Payment
Effective January 1, 2020, Medi-Cal providers became eligible for a $29 payment for conducting ACE screenings for child and adult patients with full-scope Medi-Cal. Payment is not available for patients age 65 and older or for those who are dually eligible for Medi-Cal and Medicare Part B (regardless of enrollment in Medicare Part A or Part D).
Qualifying ACE screenings are eligible for payment in any clinical setting in which billing occurs through Medi-Cal fee-for-service or to a network provider of a Medi-Cal managed care plan.
- Medi-Cal Managed Care
Network providers will receive payment from managed care plans in addition to whatever the provider is paid by the managed care plan for the accompanying office visit.
- Fee-for-Service
Payments will follow the typical process and will be paid directly to the provider submitting the claim.
Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Cost-Based Reimbursement Clinic (CBRCs), and Indian Health Services (IHS) are also eligible for the $29 payment.
Guidance on Billing for ACE Screening via Telehealth
Providers may screen a patient for ACEs via telehealth if the provider believes that the ACE screening can be administered in a clinically appropriate manner via telehealth, per new DHCS guidance in response to COVID-19. Providers must continue to comply with all other billing procedures, Medi-Cal guidelines, and confidentiality laws.
Under the existing ACE screening policy, providers must document all of the following: the tool that was used, that the completed screen was reviewed, the results of the screen, the interpretation of results, what was discussed with the member and/or family, and any appropriate actions taken. This documentation must remain in the beneficiary’s medical record and be available upon request.
See more information about telehealth and virtual/telephonic communications under the new COVID-19-related guidance.