CalAIM 行为健康计划常见问题解答
Below is a list of frequently asked questions have been collected from technical assistance and informational webinars and submissions to the BHCalAIM@dhcs.ca.gov email. DHCS will update this list on a quarterly basis.
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除了成员从急性精神病医院转移到非急性住院治疗机构的情况外，在其他情况或设施中是否可以申请行政日间服务？
不。 只有医院才可以申请行政日间服务。 当会员不再符合急性精神病医院服务的医疗需要，但尚未被接受入住符合其需求的非急性住院治疗机构时，医院可以申请行政休假。
如果客户请求不同县的 Medi-Cal 服务，但在 30 天内未完成转移其 Medi-Cal，那么他们之前几个月的服务是否会受到保障？
根据ACWDL 18-02E 、 BHIN 21-032和BHIN 21-072的规定，在跨县转移 (ICT) 开始之前、期间或之后的几个月内，Medi-Cal 受益人的福利不会中断。Short Doyle/Medi-Cal (SD/MC) 索赔系统也没有任何限制，可以阻止在 ICT 处理期间批准索赔。对于物质使用障碍索赔，SD/MC Program接受由责任县或居住县提交的索赔。 对于特殊心理健康服务索赔，SD/MC 不会将提交索赔的县与成员的居住县或责任县进行核对（当索赔是特殊心理健康索赔时）。SD/MC 会核实提交的县是否与成员的居住县或 DMC 和 DMC-ODS 索赔的责任县相符。SD/MC 不会对受益人的责任县进行任何修改，要求在居住县更新后的任何时间内更改受益人的责任县。
未获得执照或豁免的指定心理健康工作者能否以与持证心理健康从业人员 (LPHA) 相同的费率收取“评估”费用？
No. Services provided by individuals who are not licensed-eligible, waivered or a clinical trainee are not reimbursed at the same rate as an LPHA. Prior to payment reform, the rate reimbursed for an assessment was the same regardless of the individual who performs the assessment. As of July 1, 2023, when the Department implemented Payment Reform, reimbursement for an assessment performed by an LPHA is at a different rate than an assessment performed by a non-licensed individual who is not licensed-eligible, waivered, or a clinical trainee. The reimbursement rates to counties by procedure code, and provider type can be found on the Fee Schedule page on the DHCS website.
MHP 通过 Short-Doyle 系统提交的每个 SMHS 索赔都必须包含 ICD-10-CM 诊断/就诊原因代码。 可以仅使用物质滥用障碍诊断代码提交索赔吗？
Reference BHIN 21-071; BHIN 21-075; BHIN 23-068;
不，仅凭物质使用障碍诊断代码不能提交 SMHS 服务索赔。就诊原因（ICD-10-CM 代码）必须与为受益人提供的医疗必需服务相符。如果该服务是 SMHS，则就诊原因必须包含与其精神健康诊断相对应的 ICD-10-CM 代码，或者包含指示与精神健康状况相关的就诊原因的 ICD-10-CM 代码（参见BHIN 22-013 ）。关于使用 ICD-10-CM 代码（包括 Z 代码）的问题，即使没有确诊精神健康障碍，也请参阅上面的第 1 题。
If the service is a SUD service (DMC/DMC-ODS), the claim must include an ICD-10-CM code that indicates a SUD diagnosis or an ICD-10-CM code that indicates the reason for the service encounter that is related to the SUD condition (see BHIN 22-013). Inpatient and residential claims must have at least one DMC covered substance use disorder ICD-10 diagnosis code as indicated in “Appendix 5-Covered Diagnoses” of the DMC-ODS and DMC State Plan Billing Manuals located on the MedCCC Library page. If the service is a inpatient or residential service and the diagnosis code is not a covered ICD-10 code, the service will be denied.
For further guidance on the use of ICD-10-CM diagnosis codes /reason for the encounter, please refer to the CMS code tabular (list of included diagnoses/reason for service encounter for SMHS and DMC / DMC-ODS services) and the CMS coding guidelines for 2024. These guidelines are updated at least annually.