab saib xyuas lawv cov kev siv nyiaj rau cov hom phiaj no.​​ 

¹ Thov mus saib MHSUDS IN 18-058 yog xav paub ntxiv txog cov nyiaj pab rau cov chaw nyob rov qab.​​ 

² Please see MHSUDS IN 18-058 for additional information regarding funding contingencies for Transitional Housing.​​ 

Cov Lus Nug luv luv rau Qhov Kev Tso Cai Ua Ntej (BQuIP) puas tuaj yeem siv los ua kom tiav qhov kev ntsuam xyuas ntau yam kev saib xyuas (LOC)?​​ 

Reference: BHIN 24-001, BHIN 23-068​​ 

No. The BQuIP tool cannot be used to complete the multidimensional level of care (LOC) assessment. Providers are required to use an American Society of Addiction Medicine (ASAM) Criteria assessment to determine DMC-ODS members’ placement into the appropriate level of care.​​ 

Z-codes puas tuaj yeem siv los ua qhov kev kuaj mob thawj zaug rau Cov Kev Pabcuam Medi-Cal Organized Delivery System (DMC-ODS)?​​ 

Reference BHIN 24-001, BHIN 22-013​​ 

Certain Z-codes may be used during a DMC-ODS member’s assessment services when a diagnosis has yet to be established, per BHIN 22-013. Z-codes meet the federal requirement for claims. The medical record should support any Z-codes that are used in an assessment.​​ 

DMC-ODS cov ntawv thov yuav tsum suav nrog cov kev kho mob tsim nyog thoob ntiaj teb Kev faib cov kab mob, Kaum Hloov Kho (ICD-10) cov lej cuam tshuam nrog txhua qhov kev pabcuam ntsib. Cov lej ICD yuav tsum muaj nyob rau hauv kev thov kom DHCS tau txais kev koom tes hauv tsoomfwv nyiaj txiag.​​ 

Yam kev ntsuas twg yuav tsum tau ua thaum tso cai rau Drug Medi-Cal Organized Delivery System (DMC-ODS) cov neeg siv khoom rau American Society of Addiction Medicine (ASAM) 3.1 thiab 3.5 Qib Kev Kho Mob?​​ 

Reference BHIN 24-001, Exhibit A of BHIN 21-001, BHIN 23-068​​ 

DMC-ODS ASAM 3.1 and 3.5 Levels of Care require a multidimensional assessment to be conducted and completed within 72 hours following the member’s admission to the program, per Exhibit A of BHIN 21-001.​​ 

Cov tswvcuab tau txais kev pabcuam detoxification thaum nkag tau raug zam los ntawm ntau qhov kev ntsuas kev ntsuas yog tias kev ntsuas ua ntej ua tiav tsis pub dhau 72 teev tom qab nkag mus rau cov kev pabcuam detoxification thiab muaj cov phiaj xwm xwm txheej hloov cov tswvcuab mus rau Qib Kev Kho Mob uas yuav muaj kev ntsuas tag nrho.​​ 

Puas yog yuav tsum muaj kev tso cai ua ntej rau Kev Siv Tshuaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS) Kev Kho Mob thiab Kev Pabcuam Hauv Tsev?​​ 

Reference: BHIN 24-001​​ 

Yes. DMC-ODS plans shall provide independent review of authorization requests for residential and inpatient services (excluding withdrawal management services) and notify the provider of the plan’s decision within 24 hours of the submission of the request by the provider.​​  

Thov nco ntsoov tias cov phiaj xwm DMC-ODS yuav tsis yuam kom muaj kev tso cai ua ntej rau cov kev pabcuam ntsuam xyuas thiab kho mob uas tsis yog nyob hauv tsev kho mob thiab tsis yog pw hauv tsev kho mob, uas suav nrog cov kev pabcuam tswj kev rho tawm.​​ 

Puas yog qhov kev ntsuam xyuas thoob ntiaj teb American Society of Addiction Medicine (ASAM) xav tau rau cov tswv cuab kom tau txais Kev Pabcuam Rov Qab?​​ 

Reference: BHIN 24-001, BHIN 22-005, BHIN 23-068​​ 

Cov Kev Pabcuam Rov Qab tsis tas yuav muaj kev ntsuam xyuas ASAM rau cov tswvcuab kom tau txais kev pabcuam, tsis hais hom kev xa khoom.​​ 

Members may receive Recovery Services based on self-assessment or a provider’s assessment of relapse risk. Members do not have to be diagnosed as being in remission in order to access Recovery Services.​​ 

Recovery Services under DMC-ODS can be delivered in three ways: as a standalone service; separately but concurrently with the other DMC-ODS levels of care listed in BHIN 24-001’s “Covered DMC-ODS Services” section; or as a component of these DMC-ODS levels of care. DMC-ODS providers should use their clinical expertise, in accordance with each member’s clinical needs and generally accepted standards of practice, to determine the appropriate delivery method of Recovery Services for their members.​​ 

Thov nco ntsoov tias qhov kev ntsuam xyuas ASAM tsis tas yuav tsum muaj rau ib tus tswv cuab pib tau txais kev pabcuam DMC-ODS.​​  

Qhov yuav tsum tau nyob ntev npaum li cas rau Medi-Cal cov tswv cuab hauv cov kev pab cuam kho mob siv tshuaj nyob hauv tsev (SUD)? Puas yog cov kev cai no txawv rau cov neeg cev xeeb tub thiab tom qab yug menyuam?​​  

Reference BHIN 21-021; BHIN 24-001​​ 

Medi-Cal cov tswvcuab, suav nrog cov tswvcuab cev xeeb tub thiab tomqab yug menyuam, tuaj yeem nyob hauv SUD cov kev pabcuam khomob hauv tsev kom ntev npaum li kev khomob tsim nyog raws li tau txiav txim los ntawm Tus Kws Lij Choj Kev Kho Mob (LPHA). Txawm hais tias lub hom phiaj thoob plaws lub xeev rau qhov nruab nrab ntev ntawm kev nyob twj ywm rau cov kev pab cuam kho mob hauv cheeb tsam uas muab los ntawm Drug Medi-Cal Organized Delivery System (DMC-ODS) counties yog 30 hnub lossis tsawg dua, tsis muaj kev txwv rau cov hnub ntau tshaj plaws uas tus tswv cuab tuaj yeem nyob hauv kev kho vaj tse.​​ 

Please see BHIN 21-021 for additional information on the removal of a former length of stay requirement.​​ 

Yog tias ib tug tswvcuab tab tom nqis los ntawm thaj chaw nyob mus rau tus neeg mob sab nraud Cov Kev Pabcuam Kev Noj Qab Haus Huv Medi-Cal Organized Delivery System (DMC-ODS), tus kws khomob sab nraud thiab tus kws khomob puas tuaj yeem them nqi rau Kev Pabcuam Kev Khomob thaum tus tswvcuab tseem muaj npe hauv cov kev pabcuam hauv tsev?​​ 

Reference: BHIN 24-001, DMC-ODS Billing Manual, DMC-ODS Service Table​​ 

Cov Kev Pabcuam Kev Khomob Nyob Hauv Lub Nroog tsis suav nrog Kev Pabcuam Saib Xyuas Kev Khomob. Yog li, Kev Kho Mob Nyob Hauv Tsev lossis Tus Kws Kho Mob Sab Nraud tuaj yeem sau nqi thiab them rov qab rau Kev Saib Xyuas Kev Kho Mob raws li qhov kev pabcuam tsis tau muab cais tawm ntawm kev them nqi rau Kev Khomob Hauv Tsev lossis cov kev pabcuam sab nraud.​​ 

Yog tias tus kws kho mob nyob hauv tsev tau ntawv pov thawj los muab Kev Pabcuam Sab Nraud, tus kws kho mob tuaj yeem thov Kev Pabcuam Kev Khomob raws li kev pabcuam khomob sab nraud (siv tus hloov kho U7 lossis U8) thiab yuav raug them rov qab rau qhov kev pabcuam ntawm tus neeg mob sab nraud. Tus kws kho mob nyob hauv tsev kuj tuaj yeem thov rau Kev Saib Xyuas Kev Kho Mob los ntawm daim ntawv pov thawj qhov kev pab cuam nyob (ie modifier U1) tsis yog tus neeg mob sab nraud thiab muaj cai rau tib tus neeg mob sab nraud.​​ 

Cov Kev Pabcuam Kev Khomob Nyob Hauv Tsev Kho Mob bundled tus nqi suav nrog cov hauv qab no:​​ 

• Kev soj ntsuam​​ 
• Kev sab laj​​ 
• Kev Kho Mob Tsev Neeg​​ 
• Kev Pab Kho Mob​​ 
• Kev Kawm Tus Neeg Mob​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing Care Coordination services.​​ 

Rau Cov Tshuaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS), puas tseem xav tau cov phiaj xwm tso tawm thiab cov ntsiab lus tso tawm?​​ 

Siv: BHIN 19-003; BHIN 23-068, BHIN 24-001​​ 

DMC-ODS plans and providers should follow documentation requirements set forth in BHIN 23-068, which does not include discharge plans and discharge summaries. Discharge planning is a component of Care Coordination services for DMC-ODS and should be provided based on member need. Discharge planning can include coordination with substance use disorder (SUD) treatment providers to support transitions between levels of care and to recovery resources, referrals to mental health providers, and referrals to primary or specialty medical providers. For certified only programs, discharge plans and summaries are required per Alcohol and/or other Drug (AOD) Certification Standard 7120.​​ 

Further, licensed residential programs shall update resident records as necessary to ensure current accuracy and include data and reason for termination of services, per CCR Title 9, Chapter 5, Section 10568. Additionally, BHIN 19-003 updates H&S Code 11834.26(d) to include resident discharge and continuation of care as part of the required written plan to address resident relapse.​​ 

Kev tsis muaj tsev nyob puas tuaj yeem yog qhov laj thawj rau kev siv tshuaj tua kab mob (SUD) lossis txawm tias nce qib kev saib xyuas (LOC)?​​ 

Reference: BHIN 24-001​​ 

Cov tswv cuab yuav tsum ua kom tau raws li cov txheej txheem nkag mus rau Drug Medi-Cal (DMC) lossis Drug Medi-Cal Organized Delivery System (DMC-ODS) kom nkag mus rau SUD cov kev pabcuam los ntawm DMC/DMC-ODS txoj haujlwm. American Society of Addiction Medicine (ASAM) Cov Txheej Txheem yog siv los txiav txim siab tso rau hauv LOC tsim nyog rau txhua tus tswv cuab tau txais kev pabcuam los ntawm DMC lossis DMC-ODS. Dimension 5 (Rov qab ib puag ncig kev sib cuam tshuam) ntawm ntau qhov kev ntsuam xyuas ASAM suav nrog cov xwm txheej uas tuaj yeem cuam tshuam txog kev rov qab los, xws li kev tsis muaj tsev nyob, los pab txiav txim siab qhov chaw tsim nyog. Kev tso cov tswv cuab thiab kev txiav txim LOC yuav tsum xyuas kom cov tswv cuab muaj peev xwm tau txais kev saib xyuas hauv LOC tsawg kawg nkaus uas tsim nyog kho lawv tus mob.​​ 

Puas yog qhov yuav tsum tau muab naloxone ntawm qhov Kev Pabcuam Kev Kho Mob Narcotic (NTP) / Opioid Treatment Program (OTP) tuaj yeem ua tau los ntawm kev muab ib daim ntawv ntawm buprenorphine (Suboxone ® ) uas muaj buprenorphine thiab naloxone?​​ 

Reference: BHIN 24-001, BHIN 23-064​​ 

Tsis yog. Thaum NTPs/OTPs tuaj yeem muab cov qauv ntawm buprenorphine uas muaj naloxone, qhov no tsis yog hloov rau naloxone. Naloxone (los ntawm nws tus kheej) yog siv los thim rov qab kev noj tshuaj ntau dhau ntawm opioid. Kev suav nrog naloxone hauv kev sib xyaw ua ke ntawm buprenorphine / naloxone cov khoom yog tsim los tiv thaiv kev sib txawv thiab kev siv cov tshuaj buprenorphine tsis raug; Nws tsis yog tsim los thim rov qab kev noj tshuaj ntau dhau ntawm opioid.​​ 

How should a provider bill for Narcotic Treatment Program (NTP) dosing when a member temporarily receives services in a county that they do not reside in, and the member’s home NTP does not have a contract with that county? – September 17, 2024​​ 

Reference BHIN 24-001, DMC-ODS Billing Manual​​ 

As noted on page 31 of BHIN 24-001, The Drug Medi Cal-Organized Delivery System (DMC-ODS) plan is responsible for ensuring that members receiving NTP services and working in or traveling to another county (including a county that does not opt into the DMC-ODS program) do not experience a disruption of NTP services.​​ 

If the member is traveling out of the county and requires medications from an NTP, the DMC-ODS plan shall cover these services out-of-network for the member, for as long as the DMC-ODS plan’s provider network is unable to provide them. In these cases, the DMC-ODS plan shall coordinate and cover the out-of-network NTP services for the member. Per page 44 of the DMC-ODS Billing Manual, the NTP dosing should be billed using the modifiers UA and HG.​​ 

Yuav Ua Li Cas Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) cov kws kho mob tuaj yeem siv Medi-Cal rau kev sau thiab xa naloxone rau cov neeg mob?​​ 

Reference: BHIN 24-001 , BHIN 23-064​​ 

Cov kws kho mob DMC-ODS muaj qhov yooj yim los muab lossis npaj rau naloxone kom raug thiab muab rau txhua tus tswv cuab DMC-ODS los ntawm kev siv Medi-Cal Rx. Medi-Cal Rx yog cov nyiaj pab kho mob sab nraud rau txhua tus tswv cuab Medi-Cal. Medi-Cal Rx suav nrog cov tshuaj kws kho mob thiab tom khw muag khoom, suav nrog naloxone.​​ 

DMC-ODS providers that are authorized to prescribe the medication can prescribe naloxone to each member who is under their care and arrange for staff to routinely fill these naloxone prescriptions at a pharmacy on behalf of the members, as a best practice overdose prevention measure. DMC-ODS providers can also coordinate delivery of the naloxone from a pharmacy to the member’s location or refer members to pharmacies that will dispense naloxone directly to the member. Furthermore, DMC-ODS counties may cover drug product costs for treatment when the medications are purchased and administered or dispensed in a nonclinical setting (e.g., criminal justice settings or street-based outreach). Finally, medical directors and prescribing clinicians of DMC-ODS providers are also able to establish a standardized protocol that authorizes designated staff working in a DMC-ODS provider agency to issue prescriptions on behalf of the medical directors or prescribing clinicians to a local pharmacy for naloxone.​​ 

The Naloxone Distribution Project (NDP) is a project DHCS established in 2018 to reduce opioid-related overdose deaths through the provision of free naloxone, directly shipped to eligible entities. The NDP supports eligible entities, including, but not limited to, law enforcement, schools, tribal entities, county public health and behavioral health departments, and community organizations. The NDP is not the primary source for naloxone in California and other available funding sources should be used to obtain naloxone prior to utilizing the NDP.​​ 

Cov tswvcuab Medi-Cal tuaj yeem nkag mus rau Cov Tshuaj Kho Mob rau Kev Tiv Thaiv Kab Mob (MAT) li cas?​​ 

Reference BHIN 24-001, BHIN 23-064, BHIN 23-054, BHIN 22-011, and the MCP Contracts.​​ 

Drug Medi-Cal Organized Delivery System (DMC-ODS)​​ 

DMC-ODS providers can administer medications for Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD). All FDA-approved medications and biological products to treat these disorders are covered, including buprenorphine and naltrexone. MAT is covered, reimbursable, and can be provided in most DMC-ODS levels of care, including outpatient treatment, intensive outpatient treatment, partial hospitalization, residential treatment¹,  inpatient treatment, and withdrawal management. MAT is also covered, reimbursable, and can be provided by DMC-ODS providers in non-clinical settings (such as mobile clinics and street medicine teams) and when provided as a standalone service outside of these levels of care. Methadone maintenance treatment must be provided by a Narcotic Treatment Program (NTP).​​ 

Cov tswv cuab xav tau lossis siv MAT yuav tsum tau txais kev pabcuam. Cov tswvcuab tsis tuaj yeem tsis lees paub DMC-ODS cov kev pabcuam khomob, yuav tsum tau txo cov koob tshuaj, lossis raug txiav tawm cov tshuaj raws li qhov tau txais lossis txuas ntxiv cov kev pabcuam DMC-ODS. DMC-ODS cov chaw muab kev pabcuam MAT yuav tsum tsis txhob tsis lees paub kev nkag mus rau cov tshuaj lossis kev tswj xyuas tus tswvcuab uas tsis kam muab cov kev pabcuam sablaj.​​ 

As described in BHIN 24-001, DMC-ODS plans shall ensure that all DMC-ODS providers, at all levels of care, either offer MAT services directly or have an effective referral process in place to the most clinically appropriate MAT services, pursuant to the requirements set forth in BHIN 23-054. An effective referral process shall include an established relationship with a MAT provider and transportation to appointments for MAT, regardless of whether the provider seeks reimbursement through DMC-ODS. Simply providing a member with the contact information for a MAT provider does not meet the requirement of an effective referral.​​ 

MAT kuj tseem tuaj yeem muab rau Medi-Cal cov tswv cuab hauv ntau qhov chaw sab nraum DMC-ODS, suav nrog:​​ 

• Medi-Cal Managed Care Plans (MCPs). Medi-Cal cov tswv cuab tuaj yeem tau txais kev kho mob tsim nyog thiab them rau SUD cov kev pabcuam xa los ntawm MCP cov chaw muab kev pabcuam (xws li kev tshuaj xyuas cawv thiab tshuaj yeeb, kev tshuaj xyuas, kev cuam tshuam luv luv, thiab kev xa mus rau kev kho mob) los ntawm kev saib xyuas thawj zaug, chaw kho mob hauv zej zog, Federally Quality Health Centers (FQHCs), tsev kho mob hauv tsev kho mob, chaw kho mob xwm txheej ceev, thiab lwm yam kev cog lus kho mob, ib daim ntawv cog lus 2-CP1 thiab BHIN . kuj tseem npaj rau kev muab MAT muab rau hauv kev saib xyuas thawj, tsev kho mob hauv tsev kho mob, chaw kho mob xwm txheej ceev, thiab lwm qhov chaw kho mob tau cog lus.​​ 
• Emergency departments (EDs) thiab tsev kho mob. EDs tuaj yeem yog qhov chaw ruaj khov rau cov tswv cuab nrog OUD. Txhua lub tsev kho mob lossis ED tus kws kho mob tuaj yeem tswj hwm buprenorphine raws li CA Bridge Treatment Protocols los txo cov tsos mob ntawm kev tshem tawm mob hnyav thiab pab cov neeg mob xa mus rau kev kho mob. Ntau tshaj 240 EDs hauv California muab MAT los ntawm qhov chaw MAT induction hauv ED thiab cov ntawv sau luv luv ntawm buprenorphine los txuas rau cov tswv cuab kom txog thaum lawv thawj zaug rov qab mus ntsib. Thov mus saib hauv California Bridge Program lub vev xaib txhawm rau nrhiav cov peev txheej, cov cuab yeej, thiab EDs uas muab MAT thoob plaws hauv California.​​ 
• Pharmacies. Medi-Cal members can receive medications for the treatment of substance use disorders similar to any other maintenance medication from a Medi-Cal enrolled pharmacy.  All medications and biological products utilized to treat SUDs, including long-acting injectables, are available through Medi-Cal Rx without prior authorization. Medications can also be delivered directly to provider offices for onsite administration. Medi-Cal Rx pharmacies can be found by visiting the Medi-Cal Rx website, and provider training resources can be found on the Medi-Cal Rx Education & Outreach website. The complete list of approved medications for the Medi-Cal Rx program can be found on the Medi-Cal Rx Contract Drugs List website.​​ 

Ntxiv cov peev txheej rau Access MAT​​ 

• DHCS Opioid Response aims kom nkag tau mus rau MAT, txo cov kev xav tau kev kho mob tsis zoo, thiab txo qis kev siv tshuaj opioid ntau dhau los ntawm cov kev pab cuam tsom rau kev tiv thaiv, kev kho mob, thiab kev ua kom rov zoo. Ntau tus kws kho mob thawj zaug, FQHCs, cov kws kho mob tshwj xeeb SUD thiab lwm lub koom haum tau txais nyiaj txawm tias qhov project, uas tuaj yeem pab them cov nqi tshuaj thiab cov kev pab cuam rau cov tib neeg uas tsis muaj ntawv pov hwm lossis tsis muaj ntawv pov hwm.​​ 
• The Tribal MAT Project is a unified response designed to meet the specific opioid use disorder prevention, treatment, and recovery needs of California’s Tribal and Urban Indian communities. The Tribal MAT Project promotes opioid safety, improves the availability and provision of MAT, and facilitates wider access to naloxone with special consideration for Tribal and Urban Indian values, culture, and treatments.​​ 
• Treatment Locators: Please visit http://choosemat.org/ for a list of providers and facilities offering MAT in your area. The organization Shatterproof has also created a treatment locator with questions to help individuals and families access treatment that is suited to their needs, via the ATLAS platform.​​ 

¹ Licensed residential treatment programs that are authorized to provide incidental medical services (IMS) may also offer MAT.​​ 

Cov kev pab cuam nyiaj txiag puas muaj nyob hauv Drug Medi-Cal Organized Delivery System (DMC-ODS) li cas?​​ 

Reference: BHIN 24-001, DMC-ODS Billing Manual, DMC-ODS Service Table​​ 

A collateral is a family member or other person supporting the DMC-ODS member. “Collateral services” is no longer defined as a unique service component of the DMC-ODS service modalities.  As described in BHIN 24-001, the concept of including a collateral in a member’s substance use disorder treatment has been incorporated into assessment services, individual counseling, Medi-Cal Peer Support Services, and family therapy. There may be times when, based on clinical judgment, the member is not present during the delivery of this service, but the service is for the direct benefit of the member.​​ 

Assessment services 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 member. Individual counseling services and Medi-Cal Peer Support Services can also 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 member by supporting the achievement of the member’s treatment goals.​​ 

Family therapy is 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 member and help motivate their loved one to remain in treatment.​​ 

BHIN 24-001 and the DMC-ODS Medi-Cal Billing Manual detail which DMC-ODS service modalities include assessment services, individual counseling services, Medi-Cal Peer Support Services and family therapy as billable service components.​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing services involving a member’s collaterals.​​ 

Txhawm rau muab cov kev pabcuam hauv tsev kho mob ib nrab los ntawm Kev Pabcuam Kev Muag Khoom Medi-Cal Organized Delivery System (DMC-ODS), yuav tsum muaj ntawv pov thawj dab tsi los ntawm DMC-ODS txoj kev npaj?​​ 

Reference: BHIN 24-001​​ 

Kev Pabcuam Tsev Kho Mob Ib Feem yog xaiv tau rau DMC-ODS cov kev npaj. Tsis muaj DMC daim ntawv pov thawj qeb tshwj xeeb rau kev mus pw hauv tsev kho mob ib nrab. Txhawm rau muab Kev Pabcuam Hauv Tsev Khomob Ib Ntu los ntawm DMC-ODS, DMC-ODS txoj kev npaj, lossis DMC-ODS cov chaw muab kev cog lus yuav tsum:​​ 

• Tau ntawv pov thawj raws li DMC Intensive Outpatient Treatment (IOT) cov kws kho mob;​​ 
• Muaj peev xwm muab 20 lossis ntau teev ntawm kev kho mob hnyav hauv ib lub lis piam; thiab​​ 
• Ua kom pom lub peev xwm los pab txhawb kev nkag mus rau kev puas siab puas ntsws, kev kho mob, thiab kev kuaj mob, raws li xav tau.​​ 

Dab tsi yog Qhov Kev Npaj Qhia Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) cov ntaub ntawv xav tau ntsig txog kev tsis txaus siab?​​ 

Reference:  BHIN 24-001, July 1, 2022 – July 1, 2027 DMC-ODS Contract​​ 

Raws li tau teev tseg hauv Daim Ntawv Pom Zoo Sib Tham (DMC-ODS daim ntawv cog lus), txhua qhov DMC-ODS txoj kev npaj yuav tsum khaws cov ntaub ntawv tsis txaus siab thiab kev thov rov hais dua thiab yuav tsum tshuaj xyuas cov ntaub ntawv raws li ib feem ntawm nws cov txheej txheem kev saib xyuas tsis tu ncua, nrog rau kev hloov kho thiab hloov kho rau Lub Tsev Haujlwm Saib Xyuas Kev Ua Haujlwm zoo.​​ 

Cov ntaub ntawv ntawm txhua qhov kev tsis txaus siab lossis kev thov rov hais dua yuav tsum muaj, yam tsawg kawg, tag nrho cov ntaub ntawv hauv qab no:​​ 

• Cov lus piav qhia dav dav ntawm qhov laj thawj rau kev thov rov hais dua lossis tsis txaus siab.​​ 
• Hnub tau txais.​​ 
• Hnub tim ntawm txhua qhov kev tshuaj xyuas lossis, yog tias tsim nyog, lub rooj sib tham tshuaj xyuas.​​ 
• Kev daws teeb meem ntawm txhua theem ntawm kev thov rov hais dua lossis kev tsis txaus siab, yog tias muaj.​​ 
• Hnub ntawm kev daws teeb meem ntawm txhua qib, yog tias tsim nyog.​​ 
• Lub npe ntawm tus neeg tau txais kev pab uas tau thov kom rov hais dua lossis tsis txaus siab.​​ 

Each record shall be accurately maintained in a manner accessible to the Department of Health Care Services (DHCS) and available upon request to the Centers for Medicare and Medicaid Services (CMS). The written record of grievances and appeals shall be submitted at least quarterly to the plan’s quality improvement committee for systematic aggregation and analysis for quality improvement. Grievances and appeals reviewed shall include, but not be limited to, those related to access to care, quality of care, and denial of services. Appropriate action shall be taken to remedy any problems identified.​​ 

Dab tsi yog Qhov Kev Pabcuam Kev Xa Khoom Siv Tshuaj Medi-Cal (DMC-ODS) cov kev cai rau kev thov rov hais dua?​​ 

Reference:  BHIN 24-001, July 1, 2022 – July 1, 2027 DMC-ODS Contract​​ 

Raws li tau teev tseg hauv Daim Ntawv Pom Zoo Sib Tham (DMC-ODS daim ntawv cog lus), tus tswv cuab lossis tus neeg muab kev pabcuam thiab / lossis tus neeg sawv cev tau txais kev tso cai tuaj yeem foob tus kheej, hais lus, lossis sau ntawv. Yog tias lawv thov kom daws teeb meem sai sai, tus tswv cuab lossis tus neeg sawv cev yuav tsum ua raws li tus kheej los yog qhov ncauj ua ntaub ntawv nrog sau ntawv, kos npe thov rov hais dua. Qhov kev thov rov hais dua yuav tsum tsis suav nrog tus tswvcuab lossis tus neeg sawv cev tau tso cai nyob rau hauv ib txoj kev. Cov tib neeg txiav txim siab txog qhov kev txiav txim plaub ntug yuav tsum tsim nyog ua li ntawd thiab tsis koom nrog rau qib dhau los ntawm kev tshuaj xyuas lossis kev txiav txim siab.​​ 

Cov tswv cuab thiab/los yog lawv tus neeg sawv cev tso cai yuav tsum:​​ 

• Muaj txoj cai los tshuaj xyuas lawv cov ntaub ntawv, suav nrog lawv cov ntaub ntawv kho mob thiab lwm yam ntaub ntawv lossis cov ntaub ntawv khaws tseg uas tau txiav txim siab thaum lub sijhawm thov rov hais dua, ua ntej thiab thaum lub sijhawm rov hais dua.​​ 
• Muaj lub sijhawm tsim nyog los nthuav tawm cov pov thawj thiab cov lus iab liam ntawm qhov tseeb lossis kev cai lij choj, ntawm tus kheej lossis sau ntawv.​​ 
• Be allowed to have a legal representative and/or legal representative of a deceased member’s estate included as parties to the appeal.​​ 
• Nco ntsoov tias lawv qhov kev thov rov hais dua tau raug tshuaj xyuas los ntawm kev sau ntawv lees paub.​​ 
• Tau txais kev ceeb toom txog lawv txoj cai thov lub Xeev Lub Rooj Sib Hais, tom qab ua tiav cov txheej txheem thov rov hais dua.​​ 

Dab tsi yog Qhov Kev Npaj Qhia Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) cov kev xav tau thiab lub sijhawm rau Lub Xeev Lub Rooj Sib Hais?​​ 

Reference: BHIN 24-001, July 1, 2022 – July 1, 2027 DMC-ODS Contract​​ 

Raws li tau teev tseg hauv Daim Ntawv Pom Zoo Sib Tham (DMC-ODS daim ntawv cog lus), cov tswv cuab tuaj yeem thov Lub Xeev Lub Rooj Hais Plaub tsuas yog tom qab tau txais ntawv ceeb toom tias txoj kev npaj txhawb nqa qhov kev txiav txim siab tsis zoo.​​ 

Cov tswvcuab muaj 120 hnub los thov Lub Xeev Lub Rooj Sib Hais, pib txij hnub uas txoj kev npaj tau muab qhov kev txiav txim rau tus tswvcuab ntawm tus kheej, lossis hnub tomqab qhov kev txiav txim plaub ntug raug kaw lawm. Yog tias tus tswv cuab tsis tau txais Daim Ntawv Ceeb Toom Txog Kev Txiav Txim Siab Tsis Zoo (NOABD), lawv tuaj yeem xa mus rau Lub Xeev Lub Rooj Sib Hais Thaum twg los tau.​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv California yuav ua qhov kev tshuaj xyuas ywj pheej tsis pub dhau 90 hnub tom qab tau txais daim ntawv thov. Cov tswvcuab tuaj yeem thov kom muaj Lub Xeev Lub Rooj Sib Hais Ncaj Ncees. Yog tias daim ntawv thov tsim nyog rau lub Xeev Lub Rooj Sib Hais Ncaj Ncees, qhov kev txiav txim yuav raug muab tso rau hauv peb hnub ua haujlwm txij li hnub uas Lub Xeev Lub Rooj Sib Hais Plaub tau txais.​​ 

Qhov twg tuaj yeem Siv Tshuaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS) cov phiaj xwm thiab cov chaw muab kev pab nrhiav kev taw qhia ntawm Daim Ntawv Ceeb Toom Txog Kev Txiav Txim Tsis Zoo (NOABD) kev tsis txaus siab thiab kev thov rov hais dua?​​ 

Reference: MHSUDS IN 18-010E​​ 

Please refer to MHSUDS IN 18-010E: Federal Grievance and Appeal System Requirements with Revised Beneficiary Notice Templates for clarification and guidance regarding the application of revised federal regulations for processing grievances and appeals.​​ 

Cov ntaub ntawv tsis txaus siab thiab kev thov rov hais dua dab tsi yuav tsum muaj nyob rau hauv Txoj Kev Npaj Kho Mob Medi-Cal Organized Delivery System (DMC-ODS) Plan's Quality Improvement (QI) Plan?​​ 

Reference: BHIN 24-001​​ 

QI Plan yuav tsum muaj cov ntaub ntawv hais txog yuav ua li cas cov tswv cuab cov ntaub ntawv tsis txaus siab yuav raug sau, cais, thiab tshuaj xyuas rau kev saib xyuas. Yam tsawg kawg nkaus, QI Plan yuav tsum muaj cov ntaub ntawv hais txog:​​ 

• Yuav ua li cas xa daim ntawv tsis txaus siab, thov rov hais dua, thiab thov kom muaj lub rooj sib hais hauv lub xeev​​ 
• Lub sijhawm rau kev daws teeb meem ntawm kev hais plaub ntug;​​ 
• Cov ntsiab lus ntawm qhov kev daws teeb meem tsis txaus siab;​​ 
• Kev khaws cia;​​ 
• Kev txuas ntxiv ntawm cov txiaj ntsig; thiab​​ 
• Qhov yuav tsum tau muaj ntawm Xeev Lub Rooj Sib Hais.​​ 

Yog tias Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (Drug Medi-Cal Organized Delivery System) (DMC-ODS) muaj lub chaw saib xyuas kev noj qab haus huv sib koom ua ke, nws puas tuaj yeem siv tib Pawg Kev Txhim Kho Zoo (QI) uas xav tau los ntawm daim ntawv cog lus Mental Health Plan kom ua tiav DMC-ODS QI Pawg Neeg Saib Xyuas?​​ 

Reference: BHIN 24-001​​ 

Yog lawm. DMC-ODS txoj kev npaj yuav siv tib pawg neeg ua haujlwm, nrog rau kev koom nrog kev siv yeeb tshuaj, rau cov nroog uas muaj chaw saib xyuas kev noj qab haus huv.​​ 

Puas yog cov tub ntxhais kawm xyaum ua haujlwm lossis cov neeg cob qhia suav tias yog Cov Kws Kho Mob Kho Mob (LPHAs)?​​ 

Reference: BHIN 24-001, SPA 23-0026​​ 

Tsis yog. Tus Kws Lij Choj Kev Kho Mob (LPHA) suav nrog ib qho ntawm cov hauv qab no: Tus Kws Kho Mob, Tus Kws Kho Mob (NP), Tus Kws Kho Mob (PA), Tus Kws Kho Mob Sau Npe, Tus Kws Tshuaj Kho Mob, Daim Ntawv Tso Cai Kho Mob Psychologist (LCP), Daim Ntawv Tso Cai Kho Mob Social Worker (LCSW), Registered CSW, Tus Kws Lij Choj Tus Kws Kho Mob PCC, Daim Ntawv Tso Cai Sib Yuav thiab Tsev Neeg Therapist (LMFT), Sau Npe MFT, Daim Ntawv Tso Cai Ua Haujlwm (LVN), Tus Kws Lij Choj Ua Haujlwm (LOT), thiab Tus Kws Lij Choj Psychiatric (LPT).​​ 

A clinical trainee is an unlicensed individual who is enrolled in a post-secondary educational degree program in the State of California that is required for the individual to obtain licensure as an LPHA; is participating in a practicum, clerkship, or internship approved by the individual’s program; and meets all relevant requirements of the program and/or applicable licensing board to participate in the practicum, clerkship, or internship and provide substance use disorder treatment services, including, but not limited to, all coursework and supervised practice requirements.​​ 

SPA 23-0026 allows CSW, MFT, and PCC candidates to provide DMC-ODS services if the candidate:​​ 

• Submitted their application for associate registration to Board of Behavioral Sciences (BSS) within 90 days of their master’s program degree award date,​​ 
• Ua kom tiav cov sij hawm saib xyuas ntawm lawv daim ntawv tso cai, thiab​​ 
• Ua raws li lawv qhov kev coj ua raws li California txoj cai lij choj.​​ 

The BSS’ “90 Day Rule” allows CSW, MFT, and PCC candidates who have submitted their applications for associate registration within 90 days of the degree award date to count supervised experience gained during the window of time between the degree award date and the issue date of the associate registration number toward their licensure.​​ 

Puas yog tus kws kho mob tsis tuaj yeem ua haujlwm rau tus menyuam cev xeeb tub Cov Tshuaj Medi-Cal Organized Delivery System (DMC-ODS) tus tswv cuab? Tus txheej txheem los thov rau cov kev pabcuam no yog dab tsi?​​ 

Siv: Cov Lus Qhia Txog Kev Xyaum Thaum Yug Me Nyuam​​ 

Yog. Ib tug tswv cuab cev xeeb tub tuaj yeem xaiv tau txais cov kev pabcuam los ntawm tus kws kho mob uas tsis yog tus menyuam yug tshiab. Yog tias tus tswv cuab DMC-ODS tau txais kev tsim nyog los ntawm tus lej pab cev xeeb tub, daim ntawv thov yuav tsum muaj cov ntaub ntawv ntawm tus neeg mob, tseem hu ua PAT, 9 qhov qhia txog cev xeeb tub kom siv tau. Thov saib cov Lus Qhia Txog Kev Xyaum Thaum Yug Me Nyuam rau cov kws kho mob ua haujlwm nrog cov poj niam cev xeeb tub thiab cov niam txiv uas tab tom nrhiav lossis xa mus rau kev kho mob siv tshuaj yeeb dej caw.​​ 

Yuav ua li cas them nqi rau Drug Medi-Cal Organized Delivery System (DMC-ODS) pab pawg kws pab tswv yim suav?​​ 

Reference: BHIN 24-001, DMC-ODS Billing Manual, DMC-ODS Service Table​​ 

Cov chav nyob rau DMC-ODS cov kev pabcuam pab pawg sab laj yuav tsum suav nrog cov qauv hauv qab no: (Ntau feeb rau pawg pab pawg sab laj/15-feeb increments = tag nrho cov units xa mus siv tus txheej txheem H0005. DMC-ODS Cov Kev Npaj yuav tsum xa cov ntaub ntawv sib cais rau txhua tus tswvcuab tau txais kev sab laj pab pawg.​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing group counseling services.​​ 

Can you submit a claim for a member’s “room and board” during residential treatment if the member received no residential treatment covered services on the date of service for the claim?​​ 

Reference: BHIN 24-001, DMC-ODS Billing Manual, DMC-ODS Service Table​​ 

No. “Room and board” cannot be claimed separately. In order to claim for residential treatment, a member must receive at least one residential treatment covered service (i.e. required structured activity) on the date of service for the claim. BHIN 24-001 outlines the services covered under Residential Treatment.​​ 

Please see the DMC-ODS Billing Manual and separate DMC-ODS Service Table for directions on billing Residential Services.​​ 

Puas yog cov nyiaj tau los uas tsis yog 2011 cov nyiaj rov qab los tsim nyog rau tsoomfwv qhov kev sib tw?​​ 

Siv rau: SSA § 1903(w)(6); 42 CFR § 433.51.​​ 

Yog lawm. Lwm cov nyiaj hauv zos tsim nyog siv los ua qhov tsis yog tsoomfwv qhov kev sib tw yog tias lawv tsis yog tsoomfwv cov peev nyiaj thiab lwm yam tsim nyog siv raws li kev sib tw raws li cov kev xav tau teev tseg hauv SSA §1903(w)(6) thiab 42 CFR §433.51.​​