Screening and Transition of Care Tools for Medi-Cal Mental Health Services
Frequently Asked Questions
Purpose of Tools
Requirement for Use of Tools
Tool Administration
Scoring
Referrals
Translation
Compliance
Intersection with other Policies
Why are Screening and Transition of Care Tools for Medi-Cal Mental Health Services being implemented?
The Department of Health Care Services (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 individuals receive coordinated services across Medi-Cal mental health delivery systems and improve health outcomes. The goal is to ensure access to the right care, in the right place, at the right time.
What is the purpose of the Adult and Youth Screening Tools for Medi-Cal Mental Health Services?
The purpose of the Adult and Youth Screening Tools for Medi-Cal Mental Health Services (hereafter referred to as Screening Tools) is to determine the appropriate Medi-Cal mental health delivery system to refer an individual who is not currently receiving mental health services. Medi-Cal Managed Care Plan (MCP) or county Mental Health Plan (MHP) are required to use the tools when contacted by an individual, or a person on their behalf if under age 21, seeking mental health services.
Are the Screening Tools intended to function as assessments to determine medically necessary services?
No. The Screening Tools are not assessments and do not replace assessments. The Screening Tools identify initial indicators for the mental health needs of an individual who is not currently receiving mental health services. The Screening Tools determine whether an individual should be referred to the MCP or MHP to receive an assessment. Once the Screening Tool has been administered, the individual will be referred to the appropriate Medi-Cal mental health delivery system for a clinical assessment.
Do the Screening Tools address substance use disorder service needs?
The primary purpose of the Screening Tools is to identify the most appropriate Medi-Cal mental health delivery system when a beneficiary is not currently receiving mental health services. The Screening Tools include questions related to substance use disorder that do not impact the screening score but require a referral for SUD assessment if an individual responds affirmatively. If an individual responds affirmatively to an SUD question, the MCP or MHP must offer them a referral to the county behavioral health plan for SUD assessment in addition to completing the screening tool and making an appropriate mental health delivery system referral. The beneficiary may decline the referral for SUD assessment without impact to their mental health delivery system referral.
What is the purpose of the Transition of Care Tool for Medi-Cal Mental Health Services?
The Transition of Care Tool for Medi-Cal Mental Health Services (hereafter referred to as Transition of Care Tool) supports timely and coordinated care when individuals who are currently receiving mental health services from either the MCP or MHP need services transitioned to the other Medi-Cal mental health delivery system, or need to add services provided by the other delivery system.
Is the Transition of Care Tool intended to function as an assessment to determine medically necessary services?
No. The Transition of Care Tool is not an assessment and does not replace assessments. Furthermore, the Transition of Care Tool is not intended to function as a tool to determine whether an individual should transition from one Medi-Cal mental health delivery system to another or whether additional services provided by the other Medi-Cal mental health delivery system should be added to an individual's existing mental health treatment. These determinations must be made by the clinician through a patient-centered decision process. The Transition of Care Tool leverages existing clinical information to document an individual's mental health needs and support a referral for a transition of care or addition of services from the MCP or MHP as determined through an individualized clinical assessment of need.
Are the Screening Tools and Transition of Care Tool intended to be used together?
No. The Screening Tools and the Transition of Care Tool are distinct tools with distinct purposes. The Screening Tools are for when individuals who are not currently receiving mental health services contact an MCP or an MHP to be connected to services. The Transition of Care Tool is for individuals who are currently receiving mental health services from either the MCP or MHP, and who need their services transitioned from one Medi-Cal mental health delivery system to the other, or who need services added to their treatment from the other Medi-Cal mental health delivery system.
Who is required to use the Screening Tools?
MCPs and MHPs are required to use the Screening Tools as outlined in APL 22-028 and BHIN 22-065. The Screening Tools are not required for use by mental health providers (or other community providers) when individuals contact them directly to seek mental health services. Mental health providers who are contacted directly by beneficiaries seeking mental health services may 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 and BHIN 22-011.
Are MCPs and MHPs required to use the Screening Tools with everyone who contacts them for any purpose?
No. MCPs and MHPs are only required to use the Screening Tools when individuals who are not currently receiving mental health services from either Medi-Cal mental health delivery system contact them to seek mental health services. The Screening Tools are not required for use with individuals who are currently receiving mental health services or individuals who contact the MCP or MHP for purposes other than to seek mental health services. Additionally, the Screening Tools do not replace MCP or MHP policies and procedures that address urgent or emergency care needs. If an individual is in crisis or experiencing a psychiatric emergency, the MCP or MHP should follow their emergency and crisis protocols.
Who is required to use the Transition of Care Tool?
MCPs and MHPs are required to use the Transition of Care Tool to coordinate care transitions between the two delivery system as outlined in APL 22-028 and BHIN 22-065. MCPs and MHPs may choose to require providers to use the Transition of Care Tool when transitioning an individual to, or adding services from, the other Medi-Cal mental health delivery system. MCPs and MHPs must ensure that their Subcontractors and Network Providers comply with all applicable state and federal laws and regulations, contract requirements, and other DHCS guidance.
Is the Transition of Care Tool required for use when an individual is being referred within the same delivery system?
No. The Transition of Care Tool is only required for use when an individual's care is being transitioned to the other Medi-Cal mental health delivery system (i.e., MCP or MHP) or services are being added from the other mental health delivery system.
Can questions/fields be added to the Screening and Transition of Care Tools and/or can the tools be integrated with existing tools?
No. Questions/fields may not be added to or removed from the Screening Tools or the Transition of Care Tool. Further, the specific wording and ordering of the questions/fields in the tools must remain intact and the scoring methodology for the Screening Tools may not be altered. MCP or MHP processes that follow administration of the tools and do not alter these components of the tools, such as collecting beneficiary identification information or asking questions to coordinate referrals, are allowable.
The Screening Tools determine the appropriate mental health delivery system prior to assessment and should not be integrated with existing tools that serve this same purpose. The Transition of Care Tool supports documentation and coordination for transitions of care to or addition of services from the other mental health delivery system and should not be integrated with existing tools that serve this same purpose. The Transition of Care tool does not determine whether care should be transitioned or services should be added from the other delivery system and, thus, does not replace tools or other resources that may support a clinician in making those determinations.
Are those administering the Screening Tools able to deviate from the specific wording if they are asked to clarify a question?
Questions in the Screening Tools must be asked in full using the specific wording provided in the tool and in the specific order the questions appear in the tools, to the extent that the individual is able to respond. There may be instances where the person administering the screening is asked to clarify a question for the individual to be able to respond. As part of the implementation of the Screening Tools, MCPs and MHPs are expected to train staff on approaches to respond to requests for clarification that are aligned with the intent of the question(s) and existing internal policies.
Is deviation from the specific wording in the Screening Tools allowable as part of translation?
Yes. Deviation from the specific wording of screening questions is allowable as part of translation into another language if DHCS has not yet provided translated versions of the screening questions in that language. For additional information on cultural and linguistic requirements, MHPs should reference California Code Regulations (CCR) Title 9 section 1810.410 and BHIN 20-070, Threshold Languages Data. For additional information on federal and state requirements regarding nondiscrimination, discrimination grievance procedures, language assistance, and communications with individuals with disabilities, MCPs should reference APL 21-004, Standards for Determining Threshold Languages, Nondiscrimination Requirements, and Language Assistance Services, or subsequent updates.
Are MCPs and MHPs required to build the Screening and Transition of Care Tools into their electronic health record systems?
No. DHCS has provided the Screening and Transition of Care Tools as fillable PDF documents but is not requiring that MCPs and MHPs use a particular format to administer the tools. MCPs and MHPs may choose to use the fillable PDF format or may build the tools into existing systems, such as electronic health records, as long as the specific wording, order of questions, and scoring methodologies in the Screening Tools remain intact and the specific wording and order of fields in the Transition of Care Tool remain intact.
What does the Screening Tools score determine?
The Screening Tools each include a scoring methodology based on responses to the tools' questions. The score generated by the Screening Tools determines whether the individual will be referred to the MCP or the MHP for clinical assessment. The screening score does not determine level of care or which services are medically necessary. These determinations are made during clinical assessment and clinically appropriate services may be provided during the assessment period, as described in in APL 22-005 and BHIN 22-011.
What if the person administering the Screening Tool disagrees with the screening score? Are MCPs and MHPs required to adhere to the delivery system referral indicated by the screening score?
Individuals must be referred to the appropriate Medi-Cal mental health delivery system (i.e., the MCP or the MHP) for a clinical assessment based on their screening score. The Screening Tools are designed for administration by both non-clinicians and clinicians and do not require clinical judgment to be administered. Once referred to the MCP or MHP, the individual will receive a clinical assessment that will determine the level of care and medically necessary services.
Is there a scoring methodology for the Transition of Care Tool?
No. The Transition of Care Tool supports timely and coordinated care when adding a service from the other Medi-Cal mental health delivery system (i.e., MCP or MHP) or completing a transition of care to the other Medi-Cal mental health delivery system. The tool does this by providing a standardized process for sharing information and facilitating coordination across delivery systems. The tool is not meant to be diagnostic, and it is also not meant to replace existing DHCS criteria for access to specialty and non-specialty mental health services. MCPs and MHPs should follow existing access criteria and processes when determining whether a transition of care to, or addition of services from, the other delivery system is necessary for a beneficiary. Importantly, the determination as to whether a transition of care or addition of services should occur must be made by a clinician. This approach preserves flexibility for MCPs and MHPs; if an MCP or MHP uses an existing rubric that aligns with the access criteria, this policy does not prohibit them from continuing to use it to support determination of whether a referral for a transition of care to, or addition of services from, the individual's MCP or MHP is needed. Once a determination has been made to transition care to, and/or add services from, the other delivery system, MCPs and MHPs are required to use the Transition of Care Tool to facilitate the referral.
Are MCPs and MHPs allowed to re-screen individuals if they feel they were not scored appropriately?
No. Once an individual is referred to a MCP or MHP after using the Screening Tools, the receiving MCP or MHP may not re-screen individuals. If an individual is referred to an MCP or MHP based on the score generated by administration of the Screening Tool, the MCP or MHP must ensure the individual receives timely access to care, including a timely clinical assessment, in alignment with existing standards and medically necessary mental health services.
How soon after receiving a referral from the other delivery system must MCPs and MHPs offer an appointment for clinical assessment?
In accordance with AB 205, plans must comply with the appointment time standards pursuant to Section 1300.67.2.2 of Title 28 of the California Code of Regulations (CCR), as well as the standards set forth in contracts between DHCS and plans. Appointment time standards begin from the time of the initial request for health care services by an enrollee or the enrollee's treating provider. If one Medi-Cal mental health delivery system (i.e., the MCP or MHP) is referring an individual to the other mental health delivery system based on their screening score, appointment time standards would begin the day the MCP or MHP receives the referral. If a Medi-Cal mental health delivery system (i.e., the MCP or MHP) is referring an individual for a clinical assessment within its own delivery system based on their screening score, appointment time standards would begin the day the individual contacted the MCP or MHP initially seeking services.
What if an individual is referred to the MCP or MHP based on their screening score, but their subsequent clinical assessment indicates that they belong in the other delivery system?
While the Screening Tools are intended to direct individuals to the most appropriate delivery system for clinical assessment and medically necessary services, there may be instances when the clinical assessment (which captures additional information) reveals that the individual should receive services in the other delivery system. In these cases, the determination of level of care and medically necessary services from the clinical assessment would take priority over the delivery system referral indicated by the screening score. If this occurs, the MCP or MHP would use the Transition of Care Tool to facilitate a transition of care to the other mental health delivery system. As part of this process, the MCP or MHP must coordinate with the other mental health delivery system, including ensuring that the referral process has been completed, the individual has been connected with a provider in the new system, the new provider accepts the care of the individual, and medically necessary services have been made available to the individual.
Will DHCS be providing translated versions of the Screening Tools?
Yes. DHCS intends to translate the Screening Tools into Spanish and other threshold languages. Timing for the release of the translated versions of the Screening Tools will be forthcoming.
Are there reporting requirements for the Screening and Transition of Care Tools?
DHCS intends to evaluate the Screening and Transition of Care Tools initiative over time to ensure individuals are receiving appropriate and timely access to care. As part of this process, additional reporting may be requested.
How do the Screening Tools align with No Wrong Door policy?
The Screening and Transition of Care Tools do not contradict and should not serve as a barrier to the objectives of the No Wrong Door policy. The tools are focused on getting individuals to the “right" door from the start or helping transition beneficiaries to their “next" door as seamlessly as possible. The objective is to ensure individuals are directed to the most appropriate delivery system for assessment and services using a standardized approach. In addition, mental health providers who are contacted directly by beneficiaries seeking mental health services may 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 and BHIN 22-011.
