20-481 Receive Prop 56 Payments for ACEs Screenings
Date: 06/08/20
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Riverside and San Bernardino 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. |
|
The PEARLS tool and ACEs questionnaire are available on the ACEs Aware Website.
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 on the ACEs Aware website.
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* 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. - 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.
If you have questions about the status of your W-9 form, Prop 56 payments or requesting a remittance advice (RA), contact the Health Net Medi-Cal Provider Services Center within 60 days at 1-800-675-6110.