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.​​ 

Cov Ntaub Ntawv Qhia Txog Tus Cwj Pwm Kev Noj Qab Haus Huv rau DMC, DMC-ODS, & SMHS​​ 

Kev soj ntsuam​​ 

Puas yog American Society of Addiction Medicine (ASAM) Cov Cai ® tuaj yeem siv los ntsuas cov tub ntxhais hluas thiab cov tub ntxhais hluas? Puas muaj kev pom zoo ASAM cov cuab yeej ntsuas rau cov hluas thiab cov tub ntxhais hluas?​​ 

ASAM 4th Edition Development thiab BHIN 23-068​​ 

Tsis tau. Raws li lub Plaub Hlis 2024, American Society of Addiction Medicine (ASAM) tsis tau tsim cov cuab yeej ntsuas rau cov hluas thiab cov tub ntxhais hluas, tab sis ib tug hluas thiab cov hluas hnub nyoog hloov pauv ntawm ASAM Criteria ® tau xav txog yav tom ntej. Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) yuav tshuaj xyuas cov ntawv tshaj tawm yav tom ntej ntawm ASAM Cov Cai ® thiab yuav ua kom tsim nyog hloov tshiab rau lub xeev cov lus qhia thaum muaj kev txhim kho tshiab. Nyob rau lub sijhawm no, cov nroog thiab cov chaw muab kev pabcuam tseem tuaj yeem siv lawv cov cuab yeej ntsuas kev tsim kho hauv zos rau cov tub ntxhais hluas thiab cov hluas thaum cov kev cai tshiab rau cov qauv kev ntsuas ASAM ® rau cov neeg laus uas tau teev tseg hauv BHIN 23-068 tau pib siv txij lub Ib Hlis 1, 2025.
​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas yuav pom zoo ntxiv rau American Society of Addiction Medicine (ASAM) cov cuab yeej ntsuas?​​ 

Reference BHIN 23-068​​ 

Lub sijhawm no, DHCS tsis tau pom zoo ib qho ntxiv rau American Society of Addiction Medicine (ASAM) cov cuab yeej ntsuas lwm yam uas tsis yog ASAM Cov Kev Ntsuam Xyuas Kev Ntsuam Xyuas Cov Lus Qhia thiab ASAM CONTINUUM software. DHCS tuaj yeem xaiv los ntsuas thiab muaj peev xwm pom zoo cov cuab yeej ntxiv yav tom ntej; Yog tias DHCS ua li ntawd, qhov kev txiav txim siab no yuav raug tshaj tawm rau cov neeg muaj feem. Txawm li cas los xij, Lub Tsev Haujlwm tsis xav tias yuav tsim cov txheej txheem los niaj hnub pom zoo cov cuab yeej tshiab xa los ntawm cov neeg muaj feem, vim qhov no yuav tsis txhawb nqa lub hom phiaj ntawm CalAIM.​​ 

DHCS’ decision to require the use of the above tools aligns with the CalAIM goals to standardize, simplify, and streamline access to Medi-Cal services. The use of tools that have been validated by ASAM will help assure the quality of DMC/DMC-ODS services statewide by ensuring that all Medi-Cal members who receive DMC or DMC-ODS services receive a comprehensive assessment that appropriately applies ASAM level of care criteria.​​ 

Puas yog American Society of Addiction Medicine (ASAM) Cov Txheej Txheem Hloov Kho yuav cuam tshuam rau yav tom ntej Department of Health Care Services (DHCS) cov lus qhia?​​ 

Siv BHIN 23-068 thiab BHIN 21-001 Exhibit A​​ 

Yog lawm. DHCS npaj yuav hloov kho DMC thiab DMC-ODS txoj cai qhia raws li qhov xav tau los ua kom haum raws li tam sim no American Society of Addiction Medicine (ASAM) version. Cov cuab yeej ntsuas ASAM pub dawb kuj tseem yuav raug hloov kho kom muaj kev cuam tshuam rau ASAM Cov Qauv Txheej Txheem Plaub Ntug. DHCS yuav muab cov ntaub ntawv hloov tshiab ntawm cov hnub tshaj tawm rau ASAM Cov Txheej Txheem Fourth Edition txoj cai qhia kom sai li sai tau.​​ 

BHIN 23-054 qhia meej tias Kev Ntsuas Tshuaj rau Kev Kho Mob (MAT) yuav tsum tau muab ua ntej 24 teev tom qab nkag mus rau cov ntawv tso cai thiab / lossis cov ntawv pov thawj siv tshuaj tsis raug cai rov qab los yog chaw kho mob. Qhov kev taw qhia no ua raws li BHIN 23-068, uas tshem tawm lub sijhawm 30/60 yav dhau los rau kev ua tiav ASAM Qib Kev Ntsuas Kev Kho Mob li cas?​​ 

Siv BHIN 23-068; PAB 23-054​​ 

Section (a)(3)(ii) of BHIN 23-068 clarifies that “MAT assessments, as described in BHIN 23-054 or subsequent guidance, need not meet the comprehensive ASAM assessment requirements described in this BHIN.” The MAT assessments described in BHIN 23-054 serve a specific clinical purpose that is distinct from the purpose of the comprehensive ASAM assessment. As such, the MAT assessment must occur rapidly whereas the comprehensive ASAM assessment may occur over a longer period of time.​​ 

Lub hom phiaj ntawm MAT kev ntsuam xyuas yog txhawm rau txheeb xyuas tam sim yog tias MAT yuav muaj txiaj ntsig zoo rau Medi-Cal tus tswv cuab, kom MAT tuaj yeem pib ua raws sijhawm. Kev ntsuam xyuas ASAM Qib Kev Saib Xyuas Kev Tshawb Fawb tuaj yeem siv cov ntaub ntawv sau tseg thaum qhov kev ntsuam xyuas MAT tab sis yuav suav nrog lwm cov ntaub ntawv thiab. Qhov kev ntsuam xyuas ASAM muaj peev xwm ua tiav nyob rau lub sijhawm ntev dua thiab yuav tsum ua kom tau raws li tag nrho DMC/DMC-ODS cov kev ntsuas raws li tau piav qhia hauv BHIN 23-068. ​​ 

Ntu 1​​ 

Nplooj 4 ntawm Daim Ntawv Ceeb Toom Txog Tus Cwj Pwm Kev Noj Qab Haus Huv (BHIN) 23-068 tham txog cov kev taw qhia uas twb muaj lawm ntawm Lub Tsev Haujlwm Saib Xyuas Kev Khomob (DHCS) Qib Kev Saib Xyuas (LOC) uas xav kom cov chaw muab kev pabcuam khomob hauv tsev kom ntseeg tau tias cov tswvcuab tau txais ntau qhov kev ntsuas kev saib xyuas. Puas yog cov kev cai tshiab no? Puas yog lawv sib npaug ntawm cov kev ntsuas ASAM uas tau piav qhia hauv BHIN 23-068?​​ 

Reference BHIN 23-068 & BHIN 21-001​​ 

Cov kev taw qhia Medi-Cal uas tau teev tseg hauv BHIN 23-068 tsis hloov pauv qhov kev xav tau ntawm Theem Kev Kho Mob (LOC) rau cov chaw muaj ntawv tso cai uas tau teev tseg yav dhau los hauv Exhibit A ntawm BHIN 21-001. Txhua tus neeg laus uas muaj ntawv tso cai haus cawv lossis lwm yam tshuaj rov qab los yog chaw kho mob yuav tsum tau txais daim ntawv pov thawj DHCS LOC lossis ASAM Level of Care Certification. Cov kev pabcuam xa hauv cov chaw uas tuav DHCS LOC Kev Tsim Kho yuav tsum tau muab thiab sau tseg raws li cov lus qhia rau kev ntsuam xyuas thiab kev npaj saib xyuas tau teev tseg hauv BHIN 21-001. Cov neeg muab kev pab cuam uas xaiv los koom hauv Medi-Cal yuav tsum ua raws li ob qho kev taw qhia rau cov chaw muaj ntawv tso cai hauv BHIN 21-001, thiab Medi-Cal cov lus qhia hauv BHIN 23-068.​​ 

Qhov kev ntsuam xyuas LOC thawj zaug uas tau piav qhia hauv BHIN 21-001 yuav tsum tsis ua raws li tag nrho cov kev cai rau kev ntsuam xyuas ASAM, raws li tau piav qhia hauv BHIN 23-068 (nplooj 4). Txawm li cas los xij, cov ntaub ntawv khaws tseg rau kev ntsuam xyuas LOC kuj tuaj yeem siv los ua ib feem ntawm kev ntsuas ASAM. Ob lub BHIN yuav tsum tsis txhob raug txhais raws li qhov yuav tsum tau muaj kev ntsuam xyuas dua (saib hauv qab).​​ 

Ntu 2​​ 

Qhov no puas txhais tau tias yuav tsum muaj ob qhov kev ntsuas sib txawv? Puas yog cov chaw muab kev pabcuam hauv tsev yuav tsum tau ua kom tiav ASAM hauv 72 teev?​​ 

Reference BHIN 23-068 & BHIN 21-001​​ 

Tsis yog. DHCS tsis tas yuav muaj teeb meem siv tshuaj yeeb (SUD) cov chaw nyob hauv tsev los ua ob qhov kev ntsuas sib txawv. DHCS xav kom cov ntaub ntawv tseem ceeb raug sau thaum nkag mus rau kev kho mob kom ntseeg tau tias cov tswv cuab tau txais cov kev pab cuam hauv qib kev saib xyuas raug (BHIN 21-001). Tom qab ntawd, tus kws kho mob tuaj yeem ntxiv rau cov ntaub ntawv uas tau sau yav dhau los los ntawm kev ua tiav qhov kev ntsuam xyuas ASAM (BHIN 23-068).​​ 

BHIN 23-068 does not apply strict assessment timelines for behavioral health services. DHCS’ policy asserts that the assessment can happen during multiple encounters and should be done in a timeframe that meets the individual needs of each Medi-Cal member. Medi-Cal behavioral health delivery systems shall not enforce standards for timely initial assessments, or subsequent assessments, in a manner that fails to permit adequate time to complete assessments when such time is necessary due to a member’s individual clinical needs (p. 3, BHIN 23-068).​​  

Puas yog xya qhov kev ntsuas raws li tau teev tseg hauv Daim Ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv (BHIN) 23-068 yuav tsum muaj rau Cov Kev Pabcuam Kev Puas Siab Puas Hlwb Tshwj Xeeb (SMHS) kev cuam tshuam lossis kev pabcuam teebmeem teebmeem? Yuav ua li cas txog SMHS lossis Drug Medi-Cal (DMC)/Drug Medi-Cal Organized Delivery System (DMC-ODS) cov kev pab cuam mobile ntsoog?​​ 

Siv BHIN 23-068, BHIN 23-025, & Supplement 3 To Attachment 3.1-A hauv California State Plan​​ 

Txawm hais tias Kev Pabcuam Txog Kev Mob Siab Tshwj Xeeb (SMH) kev cuam tshuam lossis kev pabcuam teebmeem teebmeem lossis SMH, DMC, lossis DMC-ODS kev pabcuam mobile teebmeem yuav suav nrog kev sojntsuam, ua tiav kev sojntsuam raws li tau piav qhia hauv BHIN 23-068 tsis tas yuav tsum tau ua thaum lub sijhawm tus neeg SMH teebmeem kev cuam tshuam lossis teebmeem kev pabcuam DMC SMH, SMH stabil. ntsib. Yog tias tus tswvcuab tau txais lwm yam SMHS, DMC, lossis DMC-ODS ib txhij lossis hnub tom qab, ces cov kev ntsuas yuav tsum tau ua hauv BHIN 23-068 .​​ 

Yog xav paub ntxiv txog Medi-Cal Mobile Crisis Services kev soj ntsuam thiab cov ntaub ntawv xav tau, thov mus rau BHIN 23-025.​​ 

Puas yog cov kev hloov pauv rau ncua sij hawm ntsuam xyuas rau Cov Kev Pabcuam Kev Mob Siab Tshwj Xeeb cuam tshuam rau Kev Ntsuas Me Nyuam thiab Cov Hluas thiab Lub Zog (CANS) thiab Pediatric Symptom Checklist (PSC)-35? Yuav ua li cas txog Kev Ntsuam Xyuas Kev Xav Tau rau Cov Neeg Laus thiab Lub Zog (ANSA) (rau cov neeg laus)?​​ 

Reference BHIN 23-068​​ 

Tsis tau. Cov kev cai CANS thiab PSC-35 tsis tau hloov. DHCS tsis tas yuav ua kom tiav ANSA rau cov neeg laus.​​ 

Yog tias Txoj Kev Npaj Kho Mob Puas Siab Puas Ntsws (MHP) muaj cov qauv ntsuas tam sim no nyob rau hauv lawv cov ntaub ntawv kho mob hluav taws xob uas ntes tag nrho xya (7) Cov Kev Pabcuam Kev Puas Hlwb Tshwj Xeeb (SMHS), MHP puas yuav tsum tau rov ua lawv qhov kev ntsuam xyuas kom nws raug cais los ntawm cov npe tshiab?​​ 

Reference BHIN 23-068​​ 

Txawm hais tias qhov kev txiav txim ntawm xya lub ntsiab lus tsis tau teev tseg, qhov kev ntsuam xyuas yuav tsum ntes tag nrho ntawm xya qhov kev ntsuam xyuas uas yuav tsum tau ua raws li BHIN 23-068.​​ 

Puas yog xya (7) lub luag haujlwm rau Kev Ntsuam Xyuas Tshwj Xeeb Kev Pabcuam Kev Puas Siab Puas Ntsws yuav tsum muaj rau kev ntsuam xyuas kev puas siab puas ntsws?​​ 

Reference BHIN 23-068​​ 

Yog lawm. Xya (7) tus qauv kev ntsuas qhov ntsuas yuav tsum muaj rau kev ntsuam xyuas kev puas siab puas ntsws.​​ 

Cov kws kho mob puas yuav sau cov laj thawj rau kev siv sijhawm ntau dua li niaj zaus los ua kom tiav qhov kev ntsuas?​​ 

Reference BHIN 23-068​​ 

It is good practice to document the member’s circumstances and the provider’s efforts to assess and engage the member, when applicable.​​ 

Cov lus nug thiab cov lus teb no tau hloov mus rau FAQ no los ntawm​​  MHSUDS IN 17-040​​ , uas yog superseded los ntawm​​  PAB 22-019. BHIN 23-068 tau hloov pauv BHIN 22-019.​​ 

Kev Npaj Kho Mob​​ 

Cov Ntaub Ntawv Txog Kev Noj Qab Haus Huv Electronic (EHR) puas tuaj yeem siv rau cov phiaj xwm saib xyuas?​​ 

Reference BHIN 23-068​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tsis tswj hwm li cas cov kws kho mob lossis Medi-Cal Cov Kev Pabcuam Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv tau npaj lawv cov EHRs (lossis cov ntaub ntawv sau) ntev npaum li cov ntaub ntawv uas tau teev tseg hauv BHIN 23-068 tau ua tiav. Ib daim qauv kev npaj khomob yog qhov chaw txais tau rau cov ntaub ntawv ntawm kev npaj saib xyuas, tsuav yog tag nrho cov kev xav tau ntawm lub xeev lossis tseemfwv txoj kev npaj khomob tau ua tiav.​​ 

Thov tshuaj xyuas cov Kev Npaj Kho Mob nyob rau nplooj 11 ntawm BHIN 23-068 thiab Enclosure 1a ntawm nplooj 13 – 14 ntawm BHIN 23-068 kom paub cov lus qhia ntxaws txog yuav ua li cas cov phiaj xwm saib xyuas yuav tsum tau sau tseg rau cov kev pab cuam, kev pabcuam, lossis cov chaw uas yuav tsum muaj kev npaj khomob tseem siv tau raws li lub xeev lossis tsoomfwv txoj cai lij choj.​​ 

Do providers of substance use disorder services funded through the Substance Abuse and Mental Health Services’ (SAMHSA) Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG) need to complete standalone treatment plans?​​ 

Reference BHIN 23-068 & 45 CFR § 96.136​​   

Behavioral Health Information Notice (BHIN) 23-068 describes updated problem list and progress notes requirements and eliminates certain historical requirements for Specialty Mental Health Services client plans and Drug Medi-Cal and Drug Medi-Cal Organized Delivery System treatment plans. DHCS is also in the process of updating the Department’s Alcohol and/or Other Drug Program Certification Standards to align with Medi-Cal documentation guidance.​​ 

Ua raws li cov kev hloov tshiab no, ib leeg Kev npaj khomob tsis tas yuav tsum muaj rau cov kev pabcuam SUBG-nyiaj pab ntxiv lawm. SUBG cov ntawv cog lus ua haujlwm xav tau SUBG-nyiaj pab kev pabcuam los ua raws li tsoomfwv cov cai hauv 45 CFR § 96.136, tab sis tsis tas yuav npaj khomob yuav tsum tau sau tseg rau hauv ib hom ntawv teev tseg, piv txwv li, tus qauv kev npaj khomob ib leeg. Tsuav yog SUBG-nyiaj pab kev pab cuam ua raws li tsoom fwv cov cai hauv 45 CFR § 96.136, lawv tuaj yeem sau tau raws li Medi-Cal cov lus qhia hauv BHIN 23-068 lossis DHCS cov ntaub ntawv tom ntej.​​ 

Cov npe teeb meem​​ 

Cov npe teeb meem puas tuaj yeem siv los ua cov phiaj xwm saib xyuas?​​ 

Reference BHIN 23-068​​ 

Tsis yog. Cov npe teeb meem thiab cov phiaj xwm saib xyuas ua haujlwm sib txawv hauv cov ntaub ntawv kho mob thiab tsis tuaj yeem hloov pauv tau. Rau cov kev pab cuam, cov kev pab cuam, thiab cov chaw uas yuav tsum tau ua raws li txoj cai kev npaj saib xyuas nyob rau hauv lub xeev los yog tsoom fwv txoj cai lij choj (saib Enclosure 1a nyob rau nplooj 13 – 14 ntawm BHIN 23-068), cov npe teeb meem tsis hloov kev npaj kho mob.​​ 

Raws li tau piav qhia nyob rau nplooj 7 - 8 ntawm BHIN 23-068, cov npe teeb meem yuav suav nrog cov tsos mob, yam mob, kev kuaj mob, kev tsav tsheb hauv zej zog, thiab/lossis cov teeb meem raug txheeb xyuas los ntawm kev ntsuam xyuas, kev ntsuam xyuas kev puas siab puas ntsws, kev sib ntsib teeb meem, lossis lwm yam kev pabcuam ntsib, thiab tsim los ntawm tus kws kho mob.​​ 

Cov phiaj xwm saib xyuas, uas tseem hu ua tus neeg siv cov phiaj xwm, cov phiaj xwm kho mob, lossis cov phiaj xwm pabcuam, tau tsim los ntawm kev koom tes nrog tus kws kho mob thiab tus neeg siv khoom los txhais cov hom phiaj kho mob. Kev npaj saib xyuas yog ib qho txuas ntxiv, sib tham sib cuam tshuam ntawm kev xa cov kev pabcuam thiab tsis yog qhov tshwm sim ib zaug.​​ 

Yuav tsum muaj daim ntawv teev npe teeb meem rau txhua tus tswv cuab tau txais Medi-Cal kev pabcuam kev noj qab haus huv raws li tau piav qhia hauv BHIN 23-068. Tsis zoo li daim ntawv teev cov teeb meem, txoj kev npaj kho mob tsuas yog xav tau rau cov kev pab tshwj xeeb, hom chaw, cov peev txheej, thiab/lossis hom kev pab cuam raws li tau sau tseg hauv BHIN 23-068, Enclosure 1a.​​ 

At the discretion of the provider, elements of the care plan may be documented within the problem list, but a problem list cannot substitute for a care plan when it is required.​​ 

Dab tsi yog qhov txawv ntawm daim ntawv teev cov teeb meem thiab daim ntawv them nqi lossis thawj qhov kev kuaj mob?​​ 

Reference BHIN 23-068, BHIN 21-071, BHIN 21-073 & BHIN 23-001
​​ 

Daim ntawv teev cov teeb meem yog cov npe uas yuav suav nrog cov tsos mob, cov xwm txheej, kev kuaj mob, cov neeg tsav tsheb hauv zej zog, thiab/lossis cov xwm txheej muaj feem raug txheeb xyuas los ntawm kev ntsuam xyuas, kev ntsuam xyuas kev puas siab puas ntsws, kev sib ntsib teeb meem, lossis lwm yam kev pab cuam ntsib. Tej zaum nws yuav raug hloov kho thoob plaws hauv chav kho mob los ntawm cov tswv cuab ntawm pab neeg saib xyuas. Kev tuav ib daim ntawv teev tag nrho ntawm kev noj qab haus huv thiab teeb meem nyob rau hauv ib qho chaw hauv cov ntaub ntawv kho mob tuaj yeem pab txhawb kev saib xyuas txuas ntxiv ntawm cov kws kho mob.​​ 

An individual’s primary Diagnostic and Statistical Manual of Mental Disorders (DSM) mental health or substance use disorder (SUD) diagnosis is typically included within the problem list. However, the problem list is a broader list that also includes additional conditions and risk factors. In addition to mental health or SUD diagnoses, the problem list may include other issues that are self-reported by the member or identified by other health care providers.​​   

Cov ntawv thov Medi-Cal yuav tsum suav nrog cov kev kho mob tsim nyog thoob ntiaj teb Kev faib tawm ntawm Kab Mob, Kaum Ib Hlis (ICD-10) cov lis dej num cuam tshuam nrog txhua qhov kev pabcuam ntsib, tsis hais seb cov npe teeb meem puas tau hloov kho kom suav nrog kev kuaj DSM thawj zaug. Raws li Txoj Cai Kev Noj Qab Haus Huv thiab Tsev Kawm Ntawv Tshooj Cai 14184.402(f)(1)(A), kev kuaj mob tus cwj pwm tsis yog qhov yuav tsum tau ua ua ntej rau kev nkag mus rau Cov Kev Pabcuam Tshwj Xeeb Mental Health, Tshuaj Medi-Cal, lossis Tshuaj Kho Mob Medi-Cal Kev Pabcuam Xa Khoom.​​ 

Yog xav paub ntxiv txog cov npe teeb meem, thov saib:​​ 

• BHIN 23-068 (DHCS kev taw qhia)​​ 
• American Health Information Management Association, “Problem List Guidance in the EHR,”​​  

Tus kws kho mob puas tuaj yeem hloov kho cov npe teeb meem kom suav nrog kev kuaj mob uas tsis yog lawv qhov kev coj ua (piv txwv li, tus tswvcuab tshaj tawm txog kev kuaj mob qog noj ntshav rau Tus Kws Lij Choj thiab Tsev Neeg Therapy)?​​ 

Reference BHIN 23-068​​ 

Yes. Providers may add items to problem lists that are outside their scope of practice, including, but not limited to, physical health conditions, if they are reported to the provider by the member or by another qualified professional. For example, a primary care physician may diagnose a chronic physical health condition and share that information with the mental health or substance use disorder (SUD) provider. The mental health or SUD provider may update the problem list to include the physical health diagnosis. The member record may include information on when, by whom, and to whom the issue was reported. The mental health or SUD care team that accesses the problem list throughout the member’s treatment can then be aware of a diagnosis that may impact the member’s life or engagement in mental health or SUD treatment.​​ 

Cov kws kho mob puas tuaj yeem ntxiv cov teeb meem rau cov npe teeb meem uas tsis kuaj tau?​​ 

Reference BHIN 23-068​​ 

Yes. Providers can add problems to the problem list that are not diagnoses. The problem list should reflect the member’s current presentation and unique needs and should include an International Classification of Diseases, Tenth Revision (ICD-10) Clinical Modification (CM) code for each problem identified. BHIN 23-068, pages 7-8, list the requirements for Specialty Mental Health Services, Drug Medi-Cal, and Drug Medi-Cal Organized Delivery System problem lists.​​ 

Does identifying a staff’s credential (e.g., Licensed Clinical Social Worker) meet the requirement for “title” of provider in the problem list?​​ 

Reference BHIN 23-068​​ 

Yog lawm. Sau daim ntawv pov thawj txaus.​​ 

Because it is not feasible for all currently opened members to be transferred to having a problem list, what is DHCS’ expectation for when members who have been opened prior to 7/1/22 get a problem list?​​  

Reference BHIN 23-068​​ 

For members that were receiving Specialty Mental Health Services prior to July 1, 2022, while a problem list is not required to be created retroactively, a problem list should be developed no later than when the member receives a subsequent assessment, or when there is a relevant change to a member condition, whichever comes first. Likewise, for members receiving Drug Medi-Cal or Drug Medi-Cal Organized Delivery System services, a problem list should be created no later than when the member is reassessed because their condition has changed, or when there is a relevant change to a member’s condition, whichever comes first.​​ 

Cov Lus Ceeb Toom​​ 

Tus kws kho mob yuav ua li cas sau ib daim ntawv qhia kev kawm rau ib tug tswv cuab uas tau txais ntau tshaj ib qho kev pab cuam thaum lub sij hawm ntsib ib qho kev pabcuam?​​ 

Reference BHIN 23-068
​​ 

Raws li California Advancing and Innovating Medi-Cal (CalAIM), cov kws kho mob tsis tas yuav tsum tau tsim ntau daim ntawv qhia kev kawm thaum muaj ntau tshaj ib qho kev pabcuam. Cov kws kho mob tuaj yeem xaiv los sau ntau yam kev pab cuam uas tshwm sim thaum ib qho kev pab cuam ntsib nyob rau hauv ib daim ntawv ua tiav rau ib tug tswv cuab. Txawm li cas los xij, daim ntawv qhia kev kawm yuav tsum muaj cov ncauj lus kom ntxaws txaus los txhawb cov kev pabcuam xa tuaj thiab txhua yam yuav tsum tau ua raws li tsab ntawv ceeb toom txog kev noj qab haus huv ntawm tus cwj pwm (BHIN) 23-068 (Page 9). Tshwj xeeb, daim ntawv qhia kev kawm yuav tsum muaj cov ncauj lus kom ntxaws txaus los txhawb cov kev pabcuam code(s) xaiv rau hom kev pabcuam raws li tau hais los ntawm kev pabcuam code piav qhia.​​ 

As described on page 11 of BHIN 23-068, “Medi-Cal behavioral health delivery systems shall not enforce requirements for the location, format, or other specifications for documentation of the care plan and its elements that differ from those described within BHIN 23-068 and referenced in its Enclosures.” 
​​ 

Historically, stakeholders have raised concerns regarding burdensome requirements for progress note documentation. What sources did the Department of Health Care Services (DHCS) review to ensure DHCS’ progress note documentation requirements outlined in Behavioral Health Information Notice (BHIN) 23-068 align with current industry standards?​​  

Siv Cov Ntaub Ntawv Tus Neeg Mob Simplified thiab Coding Toolkit, Ethical Standards for Clinical Documentation Integrity (CDI) Professionals, Medicaid Documentation for Behavioral Health Practitioners, Record Keeping Guidelines, Mental Health Provider Manual, and BHIN 23-068​​ 

DHCS looked to national and local industry leaders such as the American Medical Association’s (AMA) Simplified Outpatient Documentation and Coding Toolkit, American Health Information Management Association’s Ethical Standards for Clinical Documentation Integrity (CDI) Professionals, Centers for Medicare & Medicaid Services (CMS) Medicaid Documentation for Behavioral Health Practitioners and Medicare Documentation for Behavioral Health Practitioners, as well as Carleon’s Behavioral Health Provider Handbook to guide the development of BHIN 23-068. 
​​ 

Yuav ua li cas sau ntawv ua tiav rau pab pawg yog tias ob tus neeg muab kev pabcuam ua haujlwm pab pawg?​​ 

Reference BHIN 23-068​​ 

One progress note is required for each member that participates in the group session, and only one provider needs to sign the progress note. Per footnote 15 on page 10 of BHIN 23-068, “…if a group service is rendered by more than one provider, one progress note shall be completed for each member that participates in a group session and the note shall be signed by at least one provider. The progress note shall clearly document the specific involvement and the specific amount of time of involvement of each provider of the group activity.”​​ 

Cov kos npe digital puas ua tau raws li qhov yuav tsum tau kos npe rau kev ua tiav cov ntawv sau ua tiav?​​ 

Siv BHIN 23-068, hauv DMH Tsab Ntawv No. 08-10, thiab ADP Bulletin No. 08-13​​ 

Yog lawm. Kev ntsuam xyuas yuav tsum suav nrog lub npe ntaus lossis luam tawm raws cai thiab yuav tsum muaj kos npe ntawm tus neeg muab kev pabcuam raws li tau teev tseg hauv BHIN 23-068. DHCS tsis tsim cov kev cai tshwj xeeb rau cov chaw muab kev pabcuam teeb tsa lawv Cov Ntaub Ntawv Kho Mob Hauv Hluav Taws Xob. Tsuav yog cov ntaub ntawv xav tau uas tau teev tseg hauv BHIN 23-068 yog raug sawv cev rau hauv cov ntaub ntawv tswv cuab, suav nrog tus kws kho mob kos npe, digital lossis lub cev, cov ntaub ntawv raug suav tias yog ua raws.​​ 

Xav paub ntau ntxiv txog kev siv cov kos npe hauv hluav taws xob thiab cov kev cai muaj feem xyuam muaj nyob hauv DMH Tsab Ntawv No. 08-10 thiab ADP Bulletin No. 08-13.​​ 

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) puas yuav hloov kho lub sijhawm sau ntawv ua tiav tau teev tseg hauv Daim Ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv (BHIN) 23-068? Lub sijhawm no siv li cas thaum sau ntawv ua tiav los ntawm cov chaw muab kev pabcuam hauv kev saib xyuas?​​ 

Reference BHIN 23-068​​ 

Tsis yog. DHCS tsis npaj yuav hloov kho lub sijhawm sau ntawv ua tiav uas tshwm sim hauv BHIN 23-068. Cov kws kho mob yuav tsum ua kom tiav cov ntaub ntawv kev kawm tsis pub dhau peb (3) hnub ua haujlwm ntawm kev muab kev pabcuam, tshwj tsis yog cov ntawv sau rau cov kev pabcuam teebmeem, uas yuav tsum ua kom tiav hauv ib (1) hnub. Hnub ntawm kev pabcuam yuav tsum suav tias yog hnub xoom (0). Kev ua tiav raws sij hawm ntawm cov ntawv qhia kev kawm txhawb nqa kev kho mob zoo.​​ 

Qee qhov chaw zov me nyuam ua haujlwm nyob rau hauv kev saib xyuas ncaj qha ntawm tus kws tshaj lij. Nyob rau hauv cov xwm txheej no, tus kws kho mob yuav tsum ua kom tiav cov ntaub ntawv ua tiav raws li lub sijhawm teev tseg hauv BHIN 23-068. Ib qho yuav tsum tau tshuaj xyuas cov ntawv sau ua tiav los ntawm tus kws saib xyuas yuav tsum ua kom tiav raws li kev coj ua zoo tshaj plaws hauv kev kho mob, tab sis yuav tsum tsis txhob tshwm sim nyob rau hauv lub sijhawm sau ntawv nce qib tau teev tseg hauv BHIN 23-068.​​ 

Yuav ua li cas daim ntawv ceeb toom kev kawm nyob rau hauv Behavioral Health Information Notice (BHIN) 23-068 siv rau cov kev pab cuam xws li ib tus nqi diem rau kev kho mob hauv tsev?​​ 

BHIN 23-068 & SMHS, DMC, thiab DMC-ODS phau ntawv sau nqi​​ 

DHCS xav kom cov chaw muab kev pab ua kom tiav yam tsawg kawg ib daim ntawv qhia kev nce qib txhua hnub rau cov kev pab cuam uas raug nqi txhua hnub (piv txwv li bundled services). Daim ntawv ceeb toom kev kawm yuav tsum txhawb nqa cov kev pabcuam uas tau muab thiab suav nrog txhua qhov kev xav tau ntawm kev ua tiav tau teev tseg hauv BHIN 23-068. Piv txwv li, Therapeutic Foster Care (TFC) tau thov raws li 24-teev nce ntxiv, thiab yuav tsum muaj daim ntawv qhia ua tiav rau txhua qhov kev pabcuam xa. Cov ntawv ceeb toom kev nce qib txhua lub lim tiam lossis ib ntus tsis tuaj yeem siv los ntawm kev hloov pauv ntawm tus kheej cov ntaub ntawv kev nce qib rau txhua chav haujlwm.​​ 

There are some (relatively rare) scenarios where a bundled service may be delivered concurrently with a second service that is not included in the bundled rate and may be claimed separately. In these cases, there must also be a progress note to support the second, unbundled service. For example, Medi-Cal Peer Support Specialist services may be claimed on the same day as, and separately from, residential or day services. In this scenario, DHCS would require one progress note for the bundled residential or day service and a separate progress note to support the additional, unbundled claim for Medi-Cal Peer Support Specialist services.​​ 

Cov kev cai no siv tau txawm hais tias cov kev pab cuam uas tau ntim thiab tsis tau muab los ntawm tib tus neeg muab kev pabcuam lossis los ntawm cov chaw muab kev pabcuam sib txawv.​​ 

Cov kws kho mob yuav tsum sau cov kev pabcuam pab pawg li cas yog tias nws muab los ua ib feem ntawm cov kev pabcuam pob khoom? Piv txwv li, cov tswv cuab tau txais kev kho mob hauv tsev tuaj yeem koom nrog kev pabcuam pab pawg nrog rau lwm yam kev pabcuam lossis kev ua ub no thaum lub sijhawm kawm ib hnub.​​ 

Siv BHIN 23-068 & Supplement 3 To Attachment 3.1-A hauv California State Plan​​ 

Qee Cov Kev Kho Mob Tshwj Xeeb (SMH), Tshuaj Kho Mob Medi-Cal (DMC), thiab Tshuaj Kho Mob Medi-Cal—Organized Delivery System (DMC-ODS) cov kev pab cuam suav nrog pab pawg kho mob raws li ib feem ntawm cov kev pabcuam uas tau them nqi txhua hnub lossis raws li cov kev pabcuam bundled. DHCS tsis tas yuav muaj cov ntawv sau qhia ua tiav rau txhua qhov kev pabcuam uas suav nrog hauv ib pob. Txawm li cas los xij, daim ntawv ceeb toom rau cov kev pab cuam uas tau thov yuav tsum raug suav hais tias yog cov kev pabcuam lossis cov haujlwm uas tau muab xa tuaj. Thaum pab pawg kho mob tau muab los ua ib qho kev pabcuam ntawm cov kev pabcuam bundled, daim ntawv qhia kev nce qib rau cov kev pabcuam bundled yuav tsum txhawb nqa cov kev pabcuam uas tau muab rau hauv cov kev pabcuam bundled, suav nrog pab pawg.​​  

Cov neeg koom nrog pab pawg puas tuaj yeem hloov daim ntawv sau tseg rau ib pawg neeg hauv cov ntaub ntawv cov tswv cuab?​​ 

Reference BHIN 23-068​​ 

No. While a list of participants is required to be documented and maintained by the provider when a group service is rendered, a group participant list cannot substitute for an individual group progress note. The participant list does not contain the individualized information needed to support continuity of care or demonstrate program integrity.  Every participant shall have a progress note in their clinical record that documents the service encounter and their attendance in the group, and includes the information listed on pages 9-10 of BHIN 23-068. The progress note for the group service encounter shall also include a brief description of the member’s response to the service.​​ 

Puas yog daim ntawv ceeb toom ua tiav tau teev tseg hauv Daim Ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv Kev Noj Qab Haus Huv (BHIN) 23-068 Dab tsi yog qhov tsawg kawg nkaus los ntawm DHCS?​​ 

Reference BHIN 23-068​​ 

Yog lawm. Daim ntawv ceeb toom kev nce qib tau teev tseg hauv BHIN 23-068 yog qhov yuav tsum muaj yam tsawg kawg nkaus.​​ 

Cov ntawv sau ua tiav puas yuav tsum suav nrog Phau Ntawv Qhia Txog Kev Tshawb Fawb thiab Kev Tshawb Fawb Txog Kev Puas Siab Puas Ntsws (DSM-5) ntxiv rau International Classification of Diseases, Tenth Revision (ICD-10) code?​​ 

Reference BHIN 23-068​​ 

Tsis yog. Txawm hais tias cov ntawv sau ua tiav tsis tas yuav suav nrog DSM-5 tus piav qhia, nws yuav yog qhov kev coj ua zoo tshaj plaws los suav nrog tus piav qhia ntxiv. Rau kev thov Medi-Cal uas siv tau, cov lej tshuaj ntsuam xyuas ICD-CM tsim nyog, nrog rau HCPCS/CPT cov lej, yuav tsum tshwm sim hauv daim ntawv thov thiab yuav tsum tau qhia meej meej nrog txhua qhov kev sib ntsib thiab ua raws li cov lus piav qhia hauv daim ntawv qhia ua tiav. Txawm li cas los xij, tam sim no ICD-CM cov lej thiab HCPCS / CPT cov lej tsis tas yuav tsum tau suav nrog hauv cov lus piav qhia ua tiav. Yog xav paub ntxiv txog kev siv cov lej ICD-10 thaum lub sijhawm ntsuas kev ntsuas, xa mus rau BHIN 22-013: Txoj Cai Xaiv Ua Ntej Kev Ntsuas.​​ 

Puas yog cov tswv cuab kos npe kos npe rau cov ntawv sau ua haujlwm pab pawg?​​ 

Reference BHIN 23-068​​ 

Tsis yog. Cov tswv cuab kos npe tsis tas yuav tsum muaj rau daim ntawv ceeb toom kev ua haujlwm ntawm pab pawg.​​ 

Kev Pabcuam, Kev Pabcuam, & Cov Kev Xav Tau​​ 

Qee tus kws kho mob tus cwj pwm coj tus cwj pwm Medi-Cal tau cog lus nrog Managed Care Plans (MCPs) uas muab Kev Tswj Xyuas Kev Kho Kom Zoo (ECM). Cov kws kho mob puas yuav tsum tau ua raws li ob qhov sib txawv ntawm cov ntaub ntawv xav tau rau Medi-Cal kev pabcuam kev noj qab haus huv thiab ECM?​​ 

Siv CalAIM Enhanced Care Management Policy Guide thiab BHIN 23-068​​ 

Yog tias ua tau, DHCS tau ua haujlwm los ua kom haum ECM thiab cov ntaub ntawv qhia txog kev noj qab haus huv ntawm tus cwj pwm thiab tau muab kev taw qhia rau MCPs ntawm cov ncauj lus no. Saib, tshwj xeeb tshaj yog, nplooj 28 – 29 ntawm CalAIM Txoj Cai Tswjfwm Txhim Kho Kev Saib Xyuas Kev Noj Qab Haus Huv:​​ 

• On assessment requirements: Page 28 of the Policy Guide notes that MCPs “…must avoid imposing assessment requirements that are duplicative of the SMHS/DMC/DMC-ODS screening [assessment] domain requirements.” The Policy Guide further notes that county agencies and/or contracted providers can make use of already documented assessment requirements to avoid duplication of efforts, and thus only document in any required section that is missing. MCPs may need to update their documentation policies to allow for the use of existing assessment documentation.​​ 
• On care planning requirements: Pages 28 and 29 of the Policy Guide state that MCPs “…must not impose care planning documentation requirements that duplicate existing SMHS/DMC/DMC-ODS Provider processes, but instead work with the county behavioral health agency and/or their subcontracted SMHS/DMC/DMC-ODS Providers to meet both ECM and SMHS/DMC/DMC-ODS care planning requirements in a way that leverages existing documentation processes” MCPs are directed to work with county agencies and/or contracted providers to “leverage existing documentation processes” as a means for both ECM and SMHS/DMC/DMC-ODS providers to meet documentation requirements with undue burden.​​ 

DHCS directs Medi-Cal behavioral health delivery systems and MCPs to work together to avoid duplicative documentation requirements while still achieving the goals of Medi-Cal behavioral health and ECM policies. For further instruction on streamlining and standardizing documentation requirements for ECM, please refer to the CalAIM Enhanced Care Management Policy Guide.
DHCS will consider updates to the CalAIM Enhanced Care Management Policy Guide to more explicitly align with the revised Medi-Cal behavioral health documentation requirements in BHIN 23-068, and will communicate any updates to ECM policy to stakeholders. 
​​ 

Koj puas tuaj yeem qhia meej tias qhov yuav tsum tau teev tseg hauv Enclosure 1a ntawm BHIN 23-068 txhais li cas? Piv txwv li, cov chaw kho mob hauv Cov Neeg Laus puas tau ntawv tso cai los ntawm CDSS thiab tau lees paub los ntawm DHCS yuav tsum tau tsim cov phiaj xwm kho mob ntxiv? Yuav ua li cas txog SUD cov chaw muab kev pabcuam hauv tsev uas tuav Qib Kev Pabcuam?​​  

Reference BHIN 23-068​​ 

Txawm li cas los xij, Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv (DHCS) tau tshem tawm cov ncauj lus kom ntxaws txog kev kho mob rau kev puas hlwb thiab kev siv tshuaj yeeb dawb. Qee qhov xwm txheej, vim yog lub xeev lossis tsoomfwv cov cai, DHCS tsis tuaj yeem tshem tawm cov kev cai no tag nrho. Enclosure 1a ntawm BHIN 23-068 sau tseg cov kev npaj saib xyuas uas tseem siv tau rau cov kev pab cuam, cov kev pabcuam, thiab cov chaw nyob uas DHCS tsis tuaj yeem tshem tawm lub xeev lossis tsoomfwv cov cai. Qhov no suav nrog ntau yam kev pab cuam lossis chaw kho mob uas yuav tsum tau ua raws li cov kev pab cuam / cov cai tshwj xeeb hauv chaw lossis cov cai ntxiv rau Medi-Cal cov cai. Daim ntawv tso cai thiab ntawv pov thawj Social Rehabilitation Programs, thiab cov chaw muab kev kho mob hauv SUD, yog nyob rau hauv cov kev pab cuam/cov chaw uas yuav tsum tau saib xyuas cov kev cai npaj kho mob uas tshwm sim rau lwm qhov hauv lub xeev txoj cai lossis txoj cai.​​  

Txhawm rau txiav txim siab seb yuav xav tau txoj kev npaj kho mob rau ib qho kev pabcuam kev noj qab haus huv tshwj xeeb, ua raws li cov kauj ruam no:​​ 

Does the program, service, or facility type have state or federal care planning requirements that remain in effect (see Enclosure 1a for a non-exhaustive list)?
If yes, continue to step 2.
If no, there are no care planning requirements to follow. DHCS will not monitor or enforce the use of a formal care plan, or documentation of specific care planning activities.
Review the relevant state and/or federal guidance to identify specific requirements, e.g. care planning activities, included in Enclosure 1a of BHIN 23-068. Some of these care planning requirements are more detailed/specific than others.
Providers shall document the required care plan/care planning activities within the member record. DHCS allows providers to choose where within the member record to document care planning information required by state or federal law (e.g., within a care plan template, in progress notes, or in a combination of locations or formats).
Providers must be able to produce and communicate the content of the care plan to other providers, the member, and Medi-Cal behavioral health delivery systems as needed to facilitate coordinated, high-quality care for Medi-Cal members.​​ 

Puas yog cov tswvcuab tau txais Kev Pabcuam Kev Noj Qab Haus Huv Medi-Cal (DMC) thiab Tshuaj Khomob Medi-Cal Organized Delivery System (DMC-ODS) yuav tsum muaj kev kuaj mob thiab kev soj ntsuam ua tiav li ntawm 30 hnub ntawm kev nkag mus kho?​​ 

Reference BHIN 23-068​​ 

No. BHIN 23-068 superseded 22 CCR § 51341.1, subd. (h)(1)(A)(v)(a-b) (see Enclosure 2). This removes the requirement for DMC and DMC-ODS members to receive a diagnosis and evaluation within 30 calendar days of admission to treatment. While the 30 calendar day timeframe for documenting a diagnosis has been superseded, members should still receive a comprehensive assessment and documented diagnosis in a timely manner that is aligned with current standards of practice, consistent with the assessment guidance in BHIN 23-068.​​  

Koj puas tuaj yeem piav qhia qhov yuav tsum tau ua rau Kev Pabcuam Kev Puas Siab Puas Hlwb Tshwj Xeeb (SMHS) Targeted Case Management (TCM)? Puas yog txoj cai txawv ntawm txoj cai uas nyob hauv BHIN 22-019 (tam sim no hloov pauv)?​​ 

Kev siv BHIN 23-068 thiab 42 CFR § 440.169(d)(2)​​ 

Behavioral Health Information Notice (BHIN) 23-068 updated the Department of Health Care Services’ (DHCS) previous policy for documenting TCM care plans to allow additional flexibility in the way care plans may be documented. DHCS no longer requires TCM care plans to be documented within a member’s progress notes. However, DHCS’ Medi-Cal guidance does not supersede federal requirements for TCM care planning. SMHS TCM care plans shall be documented as outlined on page 11 of BHIN 23-068, and must meet the federal requirements outlined in 42 CFR § 440.169(d)(2).​​ 

Thov nco ntsoov tias tsoomfwv cov cai tswjfwm ntawm 42 CFR § 440.169(d)(4) thiab 42 CFR § 441.18(a)(7) kuj tham txog cov kws kho mob cov cai ntsig txog kev npaj saib xyuas rau cov tswvcuab uas tau txais TCM. Cov kev cai no tsis tau teev tseg raws li txoj kev npaj saib xyuas hauv BHIN 23-068 Enclosure 1A tab sis tseem siv tau. (Raws li tau sau tseg hauv BHIN, cov rooj hauv BHIN Enclosures tsis yog tag nrho cov npe ntawm lub xeev thiab tsoomfwv txoj cai tswjfwm rau txhua qhov haujlwm, kev pabcuam, lossis hom chaw.)​​ 

Raws li tau sau tseg hauv cov lus hauv qab taw qhia 22 ntawm nplooj ntawv 14 ntawm BHIN 23-068, DHCS tau sab laj nrog Lub Chaw Pabcuam Medicare thiab Medicaid (CMS) ntawm tsab cai hloov tshiab no. CMS tau pom zoo DHCS thov kom zam dhau 42 CFR § 440.169(d)(2) thiab tau lees paub tias cov phiaj xwm saib xyuas yuav raug sau ua ntau hom, ntev npaum li qhov xav tau ntawm TCM txoj kev npaj kho mob uas tau teev tseg hauv 42 CFR § 440.169(d)(2) tau muab tso rau hauv cov ntaub ntawv kho mob. (Daim ntawv thov: Tshooj 1915(b) Kev Tso Cai Rau Kev Ua Haujlwm Hauv Xeev California thiab Kev Tsim Kho Medi-Cal (CalAIM), Kev Hloov Kho Xa Lub Kaum Ib Hlis 4, 2022, Hloov Kho Lub Rau Hli 23, 2023, (pg. 18) thiab Kev Pom Zoo: CalAIM 1915(b) Daim Ntawv Pom Zoo Hloov Kho STCs).​​ 

Dab tsi yog qhov txawv ntawm Targeted Case Management (TCM) thiab Intensive Care Coordination (ICC)? Puas yog xav tau kev npaj saib xyuas rau ICC?​​ 

Cov ntaub ntawv: BHIN 23-068, 42 CFR § 440.169(d)(2), 42 CFR § 441.18(a)(7), & Medi-Cal ICC, IHBS, & TFC Phau Ntawv Qhia​​ 

ICC yog ib qho kev pabcuam TCM, muab rau cov hnub nyoog qis dua 21 xyoos raws li tau piav qhia nyob rau nplooj 26 ntawm Medi-Cal ICC, IHBS, & TFC Phau Ntawv Qhia. Cov kev pabcuam ICC yuav tsum ua tau raws li tsoomfwv TCM kev npaj khomob hauv 42 CFR § 440.169(d)(2) raws li tau piav qhia hauv Enclosure 1a ntawm BHIN 23-068.​​ 

Thov nco ntsoov tias tsoomfwv cov cai tswjfwm ntawm 42 CFR § 440.169(d)(4) thiab 42 CFR § 441.18(a)(7) kuj tham txog cov kws kho mob cov cai ntsig txog kev npaj saib xyuas rau cov tswvcuab uas tau txais TCM, lossis ICC. Cov kev cai no tsis tau teev tseg raws li txoj kev npaj saib xyuas hauv BHIN 23-068 Enclosure 1A tab sis tseem siv tau. (Raws li tau sau tseg hauv BHIN, cov rooj hauv BHIN Enclosures tsis yog tag nrho cov npe ntawm lub xeev thiab tsoomfwv txoj cai tswjfwm rau txhua qhov haujlwm, kev pabcuam, lossis hom chaw.)​​ 

Puas yog cov ntsiab lus txhua lub limtiam tseem xav tau rau kev siv tshuaj yeeb dawb (SUD) qib kev saib xyuas nyob hauv tsev?​​ 

Siv BHIN 23-068, BHIN 21-001 Exhibit A, & DHCS AOD Certification Standards (Lub Kaum Hli 2023)​​ 

The Department of Health Care Services (DHCS) Certification for Alcohol and Other Drug (AOD) Programs Certification Standards (October 2023) require that residential programs document each member’s progress on a weekly basis.​​ 

BHIN 23-068 (pages 8-10) describe requirements for Medi-Cal behavioral health progress notes. Providers must complete at minimum a daily progress note for services that are billed on a daily basis (e.g., Drug Medi-Cal/Drug Medi-Cal Organized Delivery System Residential treatment) (BHIN 23-068(d)(6) (page 10)). A daily progress note fulfills the AOD Certification Standard requirement to document each member’s progress on a weekly basis, and an additional, weekly progress note is not required.​​ 

Puas yog Drug Medi-Cal Organized Delivery System (DMC-ODS) kev saib xyuas zoo ib yam li Targeted Case Management (TCM)?​​ 

Siv BHIN 23-001, BHIN 23-068, Supplement 1 to Attachment 3.1-A in the California State Plan, & 42 CFR § 440.169(d)(2)​​ 

No. The DMC-ODS Care Coordination service (formerly known as “case management”) is not the same as Targeted Case Management (TCM) and does not require a care plan. TCM is a distinct Specialty Mental Health service. Federal requirements for TCM (including, but not limited to, 42 CFR § 440.169(d)(2)) do not apply to DMC-ODS care coordination, regardless of what billing code is used for the DMC-ODS service.​​ 

Cov Kev Pabcuam Targeted Case Management (TCM) puas tuaj yeem muab tau ua ntej kev soj ntsuam thiab ua tiav ntawm TCM Care Plan?​​ 

Reference BHIN 23-068​​ 

Cov kev kho mob tsim nyog thiab raug them, suav nrog TCM, tuaj yeem muab tau ua ntej TCM Care Plan tau tsim.​​ 

Lwm yam​​ 

How are “business days” defined under Section (d)(5) on page 10 of BHIN 23-068? (December 3, 2024)​​ 

Reference BHIN 23-068
​​ 

Business days are defined as Monday through Friday, excluding holidays observed by the State of California. Any interpretation of the reference to “business days” within BHIN 23-068 shall comply with this definition.
​​ 

Kuv puas tseem yuav tau ua raws li cov ntaub ntawv uas yuav tsum tau ua rau kev kho mob tshwj xeeb Cov Txheej Txheem Txheej Txheem Txheej Txheem (HCPCS) / Cov Txheej Txheem Txheej Txheem Tam Sim No ® (CPT) cov lej, xws li Kev Ntsuas thiab Kev Tswj Xyuas (E/M) CPT cov lej?​​ 

Reference BHIN 23-068​​ 

Yog lawm. Daim Ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv Tus Cwj Pwm 23-068 tsis hloov HCPCS lossis CPT cov qauv ntaub ntawv. HCPCS cov qauv ntaub ntawv yog tsim los ntawm Lub Chaw rau Medicare thiab Medicaid Services, thiab CPT cov qauv ntaub ntawv yog tsim los ntawm American Medical Association. Cov ntaub ntawv yuav tsum ua raws li cov qauv no, thiab BHIN 23-068.​​ 

Yog xav paub ntxiv txog CPT thiab HCPCS coding thiab cov ntaub ntawv, thov saib:​​ 

• American Medical Association CPT thiab HCPCS Resources​​ 
• Chaw rau Medicare thiab Medicaid Services HCPCS Cov Kev Pabcuam​​ 

Puas yog qhov kev lees paub rau kev pabcuam txuas ntxiv tseem yog qhov yuav tsum tau muaj rau cov kev pabcuam tshuaj siv tshuaj yeeb dawb (SUD) tseem siv tau?​​ 

Reference BHIN 23-068 thiab CCR 22 § 51341.1(h)(5)(A)(i-iii)​​ 

No. BHIN 23-068 (Enclosure 2) has superseded the requirements to provide a justification for continuing SUD services, set forth in CCR 22 § 51341.1 (h)(5)(A)(i-iii). Previously, this was to occur no later than six months after the member’s treatment start date. Per BHIN 23-068, re-assessments for SUD services should now be conducted based on a member’s needs and clinical discretion.​​ 

Puas yog yuav tsum tau kuaj lub cev rau cov neeg mob sab nraud thiab cov kev siv tshuaj tsis zoo nyob hauv tsev (SUD)?​​ 

Reference BHIN 23-068 thiab 22 CCR § 51341.1, subd. (h)(1)(A)(iv)(ac)​​ 

Yes, physical examinations are required for members receiving Drug Medi-Cal and Drug Medi-Cal Organized Delivery System (DMC-ODS) services per 22 CCR § 51341.1, subd. (h)(1)(A)(iv)(a-c). BHIN 23-068 notes that 22 CCR § 51341.1, subd. (h)(1)(A)(iv)(c)‘s requirement related to updated treatment plans are superseded by the BHIN.​​ 

Puas yog cov tswvcuab kos npe rau hauv nplooj ntawv xav tau rau kev pabcuam pab pawg? Yuav ua li cas txog cov tswv cuab kos npe?​​ 

Reference BHIN 23-068 & 22 CCR § 51341.1 subd. (g)(2)(AE)​​ 

Daim Ntawv Ceeb Toom Txog Kev Coj Tus Cwj Pwm (BHIN) 23-068 hloov pauv 22 CCR § 51341.1 sub. (g)(2)(AE) (Enclosure 2), tshem tawm cov kev cai rau cov tswv cuab cov nplooj ntawv kos npe thiab kos npe rau Drug Medi-Cal (DMC)/Drug Medi-Cal Delivery System (DMC-ODS) thaum muab kev pabcuam pab pawg. Cov kws kho mob yuav tsum tuav cov npe koom rau tag nrho DMC/DMC-ODS thiab Cov Kev Pabcuam Tshwj Xeeb Mental Health pab pawg, raws li tau sau tseg nyob rau nplooj 9-10 ntawm BHIN 23-068, tab sis tsis tas yuav kos npe ua ib feem ntawm cov npe koom.​​ 

Vim li cas Cov Kev Kho Mob Ntxov (NTPs) raug zam los ntawm cov lus qhia hauv Daim Ntawv Ceeb Toom Txog Kev Noj Qab Haus Huv (BHIN) 23-068?​​ 

Reference BHIN 23-068, CCR Tit. 9 §§ 9995 – 10425[HT1]  & 42 CFR § 8​​ 

NTPs yog nyob rau hauv lub xeev tshwj xeeb thiab tseemfwv txoj cai raws li 42 CFR § 8, uas suav nrog cov qauv kev saib xyuas thiab cov ntaub ntawv. NTPs hauv California yuav tsum ua raws li Cal. Code Regs. Tit. 9 §§ 9995 – 10425[HT2]  thiab yuav tsum tau ua kom tau raws li cov qauv kev npaj kho mob uas tau teev tseg hauv Cal. Code Regs. Tit. 9 ZPO § 10305. Txhawm rau zam qhov nyuaj lossis tsis sib haum nrog cov qauv uas twb muaj lawm, lub sijhawm no, DHCS tau xaiv kom zam NTPs los ntawm cov qauv ntaub ntawv hauv BHIN 23-068.​​ 

Have the requirements for medication consents changed? This section was removed from the Specialty Mental Health Services Triennial Protocol and the Mental Health Plan Contract and Behavioral Health Information Notice 23-068 doesn’t touch on medication consent requirements.​​  

Reference WIC § 5325.3​​ 

California Senate Bill (SB) 184 yog tshooj ntawm 6/30/22. Tsab cai lij choj hais txog kev noj qab haus huv no tau hloov kho thiab hloov pauv lub xeev cov cai (Cal. Code Regs. Tit. 9, § 852) uas yuav tsum muaj cov chaw kho mob puas hlwb kom tau txais cov neeg mob kos npe los ua pov thawj pom zoo rau cov tshuaj tiv thaiv kev puas siab puas ntsws xa hauv cov chaw kho mob hlwb hauv zej zog. SB 184 tshem tawm qhov yuav tsum tau txais cov neeg mob kos npe, thiab hloov chaw yuav tsum muaj cov chaw khaws ntaub ntawv pom zoo uas muaj ob qho hauv qab no:​​ 

• Ib daim ntawv sau tseg tias cov ntaub ntawv hais txog kev pom zoo rau cov tshuaj tiv thaiv kev puas siab puas ntsws tau tham nrog tus neeg mob; thiab​​ 
• Ib daim ntawv qhia tias tus neeg mob nkag siab qhov xwm txheej thiab cov txiaj ntsig ntawm cov tshuaj tiv thaiv kev puas siab puas ntsws, thiab pom zoo rau kev tswj hwm cov tshuaj no.​​ 

Thov xa mus rau WIC § 5325.3 kom tiav cov lus hais.​​ 

If Mental Health Plan (MHP) providers can now deliver co-occurring treatment and focus on a member’s substance use disorder (SUD) needs as clinically appropriate, does that mean the member’s clinical record with the MHP will now be governed by 42 CFR Part 2?​​ 

Reference BHIN 23-068​​ 

Kev ceev ntiag tug ntawm SUD cov ntaub ntawv tus neeg mob raws li qhov yuav tsum tau ua los ntawm 42 CFR Tshooj 2 yuav siv tau rau txhua cov ntaub ntawv uas txheeb xyuas tus neeg mob tias muaj lossis muaj SUD thiab muaj cov ntaub ntawv hais txog SUD tau txais los ntawm tsoomfwv cov kev pabcuam SUD. Yog tias SUD cov ntaub ntawv tau txais los ntawm MHP lossis Tus Kws Pabcuam Kev Kho Mob Tshwj Xeeb, cov kev txwv no yuav tsis siv.​​ 

Puas yog cov kev cai Medicare tau raug txiav txim siab vim cov nroog yuav tsum tau them nqi rau Medicare ua ntej? Puas yog cov tswv cuab uas muaj Medicare thiab Medi-Cal xav tau kev pab kho mob?​​ 

Reference BHIN 23-068​​ 

Cov ntaub ntawv yuav tsum tau teev tseg hauv BHIN 23-068 tsis hloov lossis hloov pauv ib qho tseem ceeb ntawm tsoomfwv, suav nrog Medicare cov cai.​​ 

To reduce documentation time, is it acceptable to use checkboxes except where “narrative” is required?​​ 

Reference BHIN 23-068​​ 

Checkboxes tau tso cai ntev npaum li cov lus piav qhia yog tus kheej, muab cov ncauj lus kom ntxaws txaus los txhawb cov kev pabcuam uas tau xaiv, thiab tag nrho lwm cov kev xav tau ntawm kev ua tiav tau teev tseg hauv BHIN 23-068 tau ua tiav.​​ 

Puas tseem muaj Cov Tshuaj Kho Mob Medi-Cal Organized Delivery System xav tau los sau cov kev kuaj mob raws li cov ntsiab lus piav qhia raws li Kev Tshawb Fawb thiab Txheeb Xyuas Phau Ntawv Qhia Txog Kev Puas Siab Puas Ntsws?​​ 

Reference BHIN 23-068​​ 

No. BHIN 23-068 tsis tau khaws qhov yuav tsum tau sau cov ntsiab lus piav qhia hauv American Society of Addiction Medicine (ASAM) kev ntsuam xyuas. Thov saib nqe lus (c) pib ntawm nplooj ntawv 7 ntawm BHIN 23-068 rau cov cai ntawm cov ntaub ntawv ntawm kev kuaj mob / vim li cas rau kev pabcuam ntsib hauv cov npe teeb meem.​​  

How may providers document the member’s involvement in the treatment process?​​ 

Reference BHIN 23-068​​ 

DHCS encourages strength-based, person-centered treatment. Under the documentation requirements outlined in BHIN 23-068, the member’s perspective and involvement in treatment may be noted in the member record, e.g., the progress notes.​​