ANNUAL COGNITIVE HEALTH ASSESSMENTS
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 must complete the required Cognitive Health Assessment training in order to bill and receive reimbursement. This is a one-hour, self-paced, online training that provides up to 1.5 Continuing Education (CE)/Continuing Medical Education (CME)/Maintenance of Certification (MOC) credits. For more information, visit the Dementia Care Aware website.
What is a cognitive health assessment?
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.
Why should I conduct a cognitive health assessment?
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.”
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
- Short Informant Questionnaire on Cognitive Decline in the Elderly
How do I bill for Annual Cognitive Health Assessments?
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:
|Coverage||Visit Type||Billing Code||Note|
Cognitive health assessment
|Provider must complete the Dementia Care Aware CHA to use this billing code.|
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?
“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.
Are there more resources available?
Visit Dementia Care Aware to access:
- Provider resources
- Next steps for positive members
- Upcoming education and training events
- All Plan Letter 22-025: Responsibilities for Annual Cognitive Health Assessment for Eligible Members 65 Years of Age or Older