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Mental health assessment for young children
Developmentally appropriate assessment and diagnosis is a key component of providing effective infant-early childhood mental health services. In 2021, the Washington State Legislature passed legislation to align Apple Health policies with best clinical practices for mental health assessments for young children (birth through age five). This page helps providers, billers, and partners stay informed about these efforts.
Want to learn from other providers about how they’re doing this work?
Background
Approximately 1 in 5 young children has a diagnosed mental, behavioral, or developmental disorder (Vasileva et al., 2021). These disorders, if properly identified using diagnostic criteria relevant to infant and early childhood development, can be effectively treated. Appropriate assessment leads to more effective treatment and reduces behavioral, school, and physical health risk factors over the long term.
The infant-early childhood mental health (IECMH) community in Washington state worked for several years to advance policies supporting developmentally appropriate assessment for young children, especially those enrolled in Apple Health (Medicaid). As the result of these efforts, the Washington State Legislature passed legislation in 2021 (2021 c 126 § 2) to align Apple Health policies with best clinical practices for mental health assessments for young children (birth through age five). The policy changes, codified into law (RCW 74.09.520 (11)) and administrative code (WAC 182-531-1400(9)(a)(ii)), include:
- Allowing reimbursement for multi-session assessments
- Allowing reimbursement for provider travel costs for sessions in home/community settings
- Requiring providers to use the DC:0-5
HCA began work to implement the mental health assessment for young children (MHAYC) policies in July of 2021, and these changes went into effect in January 2022. A survey conducted in the Fall of 2022 found that implementation of these policies was underway, with positive impacts on providers, families, and children. Read more under Project updates.
How do I bill?
HCA provides regular webinars to review guidance on billing related to Mental Health Assessment for Young Children (MHAYC). These webinars are designed for mental health clinicians, billing and coding staff, and agency leadership.
HCA also provides quarterly virtual opportunities to support providers and agencies in implementing infant-early childhood mental health services, including MHAYC policies, through our IECMH Office Hours. Learn more on our Infant-Early Childhood Mental Health (IECMH) webpage, under IECMH office hours.
For multi session assessments
Providers conducting a mental health assessment (i.e., Psychiatric Diagnostic Evaluation or Intake Evaluation) with children from birth through age five can be reimbursed for up to five sessions per billing provider, per client, per calendar year without a prior authorization. Providers submit claims using the appropriate Psychiatric Diagnostic Evaluation CPT®/HCPCS codes for each of the sessions conducted with the child and/or child's family for the purpose of the assessment.
For guidance on billing these sessions, please see the Mental Health Billing Guide and Service Encounter Reporting Instructions (SERI).
For provider travel
Provider travel is eligible for reimbursement when providers are conducting a mental health assessment for children birth through age five in the home or in a community setting. The following information must be present on any submitted claims to qualify the claims for provider travel reimbursement.
- CPT®/HCPCS Code (90791, 90792, H0031)
- Client age (0 years up until 6th birthday)
- Place of Service Code (03: School, 04: Homeless Shelter, 12: Home, 99: Other Place of Service)
Provider travel will be reimbursed by mileage. Current mileage reimbursement rates can be found on the Office of Financial Management's accounting resource page regarding travel.
Claims not eligible for reimbursement
Claims with a U8 modifier, which identify services provided to Wraparound Intensive Services (WISe) participants by qualified WISe practitioners, are NOT eligible for MHAYC provider travel reimbursement.
Provider travel resources for clients enrolled in Apple Health
With a managed care plan
Providers serving children enrolled in managed care should follow guidance from the managed care organization regarding provider travel reimbursement.
Without a manage care plan (or fee-for-service)
Providers serving children enrolled in Apple Health without a managed care plan (sometimes knows as fee-for-service or FFS) should use the Mental Health Assessment for Young Children (MHAYC) FFS A-19 template, following guidance including in the instructions. Guidance regarding MHAYC provider travel is also included in the Mental Health Billing Guide.
Additional questions can be directed to the HCA mental health fee-for-service team.
Using the DC:0-5™
The DC:0-5™ is the internationally-accepted system for developmentally appropriate assessment of young children's mental health and is recommended as a best practice by both CMS and SAMHSA. It uses developmentally specific diagnostic criteria and reflects mental health disorders that are typically diagnosed in infancy and early childhood. Washington is among many other states who are working to integrate use of the DC:0-5 into state policies and systems.
Per state law (RCW 74.09.520 (11)), Apple Health mental health professionals conducting a mental health assessment for a child birth through age 5 are required to use the DC:0 - 5™. However, the original state legislation creating the MHAYC policies (2021 c 126 § 2) did not include an explicit implementation date for required use of the DC:0-5™. HCA interprets that the intent of this legislation is to support the field in moving toward standard and expected use of the DC: 0-5™ for children birth through age five. Current efforts are focused on building workforce knowledge and capacity through the resources described below.
Apple Health DC:0-5™ Crosswalk
The Apple Health DC:0-5™ Crosswalk is a tool that helps Apple Health providers ‘crosswalk’ DC:0-5™ diagnoses to associated ICD-10 diagnostic codes, which are required for Apple Health billing purposes. The Crosswalk is informed by community feedback and grounded in infant-early childhood mental health research. HCA updates the Crosswalk every year, and the current version became effective on January 1, 2024.
Community review process for the 2025 Crosswalk
HCA is looking for your feedback on the Crosswalk from October 21 - November 15, 2024. Your feedback will help HCA update the Crosswalk for 2025.
- Why is a DC:0-5™ crosswalk needed?
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Though the DC: 0 – 5™ is the clinically appropriate manual for the diagnosis of mental health conditions for infants and young children, other diagnostic systems may still be needed for billing and documentation purposes. For Apple Health providers, federal Medicaid guidance requires that all claims be submitted with an ICD-10 (International Classification of Disease) code. In addition, some behavioral health providers may configure their electronic health record systems to use DSM-5 diagnoses for clinical records. The intention of this crosswalk is to support Apple Health providers in connecting DC:0-5 diagnoses to DSM-5 and/or ICD-10 diagnoses.
Although the DC:0-5™ manual also includes a crosswalk, it is not regularly revised to align with updated ICD-10 and/or DSM-5 diagnoses, and it is not aligned with Apple Health billing policies. Therefore, Washington, like many other states, publishes its own crosswalk.
DC:0-5™ training
Because providers may not receive training in the DC:0-5™ manual as part of their education, additional professional development is needed to support implementation. In 2021, the legislature allocated ongoing funds to provide free DC:0-5™ training for Apple Health mental health and allied professionals.
This training is provided through the Infant-Early Childhood Mental Health Workforce Collaborative (IECMH-WC). The IECMH-WC provides professional development support around mental health assessment and diagnosis best practices for young children, including training in the DC:0-5. These professional development supports are provided at no-cost to professionals who serve families of young children enrolled in Apple Health.
The following professional development offerings are provided on a regular basis:
- For mental health professionals: DC:0-5 Clinical Training, Communities of Practice, Office Hours, and additional workshops.
- For allied professionals: DC:0-5 Overview Training and additional workshops.
Additional questions about or requests for professional development support on this topic may be directed to the IECMH-WC team.
DC:0-5™ in clinical records
Maintaining accurate clinical records is an important component of high-quality mental health services, including mental health assessments. Following a policy statement effective September 1, 2022 (CHS-07-20-22) and WAC amendment effective May 1, 2023, the Department of Health allows providers working in licensed behavioral health agencies to use either the DSM-5 or the DC:0-5, when completing a diagnostic assessment statement, as required in WAC 246-341-0640(c)(iv). This aligns with Apple Health guidance for mental health professionals to utilize the DC:0-5™ when completing a mental health assessment for children younger than six.
Providers serving young children may still experience other challenges translating clinical record guidance for adults, youth, and older children into developmentally relevant criteria. In the future, HCA intends to develop additional resources to support these needs. Providers or partners who may be interested in collaborating on this work should reach out to Christine Cole.
Other resources
Conducting developmentally appropriate mental health assessments for young children may be a new practice for some providers. HCA is providing additional resources to support best practices within the field.
MHAYC Provider Spotlight series
Implementing MHAYC can involve a lot of different pieces across your organizations. HCA is hosting a Provider Spotlight series to support providers like you in putting the puzzle together. Each Provider Spotlight will focus on different aspects of implementation, and feature organizations who are putting it into practice.
Visit our IECMH Office Hours page to register for upcoming events or watch past recordings.
MHAYC multi-disciplinary referral guide
A thorough mental health assessment includes gathering information about child functioning across settings and caregivers which often requires partnership from other professionals and disciplines. Further, an assessment may identify needs beyond mental health treatment necessitating referral to other services. To support providers in navigating the complex early childhood system, HCA has developed a tool to help providers identify referral partners for non-mental health specific needs related to a child's functioning and well-being. The multi-disciplinary referral guide provides examples of potential multidisciplinary partners, though it is not a comprehensive list.
Project updates
Mental health assessment for young children is an evolving project. Please check in regularly for new updates.
IECMH Statewide Tour report
In the summer and fall of 2023, HCA’s IECMH team conducted listening sessions with behavioral health providers across the state, in order to better understand barriers and potential solutions to improving access to quality IECMH services, including mental health assessments for young children. Providers elevated the positive impacts of MHAYC policy changes on their practice, but also shared about challenges to implementation, including barriers to using screening and assessment tools, as well as adapting assessment procedures and electronic health records, for developmentally appropriate practice. To learn more, including other IECMH best practices and challenges shared by providers, read the report.
MHAYC implementation survey
In the Fall of 2022, twenty different providers from across the state completed the MHAYC implementation survey, sharing their experience in adopting the various components of the MHAYC policy. While this survey only represents a small number of providers, the results indicated a moderate uptake of the mental health assessment for young children (MHAYC) policies. Providers also reported that MHAYC policies have made billing for IECMH services easier, increased provider competence in serving young children, and improved access to developmentally appropriate services. To learn more about implementation strategies and challenges, as well as what HCA is doing next, read the report.
MHAYC community presentations
HCA has hosted community presentations about the past two years of implementation of MHAYC. The presentations outlined the shared progress, lessons learned, and details on what is coming up next.
Bulletin updates
HCA also sends periodic bulletin updates on implementation progress. Sign up for the Prenatal through Age 25 behavioral health mailing list to stay informed. Recent bulletins are now available on our IECMH webpage, under IECMH updates.