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 initiative webpage.

Important! Are you an organization providing mental health services for children enrolled in Apple Health (Medicaid)? HCA wants to hear from you! Learn more about the MHAYC Implementation Survey under Project updates

Stay informed! Want to stay updated on work related to the DC:0-5™ and mental health assessment for young children?

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 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. 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 hosted a webinar to review guidance for billing related to Mental Health Assessments for Young Children (MHAYC) on August 10, 2022. This webinar was designed for mental health clinicians, billing and coding staff, and agency leadership.

HCA is continuing to provide virtual opportunities to support providers and agencies in implementing MHAYC policies through quarterly IECMH Office Hours. Learn more on our Infant-Early Childhood Mental Health (IECMH) webpage, under office hours.

Join the quarterly IECMH Office Hours: Thursday, January 26, 10-11 a.m.

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 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.

Provider travel resources for clients enrolled in Apple Health without a managed care plan

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 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.

Using the DC:0-5™

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.

What is a DC:0-5 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 this crosswalk is not regularly updated, 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.

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), the Department of Health is allowing 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.

Other Resources

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

MHAYC Clinical record guidance

Per Department of Health (DOH) guidance, Washington State mental health professionals my now document diagnosis in their clinical records using the DC:0-5™. However, providers serving young children may experience challenges translating clinical record guidance for adults, youth, and older children into developmentally relevant criteria. For this reason, HCA, in partnership with the Department of Health, will be convening an Infant-Early Childhood Mental Health (IECMH) Clinical Records Work group. This group will develop a resource to support in translation of current guidance on diagnostic assessment statements in WAC 246-341-0640(c) into developmentally appropriate equivalent criteria.

Infant-early childhood mental health (IECMH) providers with a deep knowledge of current WAC 246-341-0640(c) requirements, developmentally appropriate intake assessments, and best practices in IECMH services are encouraged to complete the Expression of Interest for participation in the workgroup by November 18, 2022.

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

Successful implementation of new policies can take time and require support and guidance. Therefore, HCA is launching the MHAYC Implementation Survey to understand how organization and providers are implementing these new policies, and what additional supports may be needed. 

The survey is estimated to take up to one hour. It is designed to be completed by organizations contracted to provide mental health services through Apple Health, including licensed Behavioral Health Agencies, individual or group mental health private practices, and other practices with integrated mental health services (such as primary care practices).

It is recommended that mental health providers and administrators (billing and coding staff, program managers, and directors) work together to formulate their response as an organization. A PDF version of the survey questions is available for download for organizations to review the questions in advance. 

The survey will remain open until November 18, 2022. If you have any questions about this survey or would like assistance in completing it, please contact Kiki Fabian or Christine Cole

MHAYC Community presentation

HCA hosted a community presentation on July 21, 2022 about the past year of implementation of MHAYC. The presentation outlines the shared progress, lessons learned, and details on what is coming up next. 

Bulletin updates

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.