24-1163m Complete Mandatory Training, Get Prop 56 Payments

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.

Step

Action

How to attend training

Contracted physicians and other providers must train on trauma-informed care, including how to use the PEARLS tool and the ACEs questionnaire. The training is required to receive payment.

The Department of Health Care Services (DHCS) will give and/or authorize ACEs-oriented trauma-informed care training for contracted physicians or other providers and their ancillary office staff.

DHCS’ training responsibilities

DHCS must:

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

Additional requirements

• Contracted rendering physicians or other providers must self-attest to completing the trauma-informed care training 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.
• 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 when screening a member:
  • 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).

HCPCS code

Description of screening performed

Amount earned

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