ANNUAL COGNITIVE HEALTH ASSESSMENTS

According to Dementia Care Aware, “The cognitive health assessment (CHA) is a dementia screening approach intended to be conducted in older adults whenever a cognitive screen is indicated. It is not a diagnostic tool.”

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. 

According to Dementia Care Aware (PDF, 534K) “Dementia impacts a person’s ability to self-manage their day-to-day activities and other medical conditions.”

“Detecting dementia early:

• Allows the person and their caregivers to connect to resources early
• Improves quality of life for affected persons and their caregivers
• Reduces unnecessary costs of care
• Allows the person to start a brain health plan earlier, which can slow progression.”

At least one of the following cognitive assessment tools listed below is required to bill screenings administered to Medi-Cal members:

Patient assessment tools:

• General Practitioner Assessment of Cognition (GPCOG)
• Mini-Cog

Informant tools (used by family members and close friends):

• Eight-item Informant Interview to Differentiate Aging and Dementia
• GPCOG
• Short Informant Questionnaire on Cognitive Decline in the Elderly

Eligible Blue Shield Promise providers must complete the online Cognitive Health Assessment training in order to bill for qualifying CHAs administered. Dementia Care Aware outlines the provider types eligible for Medi-Cal payment for CHAs. The Department of Health Care Service (DHCS) will maintain a list of providers who have completed this training.

Providers who administer a CHA should use the following code for reimbursement: 

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. 

“The CHA is an initial screening process to detect signs of cognitive decline. It is not a diagnostic tool. If the CHA is positive, next steps involve additional assessments to determine if the decline is due to mild cognitive impairment or dementia.”

Dementia Care Aware outlines the recommended framework for next steps. 

Visit Dementia Care Aware to access:

• Provider resources
• Next steps for positive members
• Upcoming education and training events

Other resources:

• Alzheimer’s Association

Policy guidance:

• All Plan Letter 22-025: Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older