Blue Shield of California Promise Health Plan supports California Senate Bill (SB) 48 (Chapter 484, Statues of 2021), which expands the Medi-Cal schedule of benefits to include annual cognitive assessments for members 65 years and older if they are otherwise ineligible for a similar assessment through the Medicare program. This expansion is effective as of July 1, 2022.
Providers are no longer required to complete training to provide this service due to changes made by California Assembly Bill (AB) 116.
What is a cognitive health assessment?
A cognitive health assessment checks for signs of dementia in older adults. Blue Shield Promise covers an annual cognitive health assessment for members who are 65 years or older and who do not have Medicare coverage. Any Medi-Cal provider who is acting within their scope of practice and is eligible to bill Evaluation and Management (E&M) codes is eligible to conduct and bill for these assessments.
Why should I conduct a cognitive health assessment?
Early detection may help to reduce the impact of dementia on the quality of life for affected individuals and their caregivers by providing earlier access to care and support resources. Early treatment can help slow progression of the disease and reduce the cost of care.
What tools can I use to conduct ACH screenings?
At least one of the following cognitive assessment tools listed below is required to bill screenings administered to Medi-Cal members:
Patient assessment tools:
Informant tools (used by family members and close friends):
- Eight-item Informant Interview to Differentiate Aging and Dementia (AD8)
- GPCOG Tool - English
- Short IQCODE
How do I bill for Annual Cognitive Health Assessments?
Providers who administer a CHA should use the following code for reimbursement:
| Coverage | Visit Type | Billing Code |
|---|---|---|
Medi-Cal only | Cognitive health assessment | 1494F |
Billing requires that the completed screening was reviewed, the appropriate screening tool was used, results were documented and interpreted, results were discussed with the member and/or family, and any clinically appropriate actions were documented.
Blue Shield Promise will also conduct a yearly chart review of randomly selected charts to ensure that appropriate annual cognitive health assessment (ACHA) services are documented in the medical records.
What if a member has a positive screen?
If your screening shows signs of cognitive decline, please confirm the findings and provide all necessary follow-up care.