CalAIM 行为健康计划常见问题解答
以下是从技术援助和信息网络研讨会以及提交至BHCalAIM@dhcs.ca.gov电子邮件中收集的常见问题列表。 DHCS 将每季度更新此列表。
心理健康服务和并发疾病无误
如果根据“无错门”政策，会员可以保留现有的 NSMHS Medi-Cal 提供商，同时还可以从 MHP 获得 SMHS，那么是否需要遵守BHIN 18-059中对提供商的审查和签约连续护理 (CoC) 要求？
不是。“不走错门”政策允许会员同时接受非专业心理健康服务 (NSMHS)（通过按服务收费或管理式护理计划 [MCP] 提供商）和 SMHS（通过心理健康计划 [MHP] 提供商），但前提是所有服务都符合临床要求、治疗在交付系统之间进行协调并且服务不会重复。 CoC 规则不适用于 No Wrong Door，且无需遵守BHIN 18-059中概述的提供商审查和签约流程。 CoC 允许具有预先存在的 MHP 提供商关系的成员向 MHP 提出请求，继续通过网络外的 Medi-Cal 提供商或将继续提供 SMHS 的已终止网络提供商（即 MHP 的员工或签约组织提供商、提供商团体或个人从业者）接受长达 12 个月的 SMHS。
“无错门”和“SMHS 会员访问标准”政策如何影响 AB 1299 推定转移 (PT) 要求？
参考ACL 18-027 BHIN 21-073 BHIN 22-011
“无错门”政策 ( BHIN 22-011 ) 和“SMHS 会员访问标准”政策 ( BHIN 21-073 ) 不会取代现有的 PT 要求。 各县应继续遵循ACL 18-027中概述的 PT 政策指导。
SMHS 提供商在向会员提供 SMHS 时，是否可以解决向会员提供的 SMHS 中同时发生的物质使用问题？
参考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.
DMC/DMC-ODS 提供商在向会员提供 SUD 服务的同时，是否可以解决在向会员提供的服务中同时发生的心理健康问题？
参考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.