Frequently Asked Questions

This page provides answers to operational questions regarding ACEs screenings paid for by Medi-Cal. If you have any questions, please contact info@ACEsAware.org.

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Screening

No. ACE screenings are not mandatory. Medi-Cal providers are encouraged to screen Medi-Cal pediatric and adult patients. Medi-Cal providers can receive payment for providing qualified ACE screenings since they will be a Medi-Cal-covered benefit beginning on January 1, 2020.

Implementation of these payments for screenings provided to beneficiaries enrolled in an MCP is subject to obtaining the necessary federal approvals.

No. It is not mandatory. Medi-Cal beneficiaries do not have to complete an ACE screening.

Yes. Eligible Medi-Cal providers who screen Medi-Cal patients for ACEs can receive payment as of January 1, 2020. Beginning on July 1, 2020, Medi-Cal providers must have taken a certified Core Training and self-attested to completing the training to continue to receive Medi-Cal payment for ACE screenings. There is currently one Core Training available, Becoming ACEs Aware in California.

Yes. MCPs will pay network providers for completing qualifying ACE screenings on Medi-Cal beneficiaries enrolled in a MCP.

For children, the screening tool required for use is the Pediatric ACEs and Related Life Events Screener (PEARLS) tool. There are versions of the tool based upon age: PEARLS for children ages 0-11, to be completed by a caregiver; PEARLS for teenagers 12-19, to be completed by a caregiver; and PEARLS for teenagers 12-19, self-reported. All versions of PEARLS are available as identified and de-identified screeners. The ACE score refers only to Part 1 of PEARLS (Part 2 asks about social determinants of health and is not required).

In total, there are eight versions of the PEARLS tool:

  • PEARLS for children ages 0-11, to be completed by a caregiver with identified responses
  • PEARLS for children ages 0-11, to be completed by a caregiver with de-identified responses
  • PEARLS for children ages 0-11, with de-identified responses in Part 1 and identified responses in Part 2
  • PEARLS for adolescents 12-19, to be completed by a caregiver with identified responses
  • PEARLS for adolescents 12-19, to be completed by a caregiver with de-identified responses
  • PEARLS for adolescents 12-19, self-reported with identified responses
  • PEARLS for adolescents 12-19, self-reported with de-identified responses
  • PEARLS for adolescents 12-19, self-reported with de-identified responses in Part 1 and identified responses in Part 2

Eligible providers will be paid for the screening if any of the versions are used. The ACEs screening portion (Part 1) of the PEARLS tool is also valid for use to conduct ACEs screening among adults age 20 and older. Access the screening tools.

 

For adults, the screening tool required for use is the ACE Assessment Tool adapted from the work of Kaiser Permanente and the Centers for Disease Control and Prevention. Access the Identified and de-identified versions of the screening tools. If an alternative version of the ACE questionnaire for individuals age 20 and older is used, it must contain questions on the ten original categories of ACEs (and be available in an identified and de-identified response format) to qualify for payment.

 

No. Eligible Medi-Cal providers who conduct qualifying ACE screenings will be paid up to $29 in the fee-for-service (FFS) delivery system and no less than $29 in the medical managed care delivery systems.

Yes. The screening tools will be available on the DHCS Trauma Screenings and Trauma-Informed Care Provider Trainings webpage. Screening tools are also currently available on the ACEs Aware website.

To bill Medi-Cal, providers should use the Healthcare Common Procedure Coding System (HCPCS) billing codes based on the results of the screening. Code G9919 is used for screens that have a score of 4 or greater (high risk) and code G9920 is used for screens that have a score of 0 to 3 (lower risk). Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the beneficiary and/or family, and any clinically appropriate actions were documented. This documentation should remain in the beneficiary’s medical record and be available upon request.

The ACE Screening Clinical Algorithm (ADA version) helps a provider assess whether a patient is at low, intermediate or high risk of a toxic stress physiology, and how to incorporate ACE screening results into clinical care and follow-up plans. The algorithm is based on a combination of both the ACE score and presence or absence of ACE-Associated Health Conditions.

Clinical response to identification of ACEs and increased risk of toxic stress should include:

  1. Applying principles of trauma-informed care including establishing trust, safety and collaborative decision-making.
  2. Identification and treatment of ACE-Associated Health Conditions by supplementing usual care with patient education on toxic stress and strategies to regulate the stress response including:
    1. Supportive relationships;
    2. Mental health treatment (if indicated);
    3. Regular exercise;
    4. Good sleep hygiene and high-quality sleep;
    5. Healthy nutrition; and
    6. Mindfulness practices.
  3. Validation of existing strengths and protective factors.
  4. Referral to patient resources including educational materials, community resources, social work, and/or mental health care as necessary.
  5. Follow-up as necessary.

Training

Providers can take a free, two-hour training to learn about ACEs, screening tools, and trauma-informed care. A certified Core Training is available at https://training.acesaware.org/. Additional trainings will be offered in 2020. Providers may receive Continuing Medical Education (CME) credits and Maintenance of Certification (MOC) credits upon completion. More information on credits can be found on the training website.

The training educates Medi-Cal providers about the importance of incorporating ACE screenings into their clinical practices, how to conduct ACE screenings, how to use clinical protocols to determine treatment plans, and best practices in providing trauma-informed care. Information for all providers interested in ACEs and trauma-informed care, as well as patients who have questions, is available at www.ACEsAware.org.

The training is available to all providers.

Providers can self-attest to their one-time completion of the state-certified trauma-informed care training on the Medi-Cal Trauma Screening Training Attestation page. DHCS will maintain a list of providers who have self-attested to their completion of the training that can also be accessed by MCPs.

Beginning July 1, 2020, Medi-Cal providers must attest to completing certified ACEs training on the DHCS website to continue receiving payment.

  • The Postgraduate Institute of Medicine accredited the Becoming ACEs Aware in California Training for:
    • 2.00 American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 Credit™
    • 2.00 American Academy of Family Physicians (AAFP) Prescribed credits
    • 2.00 American Nurses Credentialing Center (ANCC) contact hours
    • 2.00 American Academy of PAs (AAPA) Category I CME credits
    • 2.00 American Psychological Association (APA) Continuing Education (CE) credits
    • 2.00 Association of Social Work Boards (ASWB) CE credits
    • 2.00 NAADAC (the Association for Addiction Professionals) credits
    • 2.00 American Board of Internal Medicine’s (ABIM) points in the MOC II program
    • 2.00 American Board of Pediatrics’ (ABP) points in the MOC program

Learners may also take the course for attendance only. More information about credit types is available on the Becoming ACEs Aware in California training website.

 

Yes. In order to receive the payment, eligible providers must complete the Becoming ACEs Aware in California training or an ACEs Aware-certified Core Training. ACEs Aware is partnering with organizations across California to create additional training opportunities for providers interested in learning more about ACE screening and trauma-informed care.

There is not a “train the trainer” component for the ACEs Aware initiative at this time. When available, we will post all training opportunities on the ACEs Aware website.

The ACEs Aware initiative is providing grants and additional opportunities to support community and in-person ACEs Aware trainings. When available, we will post all training opportunities on the ACEs Aware website.

Billing & Documentation

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 managed care plan. For services provided on or after January 1, 2020, the following enrolled Medi-Cal provider types are eligible to receive payment:

  • Certified Nurse Midwife
  • Certified Nurse Practitioner
  • Group Certified Nurse Practitioners
  • Early and Periodic Screening, Diagnostic, and Treatment Services Providers
  • Licensed Clinical Social Worker – Individual, Group
  • Licensed Professional Clinical Counselor – Individual, Group
  • Marriage and Family Therapist – Individual, Group
  • Physician
  • Physician Group
  • Psychologist
  • County Hospital – Outpatient
  • County Clinics not associated with a Hospital
  • Indian Health Services (IHS)/Memorandum of Agreement
  • Otherwise Undesignated Clinic
  • Outpatient Heroin Detox Center
  • Rehabilitation Clinic
  • Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC)
  • Out of state

To receive payment through Medi-Cal managed care, the provider also needs to be a network provider of a Medi-Cal managed care health plan billing for services provided to a member of that health plan.

Billing and coding are based upon the beneficiary’s total ACE score. The ACE score refers to the total reported exposure to the ten ACE categories indicated in the adult ACE assessment tool or the first box of the PEARLS tool. ACE scores range from 0 to 10.

To bill Medi-Cal, providers should use the Healthcare Common Procedure Coding System (HCPCS) billing codes based upon the results of the screening.

  • HCPCS code G9919 is used for screens that have a score of 4 or greater (high risk)
  • HCPCS code G9920 is used for screens that have a score of 0 to 3 (lower risk)

Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the beneficiary and/or family, and any clinically appropriate actions were documented. This documentation should remain in the beneficiary’s medical record and be available upon request.

DHCS will not, and MCPs are not required to, provide the payment for ACE screening for beneficiaries age 65 and older. Providers will not be reimbursed for providing an ACE screen to dually eligible beneficiaries with Medi-Cal and Medicare Part B. Providers can screen beneficiaries age 65 and older and those dually eligible for Medicare and Medi-Cal but will not receive any payment from Medi-Cal.

 

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 medical managed care plan. In most cases, ACE screenings are most appropriately delivered in an outpatient primary care setting.

If the emergency physician is an eligible Medi-Cal provider, and by July 1, 2020, has self-attested to completing the certified Core Training, the provider would qualify for Medi-Cal reimbursement for screening their Medi-Cal patients. Billing requires that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the beneficiary and/or family, any clinically appropriate actions were documented , and this documentation remains in the patient’s medical record. However, this screening is intended for primary care providers and/or providers with ongoing patient contact. While it is recognized that on occasion emergency physicians may provide primary care to patients, DHCS anticipates that the emergency room will not usually be an appropriate setting for this particular screening and any follow-up care.

For screenings provided to beneficiaries enrolled in a Medi-Cal MCP, the provider must be a network provider of the MCP in order to qualify for the payment for each screening.

If the supervising physician is an eligible Medi-Cal provider, has taken the training, and assumes responsibility for ensuring that the completed screen was reviewed, the appropriate tool was used, results were documented and interpreted correctly, results were discussed with the beneficiary and/or family, any clinically appropriate actions were documented, and this documentation remains in the medical record, then they can bill on behalf of a physician assistant or nurse practitioner who provides the screening and associated follow up to Medi-Cal patients.

DHCS encourages all providers conducting ACE screenings, even non-billing providers, to complete the certified Core Training.

Provider & Stakeholder Communications

DHCS will include information about ACEs Aware in its existing stakeholder update communications. ACEs Aware will also provide email updates; email info@acesaware.org to sign up.

Clinical Operations

FQHCs are eligible to receive the $29 payment for ACE screenings, in addition to their existing Prospective Payment System payment. FQHCs should bill for the patient’s visit and bill separately for the qualified ACE screening.

FQHCs are eligible to receive the $29 payment for ACE screenings, in addition to their existing Prospective Payment System (PPS) payment. Mental health services are not always required for treatment of toxic stress (please refer to the Clinical Assessment & Treatment Planning page for more information). In cases where a patient requires mental health services, if the patient receives mental health services on the same day as the physical health visit, the FQHC will receive one PPS rate. If a patient receives mental health services during another visit on a different day as the physical health visit, the FQHC will receive the PPS rate for each visit.