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Date: December 9, 2019
To: Health Plan of San Joaquin (HPSJ) Practitioners and Providers
From: HPSJ Claims Department
Subject: Prop 56 – Screening for Adverse Childhood Experiences
Update & Webinar

  • Additional $$$ Reimbursements
  • DHCS webinar, Wednesday, December 11 (1:00 p.m. – 2:00 p.m.)
  • Upcoming: Required DHCS training
Business: Medi-Cal Managed Care

The Department of Health Care Services (DHCS) has added additional reimbursement for
Adverse Childhood Experiences (ACEs) for dates of service on or after January 1, 2020.
Health Plan of San Joaquin (HPSJ) will reimburse providers for ACEs screenings for both
children and adults up to 65 years of age, except those dually eligible for Medi-Cal and
Medicare Part B with Proposition 56 funds.

Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) and Indian Health Services (IHS) — Memorandum of Agreement (IHS-MOA) 638 –

  • Clinics will also be able to receive these payments, in addition to their
    Prospective Payment System (PPS) and all-inclusive per-visit
  • Additional information about how FQHC/RHC/IHS-MOA providers should
    bill for trauma screening will be released in a future Medi-Cal Update.

❖ Individuals under 21 years of age may receive periodic rescreening as determined
appropriate and medically necessary, but screenings will not be paid more than once
per year, per provider.

❖ The screenings for individuals 21 years of age and older will not be paid 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 and older. For individuals 18 and 19 years of age, either tool may be utilized.

Prop 56 – Screening for Adverse Childhood Experiences
Update & Webinar

*If an alternative version of the ACEs questionnaire for individuals 20 years of age and 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 (FFS) and managed care
plan (MCP) delivery systems 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

MCPs will reimburse network providers no less than $29 for each qualifying ACEs
screening. The requirements for billing are:

  1. Reviewed completed screen
  2. Standardized screening tool used
  3. Results documented and interpreted
  4. Results discussed with beneficiary and/or family
  5. Any clinically appropriate actions taken and documented

*Documentation should remain in the beneficiary’s medical record and be available
upon request.

Required DHCS Training

If you have questions, please contact our Customer Service Department at 209-942-6320.