20-319 Receive Prop 56 Payments for ACEs Screenings

Date: 03/27/20

This information applies to Physicians, Participating Physician Groups (PPGs).

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

 

Complete mandatory training and submit attestation to get payments after June 30, 2020

Directed payments for standardized adverse childhood experiences (ACEs) screenings have been approved starting January 1, 2020. These screenings evaluate trauma that occurred during the first 18 years of life.

Select the right trauma screening tool

Different trauma screening tools are used based on the patient’s age at the time of the evaluation – Pediatric ACEs and Related Life-events Screener (PEARLS) or ACEs.

Ages	Use this screening tool…	To receive directed payment
0–17	PEARLS	Not given more than once during a 12-month period, per provider, per member.
18 or 19	ACEs or PEARLS	Not given more than once during a 12-month period, per provider, per member.
20–64	ACEs screening portion of the PEARLS tool (Part 1) can also be used.	·   Not given more than once during a 12-month period, per provider, per member under age 21. ·   Not given more than once per lifetime, per provider, per member ages 21 and older.

The PEARLS tool and ACEs questionnaire are available at www.acesaware.org/screen/
screening-for-adverse-childhood-experiences/.

Complete training and follow requirements to qualify

How to attend training

Contracted providers must train on trauma-informed care, including how to use the PEARLS tool and the ACEs questionnaire. The training requirement is waived for dates of service prior to July 1, 2020, and providers have until the end of June 2020 to complete the training.

The Department of Health Care Services (DHCS) will give and/or authorize ACEs-oriented trauma-informed care training for contracted providers and their ancillary office staff. Training can be done in person, from regional gatherings and online. More information about training and other resources is available at www.acesaware.org/.

DHCS’ training responsibilities

DHCS must:

• Approve or authorize any trauma-informed care training that is not provided by DHCS.
• Establish a website for providers to self-attest to their one-time completion of the state-sponsored trauma-informed care training.
• Maintain a list of providers who have self-attested to their completion of the training that can also be accessed by the medical plan.

Additional requirements

• Contracted rendering providers must self-attest to completing the trauma-informed care training by July 1, 2020, and be on the list maintained by DHCS.
• Use either the PEARLS tool or a qualifying ACEs questionnaire. To qualify a different version of the ACEs questionnaire, it must have questions from the 10 original categories of ACEs. The 10 categories grouped under three topics include:

        -        Abuse – physical, emotional and sexual

        -        Neglect – physical and emotional

        -        Household dysfunction – incarcerated member, mental illness, substance dependence, parental separation or divorce, and exposure to domestic violence

• Submit a clean claim to Health Net*, on behalf of CalViva Health, with dates of service on or after January 1, 2020, within one year from the date of service.
• Claim data must be appropriate for the services provided. HCPCS codes G9919 and G9920 are not reported for non-qualifying ACEs screening services or for any other services.
• Document all of the following information:

        -        Screening tool used

        -        Review date of completed screen

        -        Results of the screen

        -        Interpretation of the results

        -        Discussion with member and/or family

        -        Any appropriate action taken

The documents should remain in the member’s medical record and be available upon request.

• Dually eligible members with Medi-Cal and Medicare Part B are not eligible for Prop 56 payments for ACEs screening services (regardless of enrollment in Medicare Part A or Part D).

Find your ACEs screening score

To bill for ACEs screening, contracted providers must match the correct HCPCS code based on the score and description of the screening performed.

HCPCS code	Description of screening performed	Amount	ACEs screening score is…
G9919	Positive results and provision of recommendations given	$29.00	4 or greater for high risk
G9920	Negative results	$29.00	Between 0–3 for lower risk

 

 

Payments for HCPCS G9919 and G9920

Clean claims must be received within one year from the date of service. Payments for codes G9919 or G9920 are made within 90 calendar days of receipt.

• The medical plan is financially responsible. All providers delivering ACEs services need to submit their claims to
  Health Net, on behalf of CalViva Health.
• Under age 21, payment is allowed once during a 12-month period, per member screened by that provider.
• Age 21 and up to 65 (adult), payment is allowed once per lifetime, per member screened by that provider.

How to file a grievance

For information about the appeals or dispute resolution process, access the provider website at provider.healthnet.com. Go to the Provider Library under Operations Manual > Dispute Resolution, Organization Determinations and Appeals > Provider Appeals and Dispute Resolution > Dispute Submission.

Additional information

For more information on these approved directed payments for ACEs screening, refer to the DHCS All Plan Letter (APL)
19-018, distributed on December 26, 2019, and Medi-Cal Bulletin 547, dated January 2020. You can also visit the DHCS website at www.dhcs.ca.gov/.  

If you have questions about the status of your W-9 form, Prop 56 payments or requesting a remittance advice (RA), contact CalViva Health at 1-888-893-1569.