02/26/20: 12 PM – 1 PM PST
This will be the first of a series of webinars that will offer practical information to help providers integrate ACEs screening and response into their clinic and workflows. Screening for Adverse Childhood Experiences Is a Medi-Cal Benefit. Effective for dates of service on or after January 1, 2020, screening for Adverse Childhood Experiences (ACEs) is a Medi-Cal benefit. Medi-Cal reimburses for ACEs screenings for both children and adults up to 65 years of age, except for those dually eligible for Medi-Cal and Medicare Part B, with California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56) funds. Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services – Memorandum of Agreement (IHS-MOA) 638, Clinics will also be able to receive these reimbursements, in addition to their Prospective Payment System (PPS) and all-inclusive per-visit reimbursement.
Individuals under 21 years of age may receive periodic rescreening as determined appropriate and medically necessary, but screenings will not be reimbursed more than once per year, per provider. Screenings for individuals 21 years of age or older will not be reimbursed more than once in their lifetime, per provider. The required screening tool for use by providers is the top portion of the Pediatric ACEs and Related Life-events Screener (PEARLS) for individuals under 18 years of age and the ACEs questionnaire for individuals 20 years of age or older. For individuals 18 or 19 years of age, either tool may be utilized. If an alternative version of the ACEs questionnaire for individuals 20 years of age or older is used, it must contain questions on the 10 original categories of ACEs to qualify.
ACEs screenings will be reimbursed in both the fee-for-service Medi-Cal program and Managed Care Plans (MCPs) when billed with either of the two HCPCS codes below:
G9919 – High-risk, patient score of 4 or greater
G9920 – Lower-risk, patient score of 0 – 3
These codes may be billed to Medi-Cal directly even if the recipient has Other Health Coverage (OHC).
For fee-for-service Medi-Cal providers, screenings for ACEs are reimbursed at the Medi-Cal rate up to $29. For Medi-Cal MCPs, screenings for ACEs are reimbursed no less than $29 for each qualifying ACEs screening. Billing requires that the completed screening was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the recipient and/or family and any clinically appropriate actions were documented. This documentation should remain in the recipient’s medical record and be available upon request. The Department of Health Care Services (DHCS) will release additional information in a future announcement about how FQHCs, RHCs and IHS-MOA clinics can bill for trauma screening.
In order to be eligible for the trauma screening reimbursement after July 1, 2020, providers must complete the DHCS training for ACEs screening and trauma-informed care. In December 2019, DHCS launched www.ACEsAware.org, which includes information about DHCS’ provider training and other resources.