​​​​​​​​​​​​​​​​​​CalAIM Behavioral Health Initiative Frequently Asked Questions 

(Added January 2023) The criteria for Beneficiaries under age 21 to access the Specialty Mental Health Services Delivery System identified in BHIN 21-073 states that a licensed mental health professional can provide an assessment showing that the member's condition includes significant trauma. Can a waivered or registered professional provide this assessment?

(Added December 2022) For clients who begin specialty mental health services with Z codes (e.g., Z55-Z65), will they eventually require a mental health diagnosis, or can Z or V codes be the only diagnosis that is submitted for reimbursement? Can a Z code be the primary diagnosis?​

(Added December 2022) If a mental health provider is serving clients with a co-occurring substance use disorder, will that impact clients getting to the correct level of care for SUD treatment?

(Added December 2022) Can SMHS provider submit a claim for an SMHS provided to a beneficiary who also has a Substance Use Disorder (SUD) diagnosis?

​​What is the difference between "medical necessity" and criteria for beneficiaries to access specialty mental health services (SMHS)?

Is a mental health diagnosis required to access covered SMHS?

How long can SMHS be provided prior to a beneficiary receiving a mental health diagnosis?

Which trauma screening tools have been approved by DHCS?

What is the difference between a beneficiary under the age of 21 (1) having a condition placing them at high risk for a mental health disorder due to experience of trauma; and (2) scoring in the high-risk range under a trauma screening tool?

Do the new access criteria for beneficiaries under 21 add to or replace the criteria for admission to an STRTP?​

(Added December 2022) Do the changes to assessment timelines for SMHS impact CANS and PSC-35 requirements? What about the Adult Needs and Strengths Assessment (ANSA) (for adults)?

(Added December 2022) Can providers add problems to the problem list that are not diagnoses? Additionally, are the progress note requirements stated in BHIN 22-019 what is minimally required by DHCS?

(Added December 2022) If MHP providers can now deliver co-occurring treatment and focus on a client's SUD needs as clinically appropriate, does that mean the client's clinical record with the MHP will now be governed by 42 CFR Part 2?

(Added December 2022) Does identifying a staff's credential (e.g., LCSW) meet the requirement for "title" of provider in the problem list?

(Added December 2022) What type of staff can review and obtain signatures for intake informing materials with beneficiaries? Can an administrative staff complete this task, or does it have to be a clinical staff?

(Added December 2022) Are client signatures required for group service progress notes?

(Added December 2022) Are Medicare requirements being taken into consideration since counties must bill to Medicare first? Do clients who have Medicare and Medi-Cal need treatment plans?

(Added December 2022) Because it is not feasible for all currently opened clients to be transferred to having a problem list, what is DHCS' expectation for when clients who have been opened prior to 7/1/22 get a problem list? 

(Added December 2022) Is it advisable for providers to document why a long time, i.e. longer than usual, is taken to complete an assessment?

(Added December 2022) To reduce documentation time, is it acceptable to use checkboxes except where “narrative" is required?

(Added December 2022) Is claiming documentation time allowable under Care Coordination currently and as of 7/1/2022 with the new documentation requirements?

(Added December 2022) If an MHP has a current assessment within their electronic health record (EHR) that captures all seven (7) SMHS assessment domains, will the MHP be required to re-structure their assessment so it is categorized by the new domains?

(Added December 2022) Are the seven (7) domains for an SMHS assessment required for psychiatric diagnostic evaluations?

(Added December 2022) Is there still a DMC-ODS requirement to document the diagnosis as a narrative summary based on the DSM-5 criteria?

How do Medi-Cal providers reconcile the requirements of BHIN 22-019 with the Alcohol and/or Other Drug (AOD) Program Certification Standards that pertain to treatment plans?

How do Medi-Cal providers that operate adult alcoholism or drug abuse recovery or treatment facilities comply with the requirements of BHIN 22-019?

How may providers document the beneficiary's involvement in the treatment process?

Can DHCS provide examples of the seven required SMHS assessment domains?

Can DHCS clarify the DMC-ODS treatment plan requirements?

Is DMC-ODS care coordination the same as Targeted Case Management?

Can Targeted Case Management services be provided prior to an assessment and completion of a Targeted Case Management Care Plan?

Do progress notes need to include the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) descriptor in addition to the ICD-10 code?

If a provider reviews a beneficiary's chart, in preparation for a session with a beneficiary, and the beneficiary no-shows, is the time for chart review claimable?