California – NCCP

California Strategies

Additional California Strategies

Medicaid Coverage of IECMH in Pediatric Care with Risk Factor, Child Social-Emotional Development, and Maternal Depression Screening and Response

In March 2022, the California Department of Health Care Services (DHCS), which oversees Medi-Cal, the state’s Medicaid program, released its Strategy to Support Health and Opportunity for Children and Families, which describes Medi-Cal’s approach to supporting children and families. The approach adopts a family-centered approach to children’s health, including implementing dyadic services in pediatric care settings to support IECMH. These dyadic services are intended to support both child and parent (i.e., the dyad) and include an array of screening and preventive services. The new dyadic services benefit was included in Assembly Bill 133, passed in 2021 and incorporated into state law with coverage beginning January 2023. In conjunction with new guidance on family therapy (which includes dyadic treatment models such as Child-Parent Psychotherapy and Parent-Child Interaction Therapy), these policies expand access to IECMH promotive and preventive services, screening and referrals, and treatment for families with Medi-Cal enrolled infants and young children. This profile focuses on a key component of the new dyadic services for families with children, dyadic behavioral health (DBH) well-child visits, and efforts to support their implementation.

Approximately 99 percent of Medi-Cal members are enrolled in managed care health plans (MCPs), which are responsible for a limited number of mental health services for adults and children, called non-specialty mental health services (NSMHS), including DBH well-child visits. Providers offering DBH well-child visits must deliver the following components:

“Behavioral health history for child and caregiver(s) including caregiver(s) interview addressing child’s temperament, relationship with others, interests, abilities, and caregiver concerns
Developmental history of the child
Observation of behavior of child and caregiver(s) and interaction between child and caregiver(s)
Mental status assessment of caregiver(s)
Screening for family needs which may include tobacco use, substance use, utility needs, transportation needs, and interpersonal safety, including guns in the home
Screening for social determinants of health such as poverty, food insecurity, housing instability, access to safe drinking water, and community level violence
Age-appropriate anticipatory guidance focused on behavioral health promotion/risk factor reduction, which may include:
- Educating caregiver(s) on how their life experiences (for example, ACEs) impact their child’s development and their parenting
- Educating caregiver(s) on how their child’s life experiences (for example, ACEs) impact their child’s development
- Information and resources to support the child through different stages of development as indicated
Making essential referrals and connections to community resources through care coordination and helping caregiver(s) prioritize needs.”

HealthySteps and Dulce (see PRiSM profiles of HealthySteps and Dulce for more information) are models mentioned in Medi-Cal guidance as meeting the requirements for DBH well-child visits. These models are delivered by a trained specialist and include parent and child mental health and social determinants of health risk factor screening, brief parenting interventions, and referrals to community resources, including IECMH services.

The DBH well-child visit does not require a diagnosis and is billed to the child’s Medi-Cal using CPT code H1011 with modifier U1 to indicate a dyadic service (the child’s caregiver is not required to be a Medi-Cal member). It should be provided, if possible, on the same day as the medical well-child visit. NSMHS, including DBH well-child visits, may be provided by a range of mental health professionals: Licensed Clinical Social Workers (LCSWs), Licensed Professional Clinical Counselors (LPCCs), Licensed Marriage and Family Therapists (LMFTs), licensed psychologists, Psychiatric Physician Assistants (PAs), Psychiatric Nurse Practitioners (NPs), and psychiatrists as consistent with the practitioner’s training and licensing requirements.

DHCS guidance on DBH well-child visits states that they are intended to be universal and must be offered to families without being requested. DHCS also provided information on covered dyadic services in one of its monthly forums for MCPs, and additional guidance is being developed for fee-for-service providers.

Because most healthcare providers were not delivering services like DBH well-child visits before the creation of the benefit, there has been a need for implementation support in two areas: workforce capacity and practice transformation. University of California, San Francisco (UCSF), has launched the Center for Advancing Dyadic Care in Pediatrics (CADP) to offer technical assistance to healthcare providers. The clinical team affiliated with CADP and based at the Zuckerberg San Francisco General Hospital’s (ZSFG) Children’s Health Center has offered HealthySteps since 2019, and a local HealthySteps billing pilot they spearheaded was integral to the effort to include the dyadic services benefit in state law. Among a variety of funding sources supporting CADP services, state grant funding supports CADP’s current partnership with the San Francisco Department of Public Health to expand HealthySteps to eight additional San Francisco Health Network clinics based on the prospect of Medi-Cal reimbursement. (As a federally qualified health center, the ZSFG Children’s Health Center is covered by separate Medi-Cal payment rules, which are still being finalized by the state for DBH well-child visits).

Clinicians with training in mental health often lack experience and expertise in providing services to families with infants and young children. To increase providers’ capacity to deliver DBH well-child visits, CADP provides trainings, consultation, and learning collaboratives, as well as internships and postdoctoral fellowships. HealthySteps has established a set of competencies for its specialists, and CADP can work with healthcare providers to identify competencies that existing or prospective staff need to become HealthySteps specialists, and offer needed training.

However, even with staff trained to provide DBH well-child visits, healthcare providers need to transform their practices to integrate the dyadic behavioral health approach. From its own experience of implementing dyadic services, CADP emphasizes the need for DBH well-child visit providers to build strong relationships with other members of the healthcare practice. The HealthySteps National Office offers tools for integrating HealthySteps into a practice; CADP complements HealthySteps technical assistance by offering a depth of practice transformation support to both HealthySteps sites and practices that are model agnostic, such as workflow development, workforce capacity building, and sustainability guidance adapted to their local conditions. For healthcare practices looking to implement dyadic services, CADP offers online training opportunities for staff from across departments (e.g., nursing, IT, administration) to learn together, as well as opportunities specifically for behavioral health staff to discuss clinical practice and billing. In some cases, a healthcare practice may not serve enough patients to justify a full-time dyadic services provider, in which case CADP will work with the practice to develop its own approach for delivering the DBH well-child visit, such as integrating caregiver mental health screenings and response into well-child visits.

Financing

Fee-for-service reimbursement of DBH well-child visits billed under CPT code H1011 is $92.46.

To support healthcare providers that have had to supplement their existing workforces capable of delivering DBH well-child visits, DHCS allotted $30.5 million to 63 grantees for training on evidence-based practice and community-defined evidence practice parent support programs as part of its Children and Youth Behavioral Health Initiative (CYBHI). Parent support program models include HealthySteps, as well as Positive Parenting Program (Triple P), Incredible Years, and Parent-Child Interaction Therapy (PCIT). Funding from the CYBHI evidence-based grant initiative has allowed CADP to expand HealthySteps to the San Francisco Health Network.

Monitoring and Evaluation

The Managed Care Quality and Monitoring Division within DHCS is responsible for quality and monitoring of MCPs. If an MCP is not meeting requirements on offering DBH well-child visits, then this division will work with the MCP to address the issue.

MCPs’ encounter data on utilization of services will include information on delivery of DBH well-child visits. Anecdotally, DHCS has received positive feedback from stakeholders, including MCPs, on the value of the new benefit for patients.

Special thanks to the following individuals for providing information for this profile: Kay Johnson of Johnson Policy Consulting; at the California Department of Health Care Services, Jim Elliott, Erica Holmes, and Pam Riley; and at UCSF, Kathryn Hallinan, Kate Margolis, Shay-Lee Perez, and Cheng Qian.

Last updated August 2024