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Mental health assessment for young children
Age-appropriate assessments are a key component of providing effective mental health supports for children from birth through age five. The Washington State Legislature created policy to support Apple Health providers in offering best clinical practices for mental health assessments (see RCW 74.09.520). This page helps advocates and partners stay informed on work to implement these policies.
Approximately 10-14 percent of children birth to 5 years-old experience emotional, relational, or behavioral disturbances (Brauner and Stephens, 2006). These disorders, if properly identified using diagnostic criteria relevant to infant and early childhood development, can be effectively treated. Appropriate assessment leads to more effective treatment and reduces behavioral, school, and physical health risk factors over the long term.
To support best clinical practices for the birth through five population, policy changes were needed within the Apple Health program. In April 2021, 2SHB 1325 Sec(2)(11) was signed into law, initiating several statewide policy changes that took effect on July 1, 2021.
- Allow reimbursement for up to five sessions for mental health assessment.
- Allow reimbursement for mental health assessments in home or community settings, including reimbursement for clinician travel.
- Require clinician use of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0 – 5™).
On January 1, 2022, all Apple Health mental health professionals who provide mental health assessments to children birth through age five will be eligible for reimbursement for up to 5 sessions for the mental health assessment. These providers will also be eligible for reimbursement for travel to home and community settings for these sessions.
To support providers in accessing these reimbursements, HCA is making updates to several systems, including Washington Administrative Code (WAC), integrated managed care (IMC) contracts, Service Encounter Reporting Instructions (SERI), mental health billing guides, Provider One, and fee-for-service (FFS) reimbursement systems.
If you are a provider, please visit the Mental Health Assessment for Young Children provider webpage for billing guidance regarding new reimbursement policies.
Supporting the use of the DC:0-5TM
The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Child hood (DC:05TM) is the internationally accepted system for developmentally appropriate assessment of young children’s mental health. The DC: 0 – 5™ uses developmentally specific diagnostic criteria that reflects mental health disorders that are typically diagnosed in infancy and early childhood.
To support mental health providers in adopting the DC: 0 – 5™, the HCA is taking steps to build workforce knowledge and capacity, create tools to support mental health providers practice, and to align internal policies.
The DC: 0 - 5™ is recognized as the clinically appropriate manual for diagnosing infants and young children but, in our current behavioral health system, other diagnostic manuals may still be necessary. For Apple Health providers, federal Medicaid guidance requires that all claims be submitted with an ICD (International Classification of Disease) code. Many mental health systems may also require a DSM (Diagnostic and Statistical Manual) diagnosis in the documentation of services.
To support the use of DC: 0 - 5™ in their practice, many providers refer to a tool called a DC: 0 - 5™ crosswalk. A DC: 0 - 5™ crosswalk is a reference guide for clinicians that helps to convert DC: 0 – 5™ diagnoses to associated ICD diagnostic codes and DSM diagnoses. Zero to Three, the publisher of DC: 0 – 5™, includes a crosswalk within the DC: 0 - 5™ manual.
HCA has published an interim Apple Health DC: 0 - 5™ crosswalk, based upon the national crosswalk from Zero To Three. To access the crosswalk and resources that support its use, please visit the Mental Health Assessment for Young Children provider webpage.
To develop a crosswalk that is informed by clinician, stakeholder, and advocate feedback, HCA will convene a community workgroup tasked with reviewing and revising the interim crosswalk for the purpose of developing a community-informed Apple Health DC: 0 - 5™ crosswalk. To learn more about the workgroup, please visit the Community-Informed DC:0-5™ Crosswalk Workgroup webpage.
In 2021, the legislature allocated funds to fund DC: 0 - 5™ training for Medicaid mental health providers and allied professionals.
Please visit the Apple Health DC:0-5™ training webpage to view the current training schedule and to register for upcoming trainings.
HCA is working to implement Mental Health Assessment for Young Children from July 1, 2021 through June 30, 2023. Periodically, we will send updates on implementation progress. If you are not already registered, sign up to receive notifications and stay informed.
|February 22, 2022||More DC:0-5™ trainings announced|
|February 10, 2022||Free DC:0-5™ training for Apple Health providers|
|February 3, 2022||Mental Health Assessment for Young Children provider updates|
|January 27, 2022||Rulemaking for Mental Health Assessment for Young Children|
|January 12, 2022||Interim Apple Health DC:0-5™ Crosswalk published|
|January 12, 2022||Mental health assessment for young children - billing resources|
|January 10, 2022||Procurement opportunity for professional development and training services | RFP 2021HCA30|
December 22, 2021
December 16, 2021
December 7, 2021
December 2, 2021
Work on developmentally appropriate assessment and diagnosis for infants and young children has been ongoing for several years in Washington State. The Children and Youth Behavioral Health Workgroup (CYBHWG) first recommended advocacy around developmentally appropriate diagnosis tools for children birth through five in their 2016 report to the legislature.
In 2018, a cross-agency team participated in the Infant-Early Childhood Mental Health Finance and Policy Project, a year-long national learning collaborative sponsored by Zero To Three. The team identified statewide adoption of the DC:0-5 as their top legislative priority. By partnering with the CYBHWG, the team was able to advance this priority as a legislative recommendation, and in the 2020 legislative session, a budget proviso required the HCA to conduct an analysis of the costs associated with statewide adoption.
For the 2021 legislative session, the CYBHWG recommendations to the legislature included statewide implementation of DC:0-5; the cost analysis was instrumental in informing the fiscal estimates associated with this recommendation and the resulting legislation. Following this recommendation, HB1325: Implementing Policies Related to Children and Young Behavioral Health was signed into law in April 2021.