Mental health assessment for young children

Background

Approximately 1 in 5 young children has a diagnosed mental, behavioral, or developmental disorder (Vasileva et al., 2021). 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.

The infant-early childhood mental health (IECMH) community in Washington state worked for several years to advance policies supporting developmentally appropriate assessment for young children, especially those enrolled in Apple Health (Medicaid). As the result of these efforts, the Washington State Legislature passed legislation in 2021 (2021 c 126 § 2) to align Apple Health policies with best clinical practices for mental health assessments for young children (birth through age five). The policy changes included:

• Allowing reimbursement for multi-session assessments
• Allowing reimbursement for provider travel costs for sessions in home/community settings
• Requiring providers to use the DC:0-5

HCA began work to implement the mental health assessment for young children (MHAYC) policies in July of 2021, and these changes went into effect in January 2022. A survey conducted in the Fall of 2022 found that implementation of these policies was underway, with positive impacts on providers, families, and children. Read more under Project updates. 

How do I bill?

HCA provides regular webinars to review guidance on billing related to Mental Health Assessment for Young Children (MHAYC). These webinars are designed for mental health clinicians, billing and coding staff, and agency leadership.

• View past webinar slides
• View past webinar recordings

The next MHAYC billing webinar is scheduled for September 28, 1 to 2:30 p.m.

• Date: September 28, 2023
• Time: 1 to 2:30 p.m.
• Register for the billing webinar

HCA also provides quarterly virtual opportunities to support providers and agencies in implementing infant-early childhood mental health services, including MHAYC policies, through our IECMH Office Hours. Learn more on our Infant-Early Childhood Mental Health (IECMH) webpage, under IECMH office hours.

For multi session assessments

Providers conducting a mental health assessment (i.e., Psychiatric Diagnostic Evaluation or Intake Evaluation) with children from birth through age five can be reimbursed for up to five sessions per billing provider, per client, per calendar year without a prior authorization. Providers submit claims using the appropriate Psychiatric Diagnostic Evaluation CPT^®/HCPCS codes for each of the sessions conducted with the child and/or child's family for the purpose of the assessment.

For guidance on billing these sessions, please see the Mental Health Billing Guide and Service Encounter Reporting Instructions (SERI).

For provider travel

Provider travel is eligible for reimbursement when providers are conducting a mental health assessment for children birth through age five in the home or in a community setting. The following information must be present on any submitted claims to qualify the claims for provider travel reimbursement.

• CPT^®/HCPCS Code (90791, 90792, H0031)
• Client age (0 years up until 6th birthday)
• Place of Service Code (03: School, 04: Homeless Shelter, 12: Home, 99: Other Place of Service)

Provider travel will be reimbursed by mileage. Current mileage reimbursement rates can be found on the Office of Financial Management's accounting resource page regarding travel.

Provider travel resources for clients enrolled in Apple Health

With a managed care plan

Providers serving children enrolled in managed care should follow guidance from the managed care organization regarding provider travel reimbursement.

Without a manage care plan (or fee-for-service)

Providers serving children enrolled in Apple Health without a managed care plan (sometimes knows as fee-for-service or FFS) should use the Mental Health Assessment for Young Children (MHAYC) FFS A-19 template, following guidance including in the instructions. Guidance regarding MHAYC provider travel is also included in the Mental Health Billing Guide.

• MHAYC FFS A-19 form
• MHAYC FFS A-19 instructions

Additional questions can be directed to the HCA mental health fee-for-service team.

Using the DC:0-5™

The DC:0-5™ is the internationally-accepted system for developmentally appropriate assessment of young children's mental health and is recommended as a best practice by both CMS and SAMHSA. It uses developmentally specific diagnostic criteria that reflects mental health disorders that are typically diagnosed in infancy and early childhood. Washington is among many other states who are working to integrate use of the DC:0-5 into state policies and systems.

The state legislation creating the MHAYC policies (2021 c 126 § 2) did not include an explicit implementation date for required use of the DC:0-5™. HCA interprets that the intent of this legislation is to support the field in moving toward standard and expected use of the DC: 0-5™ for children birth through age five. Current efforts are focused on building workforce knowledge and capacity through the resources described below.

Apple Health DC:0-5™ Crosswalk

Over the course of 2022, HCA facilitated a diverse work group of infant-early childhood mental health (IECMH) providers and advocates to review and update the interim Apple Health DC:0-5™ Crosswalk. HCA has published the Community-Informed Apple Health DC:0-5™ Crosswalk for use by Apple Health mental health professionals diagnosing children from birth through age five. Learn more about the work group by reading our DC:0-5™ Crosswalk announcement.

On January 20, 2022, HCA hosted the Apple Health DC:0-5 Crosswalk Kickoff meeting to announce the launch of the interim crosswalk and discuss next steps for community engagement.

• View the kickoff recording
• View the kickoff slides

What is a DC:0-5™ crosswalk?

Through the DC:0-5™ is recognized as the clinically appropriate manual for diagnosing infants and young children, other diagnostic manuals are often still necessary in our current behavioral health system. For Apple Health providers, federal Medicaid guidance requires that all claims be submitted with an ICD (International Classification of Disease) code. Additionally, many mental health electronic record systems 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 providers 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, but because this crosswalk is not regularly updated, many states and regions, including Washington, have created their own crosswalk.

DC:0-5™ training

Because providers may not receive training in the DC:0-5™ manual as part of their education, additional professional development is needed to support implementation. In 2021, the legislature allocated funds to provide free DC:0-5™ training for Apple Health mental health and allied professionals.

Apple Health DC:0-5™ training is provided through the Infant-Early Childhood Mental Health Workforce Collaborative (IECMH-WC). Register for trainings and find additional resources on the Washington Association for Infant Mental Health (WA-AIMH) website, or contact the WA-AIMH training team.

DC:0-5™ in clinical records

Maintaining accurate clinical records is an important component of high-quality mental health services, including mental health assessments. Following a policy statement effective September 1, 2022 (CHS-07-20-22) and WAC amendment effective May 1, 2023, the Department of Health allows providers working in licensed behavioral health agencies to use either the DSM-5 or the DC:0-5, when completing a diagnostic assessment statement, as required in WAC 246-341-0640(c)(iv). This aligns with Apple Health guidance for mental health professionals to utilize the DC:0-5™ when completing a mental health assessment for children younger than six.

Providers serving young children may still experience other challenges translating clinical record guidance for adults, youth, and older children into developmentally relevant criteria. In the future, HCA intends to develop additional resources to support these needs. Providers or partners who may be interested in collaborating on this work should reach out to Christine Cole.

Other resources

Conducting developmentally appropriate mental health assessments for young children may be a new practice for some providers. HCA is providing additional resources to support best practices within the field.

MHAYC multi-disciplinary referral guide

A thorough mental health assessment includes gathering information about child functioning across settings and caregivers which often requires partnership from other professionals and disciplines. Further, an assessment may identify needs beyond mental health treatment necessitating referral to other services. To support providers in navigating the complex early childhood system, HCA has developed a tool to help providers identify referral partners for non-mental health specific needs related to a child's functioning and well-being. The multi-disciplinary referral guide provides examples of potential multidisciplinary partners, though it is not a comprehensive list.

Project updates

Mental health assessment for young children is an evolving project. Please check in regularly for new updates.

MHAYC implementation survey

In the Fall of 2022, twenty different providers from across the state completed the MHAYC implementation survey, sharing their experience in adopting the various components of the MHAYC policy. While this survey only represents a small number of providers, the results indicated a moderate uptake of the mental health assessment for young children (MHAYC) policies. Providers also reported that MHAYC policies have made billing for IECMH services easier, increased provider competence in serving young children, and improved access to developmentally appropriate services. To learn more about implementation strategies and challenges, as well as what HCA is doing next, read the report. 

MHAYC community presentations

HCA has hosted community presentations about the past two years of implementation of MHAYC. The presentations outlined the shared progress, lessons learned, and details on what is coming up next.

• 2022 MHAYC community presentation slides
• 2023 MHAYC community presentation slides

Bulletin updates

HCA also sends periodic bulletin updates on implementation progress. Sign up for the Prenatal through Age 25 behavioral health mailing list to stay informed. Recent bulletins are now available on our IECMH webpage, under IECMH updates.