Behavioral HealthMedicaidNovember 27, 2023

Adult and Youth Screening and Transition of Care Tools for Medi-Cal Managed Care Mental Health Services

On December 27, 2022, the Department of Health Care Services (DHCS) released APL 22-028, Adult and Youth Screening and Transition of Care Tools for Medi-Cal Managed Care (Medi-Cal) Mental Health Services. Within this policy, DHCS provided guidance to Medi-Cal plans (MCP) on standardized, statewide Adult and Youth Screening and Transition of Care Tools to guide referrals of adult and youth Members to the appropriate Medi-Cal mental health delivery system and ensure that Members requiring transition between delivery systems receive timely coordinated care.

The DHCS California Advancing and Innovating Medi-Cal (CalAIM) initiative for Screening and Transition of Care Tools for Medi-Cal Mental Health Services aims to ensure all Medi-Cal members receive timely, coordinated services across Medi-Cal mental health delivery systems and improve member health outcomes. The goal is to ensure Member access to the right care, in the right place, at the right time.

While it is essential that each provider reviews the related APL 22-028, Anthem Blue Cross (Anthem) is providing this bulletin to ensure understanding of each provider’s role in supporting these newly mandated tools that were created to support our membership:

  • All members are screened to determine severity of symptoms based on the algorithm of the standardized screening tool. If member is experiencing non-specialty mental health symptoms or functional impairments, member is referred to a health plan contracted provider. If member meets the specialty mental health symptoms or impairments, member is referred to the MHP County Mental Health.
  • Statewide implementation of the Screening and Transition of Care tools for Medi-Cal Mental Health Services became effective January 1, 2023. DHCS developed standardized Adult and Youth Screening Tools to determine the most appropriate Medi-Cal mental health delivery system referral:
    • The Adult Screening Tool for mental health services is required for use when an individual age 21 or older, who is not currently receiving mental health services, contacts the Medi-Cal MCP or county MHP to seek mental health services.
    • The Youth Screening Tool for mental health services is required for use when an individual under age 21, or a person on behalf of an individual under age 21 who is not currently receiving mental health services, contacts their Medi-Cal MCP or county MHP to seek mental health services.

Screening tools:

  • Both Adult and Youth screening tool have a set of yes and no questions. Not every question is scored. Each scored question has a defined set of points:
    • Adult tool: 14 questions
    • Children/Youth: 23 questions (2 versions – Youth respondent, Respondent on Behalf of Youth).
  • The selected/marked yes are added together to reach a total number. The total score determines if the member is referred to MCP or MHP (County) for a clinical assessment.
  • Total score of 0-5 must be referred to the MCP (non-specialty) for clinical assessment.
  • Total score of 6 and above must be referred to MHP (County-specialty) for clinical assessment.
  • There is an SUD question which does not impact the screening score. If the member responds yes, a referral must be offered to MHP County Behavioral Health.
  • If the score indicates referral to the other delivery system (MCP to MHP (County) or MHP (County to MCP)), a referral is coordinated including sharing of the completed Screening Tool and follow-up to ensure timely assessment/intake has been made.

The Adult and Youth Screening Tools are not administered by health plan-contracted providers:

  • "The Adult and Youth Screening Tools are not required to be used when Members contact mental health providers directly to seek mental health services. Anthem must allow contracted mental health providers who are contacted directly by Members seeking mental health services to begin the assessment process and provide services during the assessment period without using the Screening Tools, consistent with the No Wrong Door for Mental Health Services Policy described in APL 22-005" (APL 22-028 page 7)
  • Outpatient mental health services are open access within the Anthem network. There is no requirement for a prior authorization or registration number for services to be rendered by an in-network provider:
    • Prior-authorization is required for covered services by an out-of-network provider.
  • In accordance with No Wrong Door (APL 22-005), NSMHS coverage includes:
    • Reimbursement for services provided during the assessment period including scenarios in which members meet criteria for services from the county.
    • Members receiving services at both levels of care, as long as services are coordinated and non-duplicative.
    • Substance use diagnosis when billed with a mental health diagnosis on a claim.

Transition of Care Tool

The Transition of Care Tool (TOC) for Medi-Cal mental health services (hereafter referred to as the Transition of Care Tool) leverages existing clinical information to document an individual’s mental health needs and facilitate a referral to the individual’s Medi-Cal plan (MCP/Anthem) or County Mental Health Plan (MHP/County) as needed. The Transition of Care Tool is to be used when an individual who is receiving mental health services from one delivery system experiences a change in their service needs and:

  • their existing services need to be transitioned to the other delivery system, or
  • services need to be added to their existing mental health treatment from the other delivery system.

The Transition of Care Tool does not:

  • Does not need to be used for referrals within the same delivery system
  • For example, member is already receiving therapy services with an Anthem provider and is needing prescriber services from an Anthem provider.
  • Does not constitute or replace clinical assessments
  • Does not determine whether an individual needs to transition (determination must be made by a clinician and the tool itself is the tool used for making the referral)
  • Providers are expected to fill out the Transition of Care Tool as described above.

Provider Transition of Care Tool workflow:

  • To request transition of care and/or add a non-duplicative service with the County Mental Health Plan (MHP) for a member, treating Anthem provider may fax the completed Transition of Care Tool form to 855-473-7902 or can send a completed Transition of Care tool form (TOC) to Anthem via email at bhcmreferrals@anthem.com
  • An Anthem licensed CM clinician will complete a review of the member's clinical information on the TOC form with the provider via phone to confirm if the member requires a transition or addition of a service with the County Mental Health Plan delivery system.
  • If member requires a transition or addition of a service, Anthem licensed CM clinician will send the Transition of Care tool form (TOC) based on the clinical information entered on the form and confirmed/gathered during the provider phone review.
  • The Anthem provider discusses the transition to the County Mental Health Plan delivery system with the member and obtains appropriate consent for the transition. The determination to transition services to and/or add services from the other mental health delivery system (in other words, MCP or MHP) must be made by a clinician via a patient-centered shared decision-making process.
  • The Anthem provider continues to treat the member until the transition is complete; Anthem staff send the Transition of Care tool form (TOC) to the County Mental Health Plan delivery system. Anthem’s internal Case Management Team ensures the member receives an intake assessment appointment at the county delivery system and is connected with a provider.
  • In some cases, some Federally Qualified Health Centers (FQHCs) or integrated behavioral and physical health provider groups may fill out the Transition of Care form (TOC) to send directly to the County Mental Health Plan delivery system.

Resources:

If you have any questions, please reach out to your assigned provider relationship management representative.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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