CalAIM Behavioral Health Initiative Cov lus nug nquag nug
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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?
Tsis muaj. CPT code 90846 txhais tau tias tsev neeg lub hlwb kho mob (tsis muaj tus neeg mob nyob ntawd). Hauv DMC txoj kev xa khoom, lub ntsiab lus ntawm kev kho mob tsev neeg hauv Txoj Kev Npaj ntawm Lub Xeev suav nrog cov kab lus hauv qab no, "Tej zaum yuav muaj lub sijhawm thaum, raws li kev txiav txim siab hauv kev kho mob, tus neeg tau txais txiaj ntsig tsis nyob ntawd thaum lub sijhawm xa khoom no ..." Qhov no yog vim li cas CPT code 90846 suav nrog hauv DMC-ODS txoj kev xa khoom. Cov lus txhais ntawm kev kho mob hauv ntu Rehabilitative Mental Health Services (piv txwv li, SMHS) ntawm Lub Xeev Txoj Kev Npaj suav nrog kab lus "Kev kho mob yuav raug xa mus rau tus neeg tau txais txiaj ntsig lossis pawg neeg tau txais txiaj ntsig thiab yuav suav nrog kev kho mob hauv tsev neeg uas tsom mus rau kev txhim kho tus neeg tau txais txiaj ntsig txoj haujlwm thiab qhov chaw uas tus neeg tau txais txiaj ntsig nyob ntawd." Vim tias lub ntsiab lus ntawm kev kho mob hauv SMHS qhov kev xa khoom yuav tsum tau kom tus tswv cuab tuaj koom, CPT code 90846 tsis muaj nyob hauv 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 txhais tau tias yog kev kho mob pab pawg ntau tsev neeg. Hauv DMC-ODS tus txheej txheem xa khoom, nws yog tus lej kho mob hauv tsev neeg. Hauv lub tshuab kev pabcuam kev noj qab haus huv ntawm lub hlwb tshwj xeeb nws tau muab faib ua pawg rau hauv pawg kev pabcuam kev kho mob hauv tsev neeg. Raws li Txoj Kev Npaj ntawm Lub Xeev, kev kho mob tsev neeg tau txhais nyob rau hauv Txoj Kev Npaj ntawm Lub Xeev tias yog "kev pabcuam kho kom rov zoo uas suav nrog cov tswv cuab hauv tsev neeg hauv cov txheej txheem kho mob, muab kev kawm txog cov yam tseem ceeb rau kev rov zoo ntawm tus tswv cuab nrog rau kev rov zoo tag nrho ntawm tsev neeg. Cov tswv cuab hauv tsev neeg tuaj yeem muab kev txhawb nqa rau tus neeg tau txais txiaj ntsig thiab pab txhawb kom lawv tus neeg hlub nyob hauv kev kho mob. Tej zaum yuav muaj tej lub sij hawm, raws li kev txiav txim siab kho mob, tus neeg tau txais txiaj ntsig tsis nyob ntawd thaum lub sij hawm muab kev pabcuam no, tab sis qhov kev pabcuam no yog rau qhov txiaj ntsig ncaj qha rau tus neeg tau txais txiaj ntsig. Vim tias lub ntsiab lus ntawm kev kho mob hauv tsev neeg tso cai rau nws, cov nroog tuaj yeem tshaj tawm CPT code 90849 hauv DMC-ODS xa khoom thaum tus tswv cuab tsis nyob ntawd.
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?
Tus lej HCPCS H0007 (kev pabcuam haus dej cawv thiab/lossis tshuaj yeeb, kev pabcuam thaum muaj xwm txheej ceev), tau muab faib ua pawg rau hauv pawg SUD Crisis Intervention Services. Raws li Txoj Kev Npaj ntawm Lub Xeev, SUD Crisis Intervention Services "muaj cov neeg uas tau txais txiaj ntsig thaum muaj teeb meem." Kev kub ntxhov txhais tau tias yog qhov rov qab mob dua lossis qhov xwm txheej lossis qhov xwm txheej uas tsis tau xav txog uas ua rau tus neeg tau txais txiaj ntsig muaj kev hem thawj ntawm kev rov qab mob dua. Cov Kev Pabcuam Tiv Thaiv Kev Kub Ntxhov SUD yuav tsum tsom mus rau kev daws teeb meem kev kub ntxhov, tsuas yog ua kom tus neeg tau txais txiaj ntsig qhov xwm txheej tam sim ntawd ruaj khov, thiab muab kev saib xyuas tsawg kawg nkaus uas tsim nyog rau lawv tus mob. Vim tias Txoj Kev Npaj ntawm Lub Xeev tau hais meej meej tias yuav tsum muab kev pabcuam rau cov tswv cuab thaum muaj teeb meem SUD, HCPCS tus lej H0007 tsis tuaj yeem siv los thov kev sib cuag ua ke.
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?
Cov nroog tuaj yeem thov cov neeg sib cuag uas siv HCPCS tus lej H0034 hauv SMHS lub kaw lus xa khoom tab sis tsis yog hauv DMC-ODS lub kaw lus xa khoom.
HCPCS tus lej H0034 txhais tau tias kev cob qhia thiab kev txhawb nqa tshuaj. Hauv Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv Lub Siab Tshwj Xeeb (SMHS), HCPCS tus lej H0034 tau muab faib ua pawg rau hauv hom kev pabcuam txhawb nqa tshuaj. Hauv cov txheej txheem Kev Pabcuam Tshuaj Medi-Cal thiab Kev Pabcuam Tshuaj Medi-Cal (DMC thiab DMC-ODS), HCPCS tus lej H0034 tau raug muab faib ua pawg rau hauv hom kev pabcuam Kev Pabcuam Tshuaj. Hauv Txoj Kev Npaj ntawm Lub Xeev, SMHS Cov Kev Pabcuam Txhawb Nqa Tshuaj yog txhais tias yog cov kev pabcuam uas "tej zaum yuav suav nrog kev sib cuag nrog cov neeg tseem ceeb lossis lwm yam khoom siv." Txawm li cas los xij, hauv DMC/DMC-ODS Lub Xeev Txoj Kev Npaj, lub ntsiab lus ntawm Cov Kev Pabcuam Tshuaj tsis suav nrog kev sib cuag nrog cov khoom siv. Ntxiv mus, cov kev pabcuam uas tso cai rau tus tswv cuab tsis tuaj yeem tuaj koom tau raug cim nrog *. Cov Kev Pab Tshuaj tsis muaj cim *. Yog li ntawd, cov nroog tsis tuaj yeem tshaj tawm H0033 thiab H0034 ua cov neeg sib cuag tseem ceeb hauv DMC thiab DMC-ODS cov txheej txheem xa khoom, tab sis tuaj yeem tshaj tawm H0033 thiab H0034 ua cov neeg sib cuag tseem ceeb hauv SMHS cov txheej txheem xa khoom.
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?
Yog. HCPCS tus lej H2017 (Kev Kho Mob Hlwb Hauv Zej Zog) tau muab faib ua pawg rau hauv pawg Kev Pabcuam Rov Qab Zoo hauv DMC-ODS thiab rau hauv pawg Kev Pabcuam Kho Mob Hauv Zej Zog hauv SMHS. Txoj Kev Npaj ntawm Lub Xeev txhais txog Kev Kho Mob Hlwb ua ib qho kev ua ub no uas "tej zaum yuav suav nrog kev sib cuag nrog cov neeg txhawb nqa tseem ceeb lossis lwm yam khoom siv yog tias lub hom phiaj ntawm lawv txoj kev koom tes yog los tsom mus rau qhov xav tau kev kho mob ntawm tus tswv cuab. Cov kev pab kho mob hauv DMC-ODS suav nrog Kev Sib Koom Tes Saib Xyuas Kev Kho Mob. Ib feem ntawm Txoj Kev Npaj ntawm Lub Xeevcov lus txhais ntawm Kev Sib Koom Tes Saib Xyuas hais tias nws suav nrog "kev sib koom tes nrog cov kev pabcuam pabcuam, suav nrog kev sib txuas lus tus kheej, kev xa mus, thiab kev sib txuas mus rau cov kev pabcuam thiab kev txhawb nqa hauv zej zog." Vim tias Txoj Kev Npaj ntawm Lub Xeevcov lus txhais ntawm Kev Kho Dua Tshiab thiab Kev Rov Qab Zoo suav nrog cov neeg tiv tauj uas muaj feem cuam tshuam, cov nroog yuav siv HCPCS tus lej H2017 los thov cov neeg tiv tauj uas muaj feem cuam tshuam.
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?
Yog. HCPCS tus lej H2021 (kev pabcuam qhwv ib puag ncig hauv zej zog) tau muab faib ua pawg rau hauv pawg kev pabcuam kho dua tshiab hauv SMHS qhov kev xa khoom thiab rau hauv pawg kev pabcuam npaj kho mob hauv DMC thiab DMC-ODS qhov kev xa khoom. Txoj Kev Npaj ntawm Lub Xeev txhais txog Kev Kho Mob Hlwb ua ib qho kev ua ub no uas "tej zaum yuav suav nrog kev sib cuag nrog cov neeg txhawb nqa tseem ceeb lossis lwm yam khoom siv yog tias lub hom phiaj ntawm lawv txoj kev koom tes yog los tsom mus rau qhov xav tau kev kho mob ntawm tus tswv cuab. Kev Npaj Kho Mob tau txhais nyob rau hauv Txoj Kev Npaj ntawm Lub Xeev tias yog "kev ua haujlwm pabcuam los tsim lossis hloov kho tus neeg tau txais txiaj ntsig txoj kev kho mob, sau cov ntaub ntawv ntawm txoj kev kho mob uas pom zoo, thiab saib xyuas kev nce qib ntawm tus neeg tau txais txiaj ntsig." Vim tias Lub Xeev Txoj Kev Npajtxhais txog Kev Kho Mob thiab Kev Npaj Kho Mob suav nrog kev sib cuag nrog cov neeg ua haujlwm lossis tsis txwv tsis pub sib cuag nrog cov neeg ua haujlwm, cov nroog yuav siv HCPCS tus lej H2021 los thov kev sib cuag nrog cov neeg ua haujlwm txawm tias tus tswv cuab nyob ntawd lossis tsis nyob ntawd.
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?
Yog. HCPCS tus lej H2019 (kev pabcuam kho tus cwj pwm) tau muab faib ua pawg rau hauv pawg Kev Pabcuam Kho Tus cwj pwm. Daim Ntawv Ceeb Toom 08-38 txhais cov kev pabcuam kho tus cwj pwm ua cov kev pabcuam uas suav nrog kev sib cuag nrog cov tswv cuab hauv tsev neeg, cov neeg saib xyuas thiab lwm tus neeg tseem ceeb hauv lub neej ntawm tus tswv cuab txawm tias tus tswv cuab nyob ntawd lossis tsis nyob ntawd. Vim tias Daim Ntawv Ceeb Toom Cov Lus Qhia cov lus txhais ntawm cov kev pabcuam kho tus cwj pwm suav nrog kev sib cuag ua ke, cov nroog yuav siv HCPCS tus lej H2019 los thov nyiaj rov qab rau kev sib cuag ua ke.
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?
Yog. HCPCS tus lej T1017 (kev tswj xyuas cov ntaub ntawv raug tsom) tau muab faib ua pawg kev pabcuam xa mus thiab txuas. Txoj Kev Npaj ntawm Lub Xeev txhais cov kev xa mus thiab kev sib txuas ua cov kev pabcuam uas suav nrog "kev txheeb xyuas cov peev txheej tsim nyog, teem sijhawm, thiab pab tus neeg tau txais txiaj ntsig nrog kev xa mus sov so kom tau txais kev txhawb nqa tas mus li." Vim tias Txoj Kev Npaj ntawm Lub Xeevcov lus txhais ntawm kev xa mus thiab kev sib txuas lus suav nrog kev sib cuag nrog cov khoom vaj khoom tsev, cov nroog yuav siv HCPCS tus lej T1017 los thov kom them rov qab rau kev sib cuag nrog cov khoom vaj khoom tsev.
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?
Yog. HCPCS tus lej H2035 (Kev kho mob haus dej cawv thiab/lossis lwm yam tshuaj) tau muab faib ua pawg rau hauv pawg kev pabcuam rov qab los hauv DMC-ODS delivery system. Txoj Kev Npaj ntawm Lub Xeev hais tias "kev kho mob tuaj yeem xa tuaj ua ib qho kev pabcuam uas sawv ntawm nws tus kheej, lossis ua ib qho kev pabcuam xa tuaj ua ib feem ntawm cov theem kev saib xyuas teev hauv qab no:
- Kev soj ntsuam
- Cov lus txhais ntawm kev ntsuam xyuas hauv Txoj Kev Npaj ntawm Lub Xeev suav nrog cov hauv qab no: kev ntsuam xyuas "tej zaum yuav suav nrog kev sib cuag nrog cov tswv cuab hauv tsev neeg lossis lwm yam khoom siv yog tias lub hom phiaj ntawm kev koom tes ntawm cov khoom siv yog los tsom mus rau qhov xav tau kev kho mob ntawm tus neeg tau txais txiaj ntsig."
- 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.”
- Lub ntsiab lus ntawm kev kho mob tsev neeg hauv Txoj Kev Npaj ntawm Lub Xeev suav nrog cov kab lus hauv qab no, "Yuav muaj tej lub sijhawm, raws li kev txiav txim siab kho mob, tus neeg tau txais txiaj ntsig tsis nyob ntawd thaum lub sijhawm muab kev pabcuam no, tab sis kev pabcuam yog rau qhov txiaj ntsig ncaj qha rau tus neeg tau txais txiaj ntsig."
- 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.