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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 providers stay informed about these efforts.
If you are an advocate or community member, and want to learn more, visit the Mental Health Assessment for Young Children program webpage.
On this page
Apple Health mental health policies have been updated to align with best practices for mental health assessments for children from birth through age five.
Allowances and requirements
The policies allow reimbursement for:
- Up to five sessions for mental health assessment.
- Provider travel to home or community settings for the purposes of assessment.
- Require Apple Health mental health providers to use the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5™).
About the DC:0-5™ system
The DC:0-5™ is the internationally-accepted system for developmentally appropriate assessment of young children’s mental health. It uses developmentally specific diagnostic criteria that reflects mental health disorders that are typically diagnosed in infancy and early childhood. Assessment using the DC:0-5™ system requires multiple visits, must involve caregivers, and must include observing children in their natural environments such as their home or child care setting (Zeanah et al., 2016).
Important! Providers must use the current version of the DC:0-5™ system.
On January 6, 2022, HCA hosted a webinar to review guidance for billing related to mental health assessments for young children.
For multisession assessments
Providers conducting an intake and a mental health assessment (i.e., Psychiatric Diagnostic Evaluation or Intake Evaluation) with children from birth through age five are allowed to conduct up to five sessions per client within a calendar year. 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 intake evaluation assessment.
For provider travel
Provider travel is eligible for reimbursement when providers are conducting a mental health diagnostic 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.
Fee-for-service provider travel resources
Providers serving children enrolled in Fee-For-Service (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 the Mental Health Billing Guide.
Please note: Providers serving children enrolled in managed care should follow guidance from the managed care organization regarding provider travel reimbursement.
To support mental health providers in adopting the DC: 0–5™, HCA is taking steps to build workforce knowledge and capacity, create tools to support clinicians’ providers’ practice, and to align internal policies.
Apple Health DC:0-5™ diagnostic crosswalk
Though 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 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 clinicians providers refer to a tool called a “DC: 0-5™ crosswalk.” A DC: 0-5™ crosswalk is a reference guide for clinicians 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 each state’s Medicaid system is different, many states and regions have created their own crosswalk.
HCA published an interim Apple Health DC:0-5™ Crosswalk that can be used by Apple Health providers.
Join us for the kick-off: Attend the DC:0-5™ Crosswalk Kick-off on Thursday, January 20 from 1 to 2:30 p.m. Register today.
Apple Health DC:0-5™ crosswalk workgroup
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.
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 DC: 0-5™ training for Medicaid mental health providers and allied professionals through June 30, 2023. HCA will be collaborating with external partners to provide the following trainings:
- Clinical DC: 0–5™ Training is designed to support mental health clinicians in adopting the approach, understanding the multi-axial system, and utilizing the classification system in their work with children birth through age five. Clinicians will be supported in adopting approaches to diagnosis and assessment that are developmentally informed, relationship-based, and culturally competent.
- DC:0-5™ Training serves as an overview of DC:0-5™, providing a foundation for understanding this diagnostic system for professionals who work with infants and young children. The training will provide participants with an overview of the background, approach, and content areas of DC:0-5™ and is particularly helpful for allied professionals in understanding the importance of developmentally appropriate diagnostic practices.
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.
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