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Nyiaj txiag
Txij li tsev neeg kev puas siab puas ntsws tsis muaj tus neeg mob tam sim no (CPT code 90846) tuaj yeem tshaj tawm hauv Drug Medi-Cal (DMC) Organized Delivery System, nws puas yuav tsum tau tshaj tawm hauv Speciality Mental Health (SMHS) kev xa khoom?
No. CPT code 90846 means family psychotherapyy (without the patient present). In the DMC delivery system, the definition of family therapy in the State Plan includes the following sentence, “There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of this service…” This is why CPT code 90846 is included in the DMC-ODS delivery system. The definition of therapy in the Rehabilitative Mental Health Services (i.e., SMHS) segment of the State Plan includes the sentence “Therapy may be delivered to a beneficiary or group of beneficiaries and may include family therapy directed at improving the beneficiary’s functioning and at which the beneficiary is present.” Since the definition of therapy in the SMHS delivery system explicitly requires the member to be present, CPT code 90846 is not available in SMHS.
Puas Muaj Kev Pabcuam Ntau Tsev Neeg Psychotherapy (CPT code 90849) tuaj yeem siv los qhia txog kev kho tsev neeg thaum tus tswvcuab tsis nyob hauv DMC-ODS kev xa khoom?
Yog, nws ua tau.
CPT code 90849 means multiple-family group therapy. In the DMC-ODS delivery system, it is a family therapy code. In the Specialty Mental Health delivery system it was grouped into the family therapy service category. According to the State Plan, family therapy is defined in the State Plan as “a rehabilitative service that includes family members in the treatment process, providing education about factors that are important to the member’s recovery as well as the holistic recovery of the family system. Family members can provide social support to the beneficiary and help motivate their loved one to remain in treatment. There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of this service, but the service is for the direct benefit of the beneficiary.” Since the definition of family therapy allows it, counties may report CPT code 90849 in the DMC-ODS delivery system when the member is not present.
Cov nroog puas tuaj yeem siv HCPCS code H0007 (kev pabcuam cawv thiab/lossis tshuaj; kev cuam tshuam txog teebmeem) los qhia txog kev sib cuag nrog cov khoom ntiag tug uas yog ib feem ntawm kev cuam tshuam kev kub ntxhov hauv DMC-ODS kev xa khoom?
No. HCPCS code H0007 (alcohol and/or drug services, crisis intervention), has been grouped into the SUD Crisis Intervention Services category. According to the State Plan, SUD Crisis Intervention Services “consists of contacts with a beneficiary in crisis. A crisis means an actual relapse or an unforeseen event or circumstance which presents to the beneficiary an imminent threat of relapse. SUD Crisis Intervention Services shall focus on alleviating the crisis problem, be limited to the stabilization of the beneficiary’s immediate situation, and be provided in the least intensive level of care that is medically necessary for their condition.” Since the State Plan explicitly states that SUD crisis intervention must be provided to the member, HCPCS code H0007 cannot be used to claim for a collateral contact.
Cov nroog puas tuaj yeem siv HCPCS code H0032 (kev pabcuam kev puas siab puas ntsws tsim los ntawm tus kws kho mob uas tsis yog kws kho mob) los tshaj tawm txog kev sib cuag nrog SMHS?
Yes. HCPCS Code H0032, mental health service plan development by non-physician, is used to claim reimbursement for Treatment Planning. Treatment Planning is defined in the State Plan as “a service activity to develop or update a beneficiary’s course of treatment, documentation of the recommended course of treatment, and monitoring of a beneficiary’s progress.” Nothing in this definition excludes contact with significant support persons or other collaterals if the purpose of their participation is to focus on the treatment of the member. Therefore, counties may use HCPCS code H0032 to claim reimbursement for Treatment Planning.
Cov nroog puas tuaj yeem siv HCPCS code H0034 (kev cob qhia tshuaj thiab kev txhawb nqa) los qhia txog kev tiv thaiv kev tiv thaiv hauv DMC-ODS thiab SMHS kev xa khoom?
Lub nroog tuaj yeem thov cov nyiaj them poob haujlwm uas siv HCPCS code H0034 hauv SMHS kev xa khoom tab sis tsis nyob hauv DMC-ODS kev xa khoom.
HCPCS code H0034 means medication training and support. In the Specialty Mental Health System (SMHS), HCPCS code H0034 has been grouped into the medication Support service type. In the Drug Medi-Cal and the Drug Medi-Cal Organized Delivery systems (DMC and DMC-ODS), HCPCS code H0034 has been grouped into the Medication Services service type. In the State Plan, SMHS Medication Support Services are defined as services that “may include contact with significant persons or other collaterals.” However, in the DMC/DMC-ODS State Plan, the definition of Medication Services does not include contact with collaterals. Further, services that allow the member not to be present are marked with an *. Medication Services are not marked with an *. Therefore, counties cannot report H0033 and H0034 as collateral contacts in DMC and DMC-ODS delivery systems, but can report H0033 and H0034 as collateral contacts in the SMHS delivery system.
Puas yog HCPCS cov lej H0038 thiab H0025 (Peer Support Services) suav nrog kev tiv tauj?
HCPCS H0038 means one-on-one peer support services, and HCPCS code H0025 means group support services. Peer support services have been grouped into peer support in all delivery systems. The State Plan definition of peer support in all delivery systems states that “peer support services can include contact with family members or other collaterals if the purpose of the collateral’s participation is to focus on the treatment needs of the beneficiary.” Since the State Plan definition of peer support services specifically states that it includes collateral contacts, counties may use HCPCS codes H0038 and H0025 to claim for services that include collateral contacts.
Puas Muaj Kev Txhim Kho thiab Kev Rov Qab Los Puas suav nrog kev sib txuas lus hauv SMHS thiab DMC-ODS cov khoom xa tuaj raws li, thiab cov nroog puas tuaj yeem siv HCPCS code H2017 los piav qhia cov neeg sib cuag?
Yes. HCPCS code H2017 (Psychosocial Rehabilitation) has been grouped into the Recovery service category in the DMC-ODS delivery system and into the Rehabilitation service category in the SMHS delivery system. The State Plan defines Psychosocial Rehabilitation as an activity that “may include contact with significant support persons or other collaterals if the purpose of their participation is to focus on the treatment needs of the member. Recovery services in DMC-ODS include Care Coordination. Part of the State Plan’s definition of Care Coordination states that it entails “coordinating with ancillary services, including individualized connection, referral, and linkages to community-based services and supports.” Since the State Plan’s definition of Rehabilitation and Recovery includes collateral contacts, counties may use HCPCS code H2017 to claim for collateral contacts.
HCPCS H2021 puas tuaj yeem siv tau (Kev Pabcuam Hauv Zej Zog Hauv Zej Zog) los piav qhia txog kev tiv tauj thaum tus tswvcuab tsis nyob?
Yes. HCPCS code H2021 (community-based wrap-around service) was grouped into the Rehabilitation service category in the SMHS delivery system and into Treatment Planning service category in the DMC and DMC-ODS delivery systems. The State Plan defines Psychosocial Rehabilitation as an activity that “may include contact with significant support persons or other collaterals if the purpose of their participation is to focus on the treatment needs of the member. Treatment Planning is defined in the State Plan as “a service activity to develop or update a beneficiary’s course of treatment, documentation of the recommended course of treatment, and monitoring of a beneficiary’s progress.” Since the State Plan’s definition of Rehabilitation and Treatment Planning either includes collateral contacts or does not prohibit collateral contacts, counties may use HCPCS code H2021 to claim for collateral contacts whether or not the member is present.
Puas Muaj Kev Pabcuam Tus Cwj Pwm Zoo, piav qhia los ntawm HCPCS code H2019, suav nrog kev lav phib xaub rau cov tib neeg uas tsis yog tus tswv cuab ntawm tsev neeg lom neeg?
Yes. HCPCS code H2019 (therapeutic behavioral services) was grouped into the Therapeutic Behavioral Service category. Information Notice 08-38 defines therapeutic behavioral services as services that include making collateral contacts with family members, caregivers and others significant in the life of the member whether or not the member is present. Since the Information Notice’s definition of therapeutic behavioral services includes collateral contacts, counties may use HCPCS code H2019 to claim reimbursement for collateral contact.
Puas tuaj yeem qhia txog kev tiv thaiv tus neeg mob sab nraud ntxiv nrog rau Kev Pabcuam Therapeutic Foster Care (TFC)?
Yes. The MHP Contract states, in part, that the Therapeutic Foster Care (TFC) “service model allows for the provision of certain specialty mental health service activities (plan development, rehabilitation and collateral) available under the EPSDT benefit as a home-based alternative to high level care in institutional settings.” Since the MHP Contract’s description of TFC states that collateral contacts that are in the plan development or rehabilitation service categories, counties may claim collateral contacts in plan development and rehabilitation service categories in addition to TFC.
Puas yog lub hom phiaj kev tswj xyuas cov ntaub ntawv (HCPCS code T1017) suav nrog kev tiv tauj?
Yes. HCPCS code T1017 (targeted case management) was grouped into Referral and Linkage service category. The State Plan defines referral and linkages as services that include “identifying appropriate resources, making appointments, and assisting a beneficiary with a warm handoff to obtain ongoing support.” Since the State Plan’s definition of referral and linkages services includes collateral contacts, counties may use HCPCS code T1017 to claim reimbursement for collateral contact.
Puas yog tus tswv cuab yuav tsum muaj nyob rau thaum Lub Hom Phiaj Kev Tswj Xyuas Cov Cai (HCPCS code T1017) tau muab?
No. HCPCS code T1017 (targeted case management) was grouped into Referral and Linkage service category. The State Plan defines referral and linkages as services that include “identifying appropriate resources, making appointments, and assisting a beneficiary with a warm handoff to obtain ongoing support.” Since the State Plan’s definition of Referral and Linkage includes services that need to be performed when the member is not present, counties can use HCPCS code T1017 to claim for services when the member is not present.
Lub nroog puas tuaj yeem tshaj tawm H2035 (kev pabcuam cawv thiab / lossis lwm yam kev pabcuam tshuaj) thiab, ntxiv rau, cais qhia txog kev pabcuam nyiaj txiag?
Yes. HCPCS code H2035 (Alcohol and/or other drug treatment program) has been grouped into the Recovery service category in the DMC-ODS delivery system. The State Plan states that “recovery can be delivered as a standalone service, or as a service delivered as part of the levels of care listed below:
- Kev soj ntsuam
- The definition of assessment in the State Plan includes the following: assessment “may include contact with family members or other collaterals if the purpose of the collateral’s participation is to focus on the treatment needs of the beneficiary.”
- Kev Sib Koom Tes
- The State Plan definition of care coordination includes the following component: “Coordinating with ancillary services, including individualized connection, referral and linkages to community-based services and supports.”
- Kev sab laj
- The State Plan definition of individual counseling includes the following sentence: “Individual counseling can include contact with family members or other collaterals if the purpose of the collateral’s participation is to focus on the treatment needs of the beneficiary by supporting the achievement of the beneficiary’s goals.”
- The definition of family therapy in the State Plan includes the following sentence, “There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of this service, but the service is for the direct benefit to the beneficiary.”
- Kev Kho Mob Tsev Neeg
Txij li cov kev pab cuam rov qab tuaj yeem thov nrog cov kev pab cuam kho mob sab nraud (kev ntsuam xyuas, kev saib xyuas, kev sab laj, thiab kev kho tsev neeg) uas tso cai rau cov kev pab cuam nyiaj txiag, lub nroog tuaj yeem thov cov kev pab cuam kho mob sab nraud uas tau muab tso rau hauv ib qho ntawm cov kev pab cuam ntxiv rau HCPCS code H2035.