Adverse Childhood Experiences (ACEs) screening initiative

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.”

"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.

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:

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.

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.

Visit ACEs Aware to access:

• Provider toolkit
• ACEs screening clinical workflow
• Patient/family education handouts
• Upcoming education events and past webinars

Other resources:

• American Academy of Pediatrics

Policy guidance:

• All Plan Letter (APL) 19-018: Proposition 56 Directed Payments for Adverse Childhood Experiences Screening Services