CalAIM Behavioral Health Initiative Cov lus nug nquag nug
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.
Kev thov
Cov kev tswj hwm hnub puas tuaj yeem thov rau qhov xwm txheej lossis cov chaw uas tsis yog thaum cuam tshuam nrog cov tswvcuab txav los ntawm lub tsev kho mob puas siab puas ntsws mus rau qhov chaw kho mob uas tsis yog mob hnyav?
Tsis muaj. Tsuas yog lub tsev kho mob tuaj yeem thov rau cov kev pabcuam hnub ua haujlwm. Lub tsev kho mob tuaj yeem thov rau hnub tswj hwm thaum tus tswvcuab tsis ua raws li qhov xav tau kev kho mob rau cov kev pabcuam hauv tsev kho mob puas siab puas ntsws tab sis tseem tsis tau txais kev tso npe rau ntawm qhov chaw kho mob uas tsis muaj mob hnyav uas ua tau raws li qhov xav tau ntawm tus tswv cuab.
Yog tias tus neeg thov kev pab thov nrog lwm lub nroog Medi-Cal tab sis tsis ua raws li kev hloov lawv Medi-Cal hauv 30 hnub, lawv cov kev pabcuam puas yuav raug them rau lub hli dhau los?
In accordance with ACWDL 18-02E, BHIN 21-032 and BHIN 21-072, there would be no interruption in benefits for the Medi-Cal beneficiary in the months prior to, during, or after an intercounty transfer (ICT) is initiated. There are also no restrictions in the Short Doyle/Medi-Cal (SD/MC) claiming system that will prevent claims from being approved while an ICT is in process. For substance use disorder claims, SD/MC is programed to accept claims submitted by either the county of responsibility or the county of residence. For specialty mental health services claims, SD/MC does not check the submitting county against the member’s county of residence or county of responsibility when the claim is for specialty mental health claims. SD/MC does verify that the submitting county matches either the member’s county of residence or county of responsibility for DMC and DMC-ODS claims. SD/MC does not apply any edits that require the beneficiary’s county of responsibility to change within any amount of time after the county of residence is updated.
Cov neeg ua haujlwm kho mob hlwb uas raug xaiv los uas tsis tsim nyog tau daim ntawv tso cai lossis tsis tau txais kev zam puas tuaj yeem them tus nqi "kev ntsuam xyuas" tib yam li LPHA?
No. Services provided by individuals who are not licensed-eligible, waivered or a clinical trainee are not reimbursed at the same rate as an LPHA. Prior to payment reform, the rate reimbursed for an assessment was the same regardless of the individual who performs the assessment. As of July 1, 2023, when the Department implemented Payment Reform, reimbursement for an assessment performed by an LPHA is at a different rate than an assessment performed by a non-licensed individual who is not licensed-eligible, waivered, or a clinical trainee. The reimbursement rates to counties by procedure code, and provider type can be found on the Fee Schedule page on the DHCS website.
Txhua daim ntawv thov rau SMHS xa los ntawm MHP los ntawm Short-Doyle system yuav tsum suav nrog ICD-10-CM kuaj mob / laj thawj rau kev sib ntsib. Puas tuaj yeem xa daim ntawv thov uas tsuas yog siv cov khoom siv tshuaj tiv thaiv kab mob?
Siv BHIN 21-071; BHIN 21-075; BHIN 23-068;
No, a claim for a SMHS service cannot be submitted with only a substance use disorder diagnosis code. The reason for the encounter (ICD-10-CM code) must correspond to the medically necessary service provided to the beneficiary. If the service is a SMHS, then the reason for the encounter must include an ICD-10-CM code that corresponds to their mental health diagnosis or an ICD-10-CM code that indicates the reason for the service encounter that is related to the mental health condition (see BHIN 22-013). Please see question #1 above regarding the use of ICD-10-CM codes, including Z codes, even if a diagnosis of a mental health disorder is not established.
Yog tias qhov kev pabcuam yog kev pabcuam SUD (DMC/DMC-ODS), daim ntawv thov yuav tsum muaj tus lej ICD-10-CM uas qhia txog kev kuaj mob SUD lossis tus lej ICD-10-CM uas qhia txog qhov laj thawj ntawm kev ntsib kev pabcuam uas cuam tshuam nrog tus mob SUD (saib BHIN 22-013). Cov kev thov nyiaj pab kho mob hauv tsev kho mob thiab cov chaw nyob yuav tsum muaj tsawg kawg ib qho kev kuaj mob ICD-10 uas DMC them raws li tau qhia hauv "Cov Lus Qhia Ntxiv 5-Covered Diagnoses" ntawm DMC-ODS thiab DMC State Plan Billing Manuals nyob rau ntawm nplooj ntawv MedCCC Library . Yog tias qhov kev pabcuam yog kev pabcuam pw hauv tsev kho mob lossis kev pabcuam nyob hauv tsev thiab tus lej kuaj mob tsis yog tus lej ICD-10 uas suav nrog, qhov kev pabcuam yuav raug tsis lees txais.
For further guidance on the use of ICD-10-CM diagnosis codes /reason for the encounter, please refer to the CMS code tabular (list of included diagnoses/reason for service encounter for SMHS and DMC / DMC-ODS services) and the CMS coding guidelines for 2024. These guidelines are updated at least annually.