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Resumen de proveedores | Número 14

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New annual cognitive health assessment requirement for Medi-Cal members 65+ years old

DHCS All Plan Letter 22-025 requires all individuals ages 65 and older who are members of California Medi-Cal managed care health plans (MCPs) to receive an annual cognitive health assessment.

DHCS has expanded this benefit for Medi-Cal only members who are ineligible for a similar assessment as part of the Medicare program. This assessment aims to identify whether individuals have signs of Alzheimer’s disease or related dementias, consistent with the standards for detecting cognitive impairment by the American Academy of Neurology (AAN)1.

Provider training requirement

All licensed health care professionals enrolled as Medi-Cal providers must complete DHCS-specified training and use DHCS-validated cognitive assessment tools (see next section for a list). Payment is based on the completion of the training. DHCS will maintain a list of providers who completed their training that will be shared with the Alliance. Complete the training on the Dementia Care Aware website.

DHCS approved cognitive assessment tools

Providers must complete at least one cognitive assessment tool listed below. These tools can help determine if a full dementia evaluation is needed:

 

As an Alliance provider, you may be asked to provide medical record documentation to ensure that appropriate screening tools are being used and the necessary follow-up services are being completed based on assessment scores.

Billing requirements

Alliance licensed health care professionals can conduct and bill for cognitive health assessments for members if they:

  • Are enrolled as a Medi-Cal provider.
  • Are acting within their scope of practice.
  • Are eligible to bill evaluation and management (E&M) codes.
  • Have completed the required training.
Billing Code Descripción
CPT Code 1494F

 

Only applicable for members 65 years of age and older without Medicare coverage.
CPT Code 99483 Comprehensive diagnostic evaluation and management (E&M) of a patient who exhibits signs and/or symptoms of cognitive impairment to establish or confirm a diagnosis, etiology or severity of the condition.
CPT Code 96125 Time spent administering standardized cognitive performance tests to the patient and time spent interpreting the results and preparing the formal medical report.

Note: 99483 and 96125 cannot be billed in conjunction with 1494F.

Documentation requirements

Providers are required to document the following in the member’s medical records, with records available upon request:

  • Screening tool(s) used.
  • Verification that screening results were reviewed by a provider.
  • Screening results and interpretation.
  • Details discussed with the member and/or authorized representative, and any appropriate actions taken regarding screening results.

If you have any questions regarding cognitive health training and/or screenings, please contact your Provider Relations Representative at 800-700-3874, ext. 5504.

Línea de ayuda para concienciar sobre el cuidado de la demencia

El Línea de ayuda para concienciar sobre el cuidado de la demencia is a consultative service for clinicians and primary care teams. You can get your questions answered about dementia care Monday-Friday via email or phone.

1AAN Guidelines on dementia and mild cognitive impairment: https://n.neurology.org/content/56/9/1143 y https://n.neurology.org/content/90/3/126

Comprender el riesgo del uso concomitante de opioides y antipsicóticos

El U.S. Food and Drug Administration has warned about serious risks including death when combining opioids with drugs such as antipsychotics that suppress the central nervous system (CNS). This is due to the possibility of additive CNS depression.

Additionally, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act requires that states have a review process to monitor patients concurrently prescribed opioids and antipsychotics. Concurrent use of these drug classes can result in excessive drowsiness, respiratory depression, overdose and death.

Per the CDC’s Clinical Practice Guideline for Prescribing Opioids for Pain, opioid therapy should only be initiated if expected benefits for pain and function are anticipated to outweigh risks to the patient.

Cuando esté justificado el uso combinado de medicamentos opioides y antipsicóticos, considere lo siguiente:

  • Hable con su paciente sobre los beneficios realistas y los riesgos conocidos de la terapia con opioides antes de iniciarla.
  • Trabaje con su paciente para establecer objetivos de tratamiento para el dolor y la función.
  • Considere utilizar la dosis de opioide efectiva más baja y la duración mínima del tratamiento.
  • Vigile a su paciente para detectar efectos adversos.
  • Reevalúe periódicamente con su paciente los beneficios y riesgos de continuar el tratamiento con opioides. Si los beneficios no superan los riesgos, considere optimizar otras terapias y trabajar para reducir gradualmente las dosis o, si lo justifican las circunstancias individuales del paciente, reducir y suspender adecuadamente un medicamento opioide.
  • Advierta a los pacientes y cuidadores sobre el riesgo de respiración lenta y/o sedación.
  • Considere la posibilidad de recetar naloxona de forma conjunta.