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.
Tsis Muaj Qhov Rooj Tsis Zoo rau Kev Pabcuam Kev Puas Siab Puas Ntsws thiab Kev Sib Koom Tes
Yog tias nyob rau hauv Txoj Cai Tsis Muaj Qhov Rooj Tsis Zoo, ib tus tswvcuab tuaj yeem khaws tau ib tus kws kho mob NSMHS Medi-Cal uas twb muaj lawm thaum tseem tau txais SMHS los ntawm MHP, puas yuav tsum tau ua raws li tus kws kho mob kuaj xyuas thiab kev cog lus Continuity of Care (CoC) raws li BHIN 18-059?
Reference BHIN 18-059 BHIN 22-011
Tsis yog. Txoj Cai Tsis Muaj Qhov Rooj Tsis Txaus Siab tso cai rau cov tswv cuab tau txais cov Kev Pabcuam Kev Puas Siab Puas Ntsws tshwj xeeb (NSMHS) (ntawm Tus Nqi-For-Service lossis Managed Care Plan [MCP]) thiab SMHS (ntawm Mental Health Plan [MHP] tus kws kho mob) ib txhij thaum tag nrho cov kev pabcuam raug tsim nyog, kev kho mob yog sib koom ua ke ntawm cov kev pabcuam xa thiab cov kev pabcuam. CoC txoj cai tsis siv rau Tsis Muaj Qhov Rooj Tsis Zoo thiab tsis tas yuav ua raws li tus kws kho mob kuaj xyuas thiab kev cog lus cov txheej txheem teev tseg hauv BHIN 18-059. CoC tso cai rau cov tswv cuab uas muaj kev sib raug zoo ntawm MHP tus kws kho mob ua ntej uas thov rau MHP kom tau txais SMHS txuas ntxiv mus txog 12 lub hlis nrog tus kws kho mob sab nraud Medi-Cal lossis ib tus kws kho mob uas raug txiav tawm uas yuav xa SMHS txuas ntxiv (piv txwv li, ib tus neeg ua haujlwm ntawm MHP lossis ib lub koom haum muab kev cog lus, pab pawg neeg muab kev pabcuam, lossis tus kws kho mob ib leeg).
Yuav Ua Li Cas Qhov Tsis Muaj Qhov Rooj Thiab Cov Txheej Txheem rau Kev Nkag Mus Rau Cov Tswv Cuab rau SMHS cov cai cuam tshuam rau AB 1299 qhov xav tau hloov pauv (PT) cov cai?
Reference ACL 18-027 BHIN 21-073 BHIN 22-011
Txoj Cai Tsis Muaj Qhov Rooj Tsis Txaus Siab (BHIN 22-011) thiab Cov Txheej Txheem rau Cov Tswvcuab Nkag Mus Rau SMHS txoj cai (BHIN 21-073) tsis hloov pauv cov kev cai PT uas twb muaj lawm. Lub nroog yuav tsum ua raws li PT txoj cai qhia tau hais tseg hauv ACL 18-027.
Tus kws kho mob puas tuaj yeem muab SMHS, thaum lawv tab tom muab SMHS rau ib tus tswv cuab, hais txog kev txhawj xeeb txog kev siv tshuaj yeeb dej caw hauv SMHS muab rau tus tswv cuab?
Reference BHIN 22-011
Yes. For example, during a therapy session, a Specialty Mental Health Services (SMHS) provider may discuss and treat a member’s co-occurring substance use; however, the session must primarily address the member’s mental health (e.g. symptoms, condition, diagnosis, and/or risk factors), which can include co-occurring substance use disorder. A claim for SMHS, submitted by a SMHS provider, will not be denied for including documentation, including a diagnosis, about a member’s co-occurring substance use concern. Note: A provider must only provide services within their scope of practice, and about subject matter that is within their scope of competence.
Puas yog tus kws kho mob DMC/DMC-ODS, thaum lawv tab tom muab kev pabcuam SUD rau ib tus tswvcuab, hais txog kev txhawj xeeb txog kev puas siab puas ntsws nyob rau hauv cov kev pabcuam muab rau tus tswvcuab?
Reference BHIN 22-011
Yes. For example, during a counseling session, a Drug Medi-Cal (DMC)/Drug Medi-Cal Organized Delivery System (DMC-ODS) provider may discuss a co-occurring mental health concern; however, the session must primarily address the member’s substance use (e.g. symptoms, condition, diagnosis, and/or risk factors), which can include co-occurring mental health conditions. A claim for DMC/DMC-ODS services, submitted by a DMC/DMC-ODS provider, will not be denied for including documentation, including a diagnosis, about a member’s co-occurring mental health concern. Note: A provider must only provide services within their scope of practice, and about subject matter that is within their scope of competence.