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Thế chấp​​ 

Vì liệu pháp tâm lý gia đình mà không có bệnh nhân hiện diện (mã CPT 90846) có thể được báo cáo trong Hệ thống phân phối có tổ chức của Drug Medi-Cal (DMC), vậy thì liệu liệu pháp này cũng có nên được báo cáo trong hệ thống phân phối Sức khỏe tâm thần chuyên khoa (SMHS) không?​​ 

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.​​ 

Liệu pháp tâm lý nhóm gia đình đa thế hệ (mã CPT 90849) có thể được sử dụng để báo cáo buổi trị liệu gia đình khi thành viên không có mặt trong hệ thống cung cấp DMC-ODS không?​​ 

Có, có thể.​​ 

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.​​ 

Các quận có thể sử dụng mã HCPCS H0007 (dịch vụ về rượu và/hoặc ma túy; can thiệp khủng hoảng) để báo cáo các trường hợp tiếp xúc ngoài ý muốn như một phần của can thiệp khủng hoảng trong hệ thống cung cấp DMC-ODS không?​​ 

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.​​ 

Các quận có thể sử dụng mã HCPCS H0032 (kế hoạch dịch vụ sức khỏe tâm thần do người không phải bác sĩ xây dựng) để báo cáo về liên hệ ngoài luồng trong hệ thống cung cấp dịch vụ SMHS không?​​ 

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.  ​​ 

Các quận có thể sử dụng mã HCPCS H0034 (đào tạo và hỗ trợ thuốc) để báo cáo các trường hợp tiếp xúc ngoài ý muốn trong hệ thống cung cấp DMC-ODS và SMHS không?​​ 

Các quận có thể yêu cầu hợp đồng thế chấp bằng cách sử dụng mã HCPCS H0034 trong hệ thống phân phối SMHS nhưng không phải trong hệ thống phân phối DMC-ODS.​​ 

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.​​ 

Mã HCPCS H0038 và H0025 (Dịch vụ hỗ trợ ngang hàng) có bao gồm các hợp đồng thế chấp không?​​ 

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.​​ 

Liệu chương trình Phục hồi chức năng và Phục hồi có bao gồm các liên hệ thế chấp trong hệ thống cung cấp SMHS và DMC-ODS không và các quận có thể sử dụng mã HCPCS H2017 để mô tả các liên hệ đó không?​​ 

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.​​ 

Có thể sử dụng HCPCS H2021 (Dịch vụ hỗ trợ cộng đồng) để mô tả các mối quan hệ thế chấp khi thành viên không có mặt không?​​ 

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.​​ 

Dịch vụ Hành vi Trị liệu, được mô tả theo mã HCPCS H2019, có thể bao gồm tài sản thế chấp cho những cá nhân không phải là gia đình sinh học của thành viên không?​​  

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.​​ 

Có thể báo cáo thêm trường hợp tiếp xúc ngoại trú ngoài dịch vụ Chăm sóc nuôi dưỡng trị liệu (TFC) không?​​ 

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.​​ 

Quản lý trường hợp có mục tiêu (mã HCPCS T1017) có bao gồm các liên hệ thế chấp không?​​ 

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.​​ 

Thành viên có cần phải có mặt khi Dịch vụ Quản lý trường hợp có mục tiêu (mã HCPCS T1017) được cung cấp không?​​ 

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.​​ 

Một quận có thể báo cáo H2035 (dịch vụ cai nghiện rượu và/hoặc ma túy khác) và ngoài ra, báo cáo riêng một dịch vụ phụ trợ không?​​ 

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:​​ 

• Đánh giá​​ 
  • 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.”​​ 
• Điều phối chăm sóc​​ 
• 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.”​​ 
• Tư vấn​​ 
• 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.”​​ 
• Liệu pháp gia đình​​ 

Vì các dịch vụ phục hồi có thể được yêu cầu cùng với các dịch vụ ngoại trú (đánh giá, điều phối chăm sóc, tư vấn và trị liệu gia đình) cho phép các dịch vụ bổ sung, nên quận có thể yêu cầu một dịch vụ ngoại trú bổ sung được nhóm vào một trong các danh mục dịch vụ đó ngoài mã HCPCS H2035.​​