Adverse Childhood Experiences (ACEs) screening initiative
Blue Shield of California Promise Health Plan supports the goals of ACEs Aware, a partnership initiative by the California Surgeon General and the California Department of Health Care Services (DHCS) to screen for childhood trauma and treat the impacts of toxic stress.
ACEs Aware offers provider resources and education on Adverse Childhood Experiences (ACEs), how to screen for ACEs, and a free, 2-hour online training that, upon completion, allows eligible providers to bill for ACEs screenings administered to pediatric and adult Medi-Cal members. Providers who complete and attest to taking the training may receive 2.0 Continuing Medical Education (CME) and 2.0 Maintenance of Certification (MOC) credits.
For billing questions related to ACEs screenings, email Prop56Inquiries@blueshieldca.com.
What are Adverse Childhood Experiences (ACEs)?
According to ACEs Aware,
“The term Adverse Childhood Experiences (ACEs) comes from the landmark 1998 study by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente. ACEs describe 10 categories of adversities in three domains experienced by age 18: abuse, neglect, and/or household challenges. A child or adolescent who experiences ACEs without the buffering protections of trusted, nurturing caregivers and safe, stable environments can develop a toxic stress response, which can impact brain development, hormone and immune systems, and genetic regulatory systems.”
Why should I screen for ACEs, and how?
"ACEs are strongly associated, in a dose-response fashion, with some of the most common and serious health conditions facing our society today, including at least 9 of the 10 leading causes of death in the United States. Identifying a history of trauma in children and adults and responding with trauma-informed care can improve the health and well-being of individuals and families and lower long-term health costs."
The following tools must be used to bill for screenings administered to Medi-Cal members:
- PEARLS (for children and adolescent members up to age 19)
- ACE questionnaire (for adult members 18 and older).
- Either the PEARLS or ACE questionnaire tool can be used to screen members who are 18 or 19 years old.
- Per ACEs Aware, if an alternative version of the ACE questionnaire for adults is used, it must contain questions on the 10 original categories of ACEs to qualify.
How do I bill for ACEs screenings?
Eligible Blue Shield Promise providers must complete and attest to taking the online ACEs Aware training in order to bill for qualifying ACEs screenings administered. ACEs Aware outlines the provider types eligible for Medi-Cal payment for ACEs screenings.
Billing and coding are based on the member’s total ACE score. ACE scores range from 0-10. Providers should use the Healthcare Common Procedure Coding System (HCPCS) billing codes based on the results of the screening:
| HCPCS Code | Description |
|---|---|
| G9919 | Screening had a score of 4 or greater (high risk) |
| G9920 | Screening had a score of 0 to 3 (lower risk) |
Billing requires that the completed screening was reviewed, the appropriate tool was used, results were documented and interpreted, results were discussed with the member and/or family, and any clinically appropriate actions were documented. This documentation should remain in the member’s medical record and be available upon request.
Providers can bill for ACEs screenings administered to Medi-Cal members younger than 21 once annually, and once per lifetime (per provider) for adult members age 21 through 64.
For billing questions related to ACEs screenings, email Prop56Inquiries@blueshieldca.com.
What if a member screens high-risk for ACEs?
Not all members who screen high-risk for ACEs will require treatment, such as outpatient therapy. Providers are encouraged to review the ACEs Aware Clinical Assessment and Treatment Planning guidelines, which outline next steps after screening, including patient education on toxic stress, strategies to regulate the stress response, and validation of existing strengths and protective factors.
Blue Shield Promise offers behavioral health services and can help Medi-Cal members navigate their options for follow-up care, if needed.
| Resource | Region | Contact | Additional Information |
|---|---|---|---|
| Mild to moderate behavioral health conditions | Los Angeles | (855) 765-9701 | Providers can also use the PCP referral form |
| San Diego | (855) 321-2211 | ||
| Blue Shield Promise Social Services – can help members navigate resources and options for treatment for behavioral health | Los Angeles | Fax referral form to: (323) 889-2109 | Department phone: (877) 221-0208 |
| San Diego | Fax referral form to: (619) 219-3320 | ||
| Department of Mental Health – for severe mental health impairment and substance use disorder services | Los Angeles | ACCESS hotline: (800) 854-7771 Beacon Health Options as liaison: (855) 765-9701 |
Blue Shield Promise’s responsibility for administering and managing care is dependent on the Medi-Cal member’s severity of impairment. When making a referral, please consult the Mental Health Severity Screening Tool for guidance. |
| San Diego | ACCESS hotline: (888) 724-7240 |
Are there additional resources about ACEs?
Visit ACEs Aware to access:
- Provider toolkit
- ACEs screening clinical workflow
- Patient/family education handouts
- Upcoming education events and past webinars
Other resources:
Policy guidance:
Behavioral health treatment for Medi-Cal members under the age of 21
Learn about Blue Shield Promise Medi-Cal benefits, eligibility requirements, and referral procedures.
Behavioral Health Services
Blue Shield Promise behavioral health services cover mental health, substance use disorder, and autism spectrum disorder behavioral health treatment.