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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, billers, and partners 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.

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What do I need to know?

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.

They also:

  • 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).

How do I bill?

HCA will be hosting a webinar to review guidance for billing related to Mental Health Assessments for Young Children (MHAYC) on August 10.

  • Audience: Mental health clinicians, billing and coding staff, and agency leadership.
  • Date: Wednesday, August 10 from noon to 1 p.m.
  • Register to attend.

HCA previously hosted an introductory webinar to review guidance for billing related to MHAYC on January 6, 2022.

HCA is continuing to provide virtual opportunities to support providers and agencies in implementing MHAYC policies through quarterly IECMH Office Hours.

Join the quarterly IECMH Office Hours: Thursday, October 27, 10-11 a.m.

For multisession 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 client within a 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 diagnostic 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.

Please note: Claims with a U8 modifier, which identify services provided to Wraparound Intensive Services (WISe) participants by qualified WISe practitioners, are NOT eligible for MHAYC provider travel reimbursement.

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. Additional questions can be directed to FFSquestions@hca.wa.gov.

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

Resources to support DC:0-5™ adoption

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

HCA has published the interim Apple Health DC:0-5™ Crosswalk for use by Apple Health mental health professionals diagnosing children from birth through age five.

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.

HCA is currently convening a work group tasked with reviewing and revising the interim crosswalk for the purpose of developing a community-informed Apple Health DC: 0-5™ crosswalk, which is planned to be released in Fall/Winter of 2022.

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.

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). In March 2022, HCA awarded the contract for the IECMH-WC to the Washington Association for Infant Mental Health (WA-AIMH). WA-AIMH will coordinate DC:0-5™ trainings, as well additional professional development resources, from June 2022 through June 2023. If you have questions about DC: 0-5™ training, please contact training@wa-aimh.org.

To view the current DC: 0-5™ training schedule and to register for upcoming trainings, please visit the WA-AIMH DC:0-5™ training webpage.

Project updates

HCA will be hosting a community presentation for all interested parties to learn about the past year of implementation of MHAYC. Join us in sharing progress, reflecting on lessons learned, and providing details on what is coming up next. 

Mental Health Assessment for Young Children: Community Presentation

HCA also sends periodic bulletin updates on implementation progress. Sign up for the Prenatal – Age 25 Behavioral Health GovDelivery to stay informed. Recent bulletins are linked below, and older bulletins are available upon request. 

Contact

Christine Cole, LCSW, IMH-E®
Infant and early childhood mental health program manager

Kimberly “Kiki” Fabian, M. Ed
Infant and early childhood mental health systems analyst