The California Department of Health Care Services (DHCS), in partnership with the California Office of the Surgeon General, created a first-in-the-nation statewide effort to screen patients for Adverse Childhood Experiences (ACEs) that lead to trauma and the increased likelihood of ACEs-Associated-Health Conditions due to toxic stress. The bold goal of this initiative is to reduce ACEs and toxic stress by half in one generation.
Health Plan of San Joaquin supports this initiative and is working diligently with you, as a provider, to ensure you are informed and have the necessary resources to conduct the screening and support members in need.
ACEs Aware offers provider resources and education on Adverse Childhood Experiences (ACEs), how to screen for ACEs, and a free, 2-hour online training that, upon completion, allows eligible providers to bill for ACEs screenings administered to pediatric and adult Medi-Cal members. Providers who complete and attest to taking the training may receive 2.0 Continuing Medical Education (CME) and 2.0 Maintenance of Certification (MOC) credits.
For billing questions related to ACEs screenings, you can contact our Provider Relations department at 209-942-6340.
The following tools must be used to bill for screenings administered to Medi-Cal members:
PEARLS (for children and adolescent members up to age 19)
Eligible HPSJ providers must complete and attest to taking the online ACEs Aware training in order to bill for qualifying ACEs screenings administered. ACEs Aware outlines the provider types eligible for Medi-Cal payment for ACEs screenings.
Billing and coding are based on the member’s total ACE score. ACE scores range from 0-10. Providers should use the Healthcare Common Procedure Coding System (HCPCS) billing codes based on the results of the screening:
Screening had a score of 4 or greater (high risk)
Screening had a score of 0 to 3 (lower risk)
Billing requires that the completed screening was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the member and/or family, and any clinically appropriate actions were documented. This documentation should remain in the member’s medical record and be available upon request by the member and/or the member’s parent(s) or guardian(s), in compliance with all relevant state and federal privacy requirements.
Providers can bill for ACEs screenings administered to Medi-Cal members younger than 21 once annually, and once per lifetime (per provider) for adult members age 21 through 64.
What if a member screens high risk for ACEs?
Not all members who screen high-risk for ACEs will require treatment, such as outpatient therapy. Providers are encouraged to review the ACEs Aware Clinical Assessment and Treatment Planning guidelines, which outline next steps after screening, including patient education on toxic stress, strategies to regulate the stress response, and validation of existing strengths and protective factors.
HPSJ offers behavioral health services and can help Medi-Cal members navigate their options for follow-up care, if needed.
Contact our Mental Health Services administrator at 1-888-581-PLAN (7526).