CalAIM គំនិតផ្តួចផ្តើមសុខភាពអាកប្បកិរិយា សំណួរដែលគេសួរញឹកញាប់
ខាងក្រោមនេះគឺជាបញ្ជីសំណួរដែលសួរញឹកញាប់ត្រូវបានប្រមូលពីជំនួយបច្ចេកទេស និងសិក្ខាសាលាព័ត៌មាន និងការបញ្ជូនទៅកាន់អ៊ីមែល BHCalAIM@dhcs.ca.gov ។ DHCS នឹងធ្វើបច្ចុប្បន្នភាពបញ្ជីនេះរៀងរាល់ត្រីមាស។
វត្ថុបញ្ចាំ
ដោយសារការព្យាបាលចិត្តសាស្ត្រគ្រួសារដោយគ្មានអ្នកជំងឺមានវត្តមាន (លេខកូដ CPT 90846) អាចត្រូវបានរាយការណ៍នៅក្នុងប្រព័ន្ធដឹកជញ្ជូនដែលរៀបចំដោយឱសថ Medi-Cal (DMC) តើវាគួរត្រូវបានរាយការណ៍នៅក្នុងប្រព័ន្ធផ្តល់សេវាសុខភាពផ្លូវចិត្តពិសេស (SMHS) ដែរឬទេ?
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.
តើការព្យាបាលចិត្តសាស្ត្រជាក្រុមច្រើនគ្រួសារ (លេខកូដ CPT 90849) អាចត្រូវប្រើដើម្បីរាយការណ៍វគ្គព្យាបាលជាលក្ខណៈគ្រួសារ នៅពេលដែលសមាជិកមិនមានវត្តមាននៅក្នុងប្រព័ន្ធចែកចាយ DMC-ODS ដែរឬទេ?
បាទ វាអាចទៅរួច។
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.
តើខោនធីនានាអាចប្រើប្រាស់លេខកូដ HCPCS H0007 (សេវាគ្រឿងស្រវឹង និង/ឬឱសថ អន្តរាគមន៍វិបត្តិ) ដើម្បីរាយការណ៍ទំនាក់ទំនងវត្ថុបញ្ចាំដែលជាផ្នែកនៃអន្តរាគមន៍វិបត្តិនៅក្នុងប្រព័ន្ធដឹកជញ្ជូន DMC-ODS បានទេ?
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.
តើខោនធីអាចប្រើលេខកូដ HCPCS H0032 (ផែនការសេវាសុខភាពផ្លូវចិត្តដែលបង្កើតឡើងដោយអ្នកមិនមែនជាគ្រូពេទ្យ) ដើម្បីរាយការណ៍ទំនាក់ទំនងវត្ថុបញ្ចាំនៅក្នុងប្រព័ន្ធចែកចាយ SMHS បានទេ?
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.
តើខោនធីអាចប្រើលេខកូដ HCPCS H0034 (ការបណ្តុះបណ្តាល និងជំនួយថ្នាំ) ដើម្បីរាយការណ៍ទំនាក់ទំនងវត្ថុបញ្ចាំនៅក្នុងប្រព័ន្ធដឹកជញ្ជូន DMC-ODS និង SMHS បានទេ?
ស្រុកនានាអាចទាមទារទំនាក់ទំនងវត្ថុបញ្ចាំដោយប្រើលេខកូដ HCPCS H0034 នៅក្នុងប្រព័ន្ធចែកចាយ SMHS ប៉ុន្តែមិនមែននៅក្នុងប្រព័ន្ធដឹកជញ្ជូន DMC-ODS ទេ។
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.
តើលេខកូដ HCPCS H0038 និង H0025 (សេវាគាំទ្រមិត្តភ័ក្តិ) រួមបញ្ចូលទំនាក់ទំនងវត្ថុបញ្ចាំដែរឬទេ?
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.
តើការស្តារនីតិសម្បទា និងការស្តារឡើងវិញ រួមបញ្ចូលទំនាក់ទំនងវត្ថុបញ្ចាំនៅក្នុងប្រព័ន្ធចែកចាយ SMHS និង DMC-ODS រៀងៗខ្លួន ហើយស្រុកនានាអាចប្រើប្រាស់លេខកូដ HCPCS H2017 ដើម្បីពណ៌នាអំពីទំនាក់ទំនងទាំងនោះបានទេ?
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.
តើ HCPCS H2021 (សេវារុំជុំវិញផ្អែកលើសហគមន៍) អាចប្រើដើម្បីពិពណ៌នាទំនាក់ទំនងវត្ថុបញ្ចាំ នៅពេលដែលសមាជិកមិនមានវត្តមានទេ?
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.
តើសេវាព្យាបាលអាកប្បកិរិយាដែលពិពណ៌នាដោយលេខកូដ HCPCS H2019 អាចរួមបញ្ចូលវត្ថុបញ្ចាំដល់បុគ្គលដែលមិនមែនជាគ្រួសារជីវសាស្រ្តរបស់សមាជិកដែរឬទេ?
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.
តើទំនាក់ទំនងវត្ថុបញ្ចាំអ្នកជំងឺក្រៅអាចរាយការណ៍បន្ថែមលើសេវាថែទាំព្យាបាលកុមារ (TFC) បានទេ?
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.
តើការគ្រប់គ្រងករណីគោលដៅ (លេខកូដ HCPCS T1017) រួមបញ្ចូលទំនាក់ទំនងវត្ថុបញ្ចាំដែរឬទេ?
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.
តើសមាជិកត្រូវមានវត្តមាននៅពេលដែលការគ្រប់គ្រងករណីគោលដៅ (លេខកូដ HCPCS T1017) ត្រូវបានផ្តល់ជូនទេ?
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.
ខោនធីអាចរាយការណ៍ H2035 (សេវាព្យាបាលគ្រឿងស្រវឹង និង/ឬថ្នាំផ្សេងទៀត) ហើយលើសពីនេះទៀត រាយការណ៍ដាច់ដោយឡែកពីសេវាកម្មវត្ថុបញ្ចាំដែរឬទេ?
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:
- ការវាយតម្លៃ
- 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.”
- ការសម្របសម្រួលការថែទាំ
- 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.”
- ការប្រឹក្សាយោបល់
- 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.”
- ការព្យាបាលគ្រួសារ
ដោយសារសេវាសង្គ្រោះអាចត្រូវបានទាមទារជាមួយនឹងសេវាអ្នកជំងឺក្រៅ (ការវាយតម្លៃ ការសម្របសម្រួលការថែទាំ ការប្រឹក្សា និងការព្យាបាលគ្រួសារ) ដែលអនុញ្ញាតឱ្យមានសេវាធានា ខោនធីអាចទាមទារសេវាអ្នកជំងឺក្រៅវត្ថុបញ្ចាំ ដែលត្រូវបានដាក់ជាក្រុមក្នុងប្រភេទសេវាកម្មមួយក្នុងចំណោមប្រភេទសេវាកម្មទាំងនោះ បន្ថែមពីលើលេខកូដ HCPCS H2035 ។