卡拉伊姆行為健康計劃常見問題
以下是從技術支援和資訊網路研討會收集的常見問題清單，並提交至 BHCalAIM@dhcs.ca.gov 電子郵件中的提交內容。DHCS 將每季更新此列表。
抵押品
由於沒有病人出現的家庭心理治療（CPT 代碼 90846）可以在藥物醫療（DMC）組織分配系統中報告，是否應該在專科心理健康（SMHS）分配系統中報告？
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.
當成員不在 DMC-ODS 分泌系統時，可否使用多家庭團體心理治療（CPT 代碼 90849）報告家庭治療會議？
是的，它可以。
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.
各縣可否使用 HCPCS 代碼 H0007（酒精和/或毒品服務；危機干預）報告附屬聯繫，作為 DMC-ODS 配送系統中危機干預的一部分？
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.
各縣可以使用 HCPCS 代碼 H0032（非醫生制定的心理健康服務計劃）在 SMHS 交付系統中報告附屬聯繫人嗎？
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.
各縣可以使用 HCPCS 代碼 H0034（藥物培訓和支持）報告 DMC-ODS 和 SMHS 交付系統中的附屬聯繫人嗎？
各縣可以在 SMHS 交付系統中使用 HCPCS 代碼 H0034 索取抵押聯繫人，但不可在 DMC-ODS 傳遞系統中。
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.
HCPCS 代碼 H0038 和 H0025 (同行支援服務) 是否包括附屬聯絡人？
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.
復康和恢復是否分別包括 SMHS 和 DMC-ODS 遞送系統中的附屬聯繫人，各縣是否可以使用 HCPCS 代碼 H2017 來描述這些聯繫人？
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.
會員不在時，HCPCS H2021（以社區為本的整合服務）可以用於描述抵押聯繫人嗎？
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.
由 HCPCS 代碼 H2019 描述的治療行為服務可否包括對非成員的生物家庭的個人提供抵押品？
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.
除了治療寄養服務之外，還可以報告門診輔助接觸嗎？
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.
針對性案件管理（HCPCS 代碼 T1017）是否包括附屬聯繫人？
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.
提供針對性案件管理（HCPCS 代碼 T1017）時，會員是否需要在場？
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.
一個縣可否報告 H2035（酒精和/或其他藥物治療服務），並另外另行報告一項抵押服務？
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:
- 評估
- 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.”
- 護理協調
- 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.”
- 輔導
- 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.”
- 家庭治療
由於可以通過支援服務的門診服務（評估、護理協調、諮詢和家庭治療）申請復康服務，所以該縣還可以申請附屬門診服務，該縣除了 HCPCS 代碼 H2035 之外，還可以索取其中一個服務類別中的附屬門診服務。