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CARE Act

NOTE: CalMHSA is aware of SB42 and SB1400 and is in the process of reviewing the information put out by CBHDA regarding changes. We will be updating this protocol as we develop items in response to these changes.

NOTE: Development is still in progress and therefore workflows may change if development or requirements are adjusted.

NOTE: Since county QA environments do not sync with the CalMHSA QA environment, some of the following setup may not be present in your QA environment. Please use the information in the System Administration Documentation Knowledge Base related to the CARE Act for guidance on what setup you may need to do in your QA environment.

Overview

CalMHSA is currently working with Streamline to fully implement the CARE Act requirements in SmartCare. This includes creating a CARE Plan/CARE Agreement document that includes all the reportable service categories. This also includes a reporting document that will meet state reporting requirements and can be used to supplement information provided during status review hearings. CalMHSA is working with HMA, the agency contracted by DHCS to collect and analyze this data, to ensure all requirements are met.

The summary of the flow of a client through the CARE Act process is as follows:

  1. CARE Process Initiation
    1. Petition – someone petitions the court to have the person (respondent) receive services under the CARE Act. In some cases, this is the county themselves on behalf of a current client. It can also be by anyone in the community.
  2. Engagement
    1. Prima Facie – the court decides if the respondent meets, or may meet, eligibility criteria for the CARE Act.
    2. Investigation – if the petitioner is not the county behavioral health agency, the court will order the agency to investigate and submit a report to determine if the respondent meets, or may meet, eligibility criteria for the CARE Act.
    3. Voluntary services – the county behavioral health agency will also attempt to engage the respondent in voluntary services, and report back to the court the outcome of these efforts.
  3. Court Process/Service Connection
    1. If the court finds that the respondent qualifies for the CARE Act and the respondent did not engage in voluntary services, the case will proceed through the court flow. The court will appoint an attorney to represent the respondent.
    2. Voluntary Supporter – the respondent has the option to select a supporter, or ask that one be appointed.
    3. The court determines if the respondent meets eligibility criteria.
    4. CARE Agreement/Plan – the respondent, their attorney, their supporter, and the behavioral health agency work together to create a CARE Agreement and engage the respondent in services. If a CARE Agreement is not likely to be reached, the court will order the behavioral health agency to conduct a clinical evaluation, and if upon review the court determines the respondent meets CARE criteria, the court will order a CARE Plan.
  4. Service Delivery/Assess Next Steps: Treatment, Housing, and Support
    1. Respondent receives services that are indicated on their CARE Agreement/Plan. This includes behavioral health services, medically-necessary stabilization medications, housing resources and supports, and social services.
    2. Progress will be checked a status review hearings, which are scheduled by the court.
    3. At month 11, the court determines whether the respondent is ready to graduate or may be reappointed to the program to continue for up to one year.

The county behavioral health agency generally becomes involved at the Engagement phase, unless they are the ones initiating the process via a petition. Throughout the client’s CARE Act lifecycle, the county must provide monthly reports. There are 3 main reporting periods:

  1. Initiation Phase
    1. Captures baseline data, including petition information and basic client demographics.
  2. Active Service Phase
    1. Captures ongoing CARE Act data, including the status of the client’s CARE Act case and what services are provided.
  3. Follow Up Phase
    1. CARE Act program staff continue to monitor and report on what services a client is receiving post-graduation for up to 1 year after graduation.

More information and trainings on the client journey through this process can be found at the CARE Act Resource Center.

General County Workflow for CARE Act Staff

  1. Receive court order to initiate engagement with a CARE Act client.
    1. Open the client to the CARE Act program in Requested status with the date you received the court order to engage the client.
    2. Scan in related documents, including the Petition, under the CARE Act program.
    3. Start the initial CARE Act Reporting document
  2. Attempt to engage the client.
    1. Document all attempts to contact the client using service notes.
    2. When you’ve been able to engage with the client, change their program status to Enrolled.
    3. Complete the required court documents and summarize in a service note.
  3. Provide CARE Act services
    1. Document services provided, including administrative tasks, using service notes.
      1. There are 5 non-billable procedure codes that are CARE Act specific that are reimbursed through means other than the SmartCare billing process. Make sure to document all time spent in order to be reimbursed properly.
    2. Document the client’s CARE Plan/Agreement details using the CARE Plan/Agreement document in SmartCare. This will help with later reporting.
    3. Scan all relevant court documents into SmartCare to demonstrate you’ve provided these documents to the client and have completed these documents.
    4. Complete monthly reporting for all CARE Act clients, including elective clients.
      1. The first report will require the completion of all demographic information. All subsequent reports will pull this information forward, though the information is editable if information changes or becomes available. This information cannot be pulled from other sources, as the data dictionaries used do not match other state reporting data dictionaries, nor USCDI data dictionaries.
      2. The client’s case status will determine which questions are visible and required based on the state reporting requirements.
      3. When reporting on what services were provided compared to what services were on the client’s CARE Plan/Agreement, SmartCare will pull in information from the client’s current CARE Plan/Agreement automatically, as well as any services that have been entered into SmartCare. This is based on a crosswalk that CalMHSA has developed. You can still make changes to what services were or were not provided, based on your knowledge, overriding the automatic initialization.
      4. These reports may also be helpful for Status Review Hearings.
  4. Discharge the client
    1. Once the client has completed the follow-up phase, complete the final discharge report and discharge the client from the CARE Act program.

Expected County Setup - Programs & Procedures

CalMHSA recommends creating a CARE Act program in SmartCare. Any clients that are part of the CARE Act process should be enrolled in this program. Since the CARE Act is about coordinating services for clients, this means keeping the client enrolled in the CARE Act program even during their post-graduation phase. Only once all reporting requirements are completed should the client be discharged from the CARE Act program.

The CARE Act program must include the following non-billable procedure codes:

  1. CARE Act – Court Report Activity
  2. CARE Act – Data Reporting
  3. CARE Act – Hearing Time Activity
  4. CARE Act – Notice Activity
  5. CARE Act – Outreach and Engagement Activity

Time spent on CARE Act activities are documented in service notes using these procedure codes. 

CalMHSA is adding more specific hearing-related procedure codes to help counties track each type of hearing and their relative results. This was done at the request of a phase 1 county, who had helped in the development of this implementation. These codes, once deployed to production systems, will be the following:

  • CARE Act – Initial Hearing
  • CARE Act – Hearing on Deferred Ruling
  • CARE Act – Case Management Hearing
  • CARE Act – Evaluation Review Hearing
  • CARE Act – CARE Plan Review Hearing
  • CARE Act – Progress Review Hearing
  • CARE Act – Status Review Hearing
  • CARE Act – 1 Year Status Review Hearing
  • CARE Act – Graduation Hearing

This development is in process and can be tracked via the Initiatives Tracker.

Per the webinar on 11/8/24, CalMHSA has added “CARE Act – Implementation Activity” and “CARE Act – Data Reporting” as appointment types that can be used in Calendar Entries rather than client-specific services. The CARE Act Claiming Report will be updated to include these additional codes. This development is in process and can be tracked via the Initiatives Tracker.

All of the CARE Act codes (procedure codes and appointment types) will be added to the productivity report as “productive time”, much like “QI Time” is included now. This development is in process and can be tracked via the Initiatives Tracker.

NOTE: Non-clinical staff are not able to track time in SmartCare, since they do not have a Staff Calendar on which to include services or calendar events. These staff must track their time separately outside of SmartCare. CalMHSA is exploring a non-clinical staff calendar in SmartCare, which can be tracked via the Initiatives Tracker.

Expected County Setup – Privacy and Permissions

Counties will need to add their CARE Act program to whichever CDAGs they feel are appropriate to do so. This will determine which staff can see that the client is associated with the CARE Act program and that certain CARE Act documents or services exist.

In order to see the details of any CARE Act document, a user will need to be granted the “CARE Act Add-On” user role. Staff who do not have this user role will receive a permissions error when attempting to open a CARE Act document, regardless of what program the document is associated with. As more CARE Act specific document types are created, such as court report documents, this user role will be granted permission to view, created, and edit these documents.

System Admins will also be granted permission to these documents. This is required in order for them to manage the system appropriately. This includes the “CalMHSA Sys Admin” and the “County Affiliate Sys Admin” user roles. No other user roles will be provided access.

CARE Act Reimbursement

CalMHSA has created a CARE Act Claiming Report that will provide you with the necessary information in order to complete the DHCS reimbursement form. This is the only CARE Act-specific item in SmartCare that will given to non-CARE Act user roles. The “Medical Records/Quality Assurance” and “Billing” user roles will be provided access to this report, which does not contain any client information.

BHIN 24-015 indicates that DHCS will reimburse counties an hourly rate for time spent on administrative functions as part of the Community, Assistance, Recover, and Empowerment (CARE) Act. DHCS identified 5 types of activities which may be reimbursed. CalMHSA created a procedure code for each of the 5 activities listed. This means that the activity can be tied directly to a CARE Act client but is not billed to Medi-Cal or any other payor. This report was created to provide counties with the information needed to submit the necessary claims to DHCS on a quarterly basis. Due to the nature of the DHCS-created submission file, this is not a report that can simply be run and submitted to DHCS as-is. There will likely be some manual manipulation needed. However, this report should provide you with all the necessary information you will need.

Related Knowledge Base Articles

Clinical Documentation
System Administration Documentation

Other Notes

  • Per the webinar on 11/8/24, CalMHSA has added “CARE Act Petition” and “Information about CARE Act” to the global code in the “Inquiry Type” field. This will allow counties to track any requests for information and to track petitions they receive, per their county-specific processes.

Known Issues

CARE Act Reporting Document

  • Clicking the Refresh button clears the Sexual Orientation field. Partially Fixed – this is due to mapping between the Client Information and the CARE data dictionary. Mapping has been added, but not all options can be mapped. We are working on an improved mapping method.
  • Additional text field when selecting “Other” is always available and editable. Partially Fixed Some fields have been fixed but more fields have been found and are in the process of being conditionally visible.
  • When selecting a CARE Episode, multiple options are available when only 1 CARE Episode should have been created. Some seem to be blank spaces, some seem to be duplicates, and some are from since-deleted CARE Act Reporting Documents. FIXED
  • Ethnicity field is not pulling forward from the previous CARE Act Reporting Document. FIXED
  • Field “If the client has a CARE plan, on what date was the completed CARE plan approved by the court?” is showing even when the CARE status does not indicate a current CARE Plan. FIXED

CARE Plan/Agreement

  • Client Agreement section is blank. CalMHSA would prefer this section be removed from view, since we are not adding language to this section. IN PROCESS
  • When selecting a CARE Episode, multiple options are available when only 1 CARE Episode should have been created. Some seem to be blank spaces, some seem to be duplicates, and some are from since-deleted CARE Act Reporting Documents. FIXED
  • A validation is indicating that the CARE Episode is required, even though it’s completed. FIXED

CARE Act CPT/HCPCS Crosswalk

  • HK modifier isn’t available for selection. IN PROCESS
  • Typo: “HCPS” should be “HCPCS”. IN PROCESS
  • Crosswalk was not loaded into QA systems. FIXED loaded into QA and Prod systems

General

  • Some typos where “CARE” is spelled “Care” FIXED
  • CARE Act Reporting Document was deployed as “Care Act”. CalMHSA will make this change in CalMHSA Prod upon deployment. FIXED

Updated 12/12/24