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
If under the No Wrong Door policy, a member can retain a pre-existing NSMHS Medi-Cal provider while also receiving SMHS from the MHP, is there a need to adhere to the provider vetting and contracting Continuity of Care (CoC) requirements per BHIN 18-059?
No. The No Wrong Door policy allows members to receive non-Specialty Mental Health Services (NSMHS) (via a Fee-For-Service or Managed Care Plan [MCP] provider) and SMHS (via a Mental Health Plan [MHP] provider) concurrently when all of the services are clinically appropriate, the treatment is coordinated between the delivery systems and the services are not duplicative. CoC rules do not apply to No Wrong Door and there is no need to adhere to the provider vetting and contracting processes outlined in BHIN 18-059. CoC allows members with pre-existing MHP provider relationships who make a request to the MHP to continue receiving SMHS for up to 12 months with an out-of-network Medi-Cal provider or a terminated network provider who would continue delivering SMHS (i.e., an employee of the MHP or a contracted organizational provider, provider group, or individual practitioner).
“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.