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CARE Act

UPDATE 5/2/25: We have posted our proposed design changes below. These are not full technical specs but rather a list of changes we’re working to implement. Due to the amount of changes required, this is a substantial development effort that will take time. We do not currently have an ETA for any of these items. Items will be deployed as they become available. CalMHSA will be alerting counties as these are changes are deployed, as well as providing updated Knowledge Base articles. Please make sure you are passing the information to your relevant staff and providing staff training as necessary.

Table of Contents

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. System Referral (optional)
    1. Agency refers an individual to County BH to have them evaluated for CARE Act petition. 
  2. 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.
  3. 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.
  4. 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.
  5. 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. System Referral
    1. Captures baseline data, including referral source and basic client demographics
  2. Initiation Phase
    1. Captures baseline data, including petition information and basic client demographics.
  3. Active Service Phase
    1. Captures ongoing CARE Act data, including the status of the client’s CARE Act case and what services are provided.
  4. 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.

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General County Workflow for CARE Act Staff

  1. Receive referral to evaluate individual for CARE Act petition.
    1. Complete a monthly report for the referral (TBD – in development)
  2. Receive court order to initiate engagement with a CARE Act client.
    1. Open the client to the CARE Act program.
    2. Scan in related documents, including the Petition, under the CARE Act program.
    3. Start the initial CARE Act Reporting document
  3. 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.
  4. 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. 
      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.
  5. 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.

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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.

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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.

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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.

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Clinical Documentation
System Administration Documentation
State Reporting

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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.

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.

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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. FIXED
  • 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. FIXED IN QA, will deploy to Prods 5/12/25
  • 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 DEVELOPMENT
  • Typo: “HCPS” should be “HCPCS”. FIXED 
  • Crosswalk was not loaded into QA systems. FIXED 

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

Reporting

  • The report file is currently missing reporting item 3.11.5. FIXED
    When you copy/paste into the DHCS spreadsheet, please note that you will likely have to copy/paste in sections, as an entire column is missing. We are working on getting this fixed. The information is present in the individual records and may be added to the DHCS spreadsheet manually. Below are the SmartCare spreadsheet tabs and the corresponding column Id where the missing column should be:

    • CARE Process Initiation Period: Before DH
    • Dismissed: not applicable
    • Active CARE Agreement: Before RV
    • Active CARE Plan: Before RV
    • Elective Client: Before GZ
    • Termination: not applicable
    • Graduated or After 12 Months: Before GZ

    Note: For records created prior to this fixed being deployed, you will see an error on the reporting list page that these records are missing the PAD question. Select these records and select the action “refresh data”. This should clear the error and allow these records to be batched. 

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Design Changes 2025

The following changes will not all be deployed at once, but rather will be deployed as they become available. Counties will be informed as they are being deployed.

CARE Act Data Dictionary v2.0

We are working on making all the necessary changes to the CARE Act Reporting Document. Due to the amount of changes, including adding entirely new sections of reporting types, this development will take months to complete. We have been working on this since we received the draft of the data dictionary and took action as soon as the finalized version was received.

Additional changes had been planned before the new data dictionary was received. This includes pulling additional fields forward (e.g. employment status, housing status) and adding some logic around “unknown” or “none” (e.g. not letting other options be selected if one of these is selected).

We’re also trying to make some changes to the Services and Supports tab. We already added a validation to ensure at least one item is checked in each column. We’re working on removing the requirement for “reason not provided” when “unknown” or “none” are checked. We’re also working on making sure only “was provided” or “was not provided” can be checked for the same row, except for “unknown” or “none” options.

Referral Tracking

We currently have a process of gathering some basic information about referrals on the Inquiry Details screen. This is a workaround until additional development can be completed. Now that we have the full list of required data points for referrals, we will be making changes to the CARE Act Reporting Document to include a “Referral” type option (next to the “Initiation”, “Active”, and “Follow Up” options) that will include all the required data entry fields.

CARE Act Inquiry Tracking

We are working on a report that will provide counties with information about CARE Inquiries that have been entered via the Inquiry Details screen. This will be a human-readable report that should be able to be used to fill out the CARE Inquiries tab of the reporting workbook. Reporting on CARE Act Inquiries is an aggregated report, but this CalMHSA report will provide details of each CARE Act Inquiry so as to help administrators ensure all records are complete. The report will be structured in a way that administrators can easily sum the inquiry records as needed for different reporting data points.

CARE Episode

Right now, a “CARE Episode” is created when a user completes their first CARE Act Reporting Document. This “CARE Episode” can be selected in subsequent CARE Act Reporting Documents, which will initialize data from the previous CARE Act Reporting Document with that same CARE Episode.

CalMHSA was working on creating court reporting documents for the CARE Act implementation and wanted to be able to tie these to the CARE Episode. This would allow for good tracking for the entire episode. Having the episode be created in the initial CARE Act Reporting Document therefore meant that the initial reporting document must be signed before anything could be attributed to this episode. Since these reporting documents are completed at the end of the month for the previous month, this created a slow-down in the process.

Also, with the introduction of the System Referral process, a CARE Episode may now be created via referral, rather than via petition.

Therefore, CalMHSA has requested that the creation of the CARE Episode be separated from the CARE Act Reporting Document. The CARE Episode Document will include minimal information. It will ask whether the episode started via referral or petition, and then ask corresponding questions related to the tracking of that type of initiation. If the episode started with a petition, then the petition number (e.g. case number) and the petition date would be entered (unknown will still be an option for the date field). If the episode started with a referral, the referral date and referral source would be entered.

The CARE Act Reporting Document will still be able to utilize the CARE Episode, but now all types of report, including Initiation, will be able to use the CARE Episode. The information from the CARE Episode Document will be pulled into the CARE Act Reporting Document. Any subsequent documents will continue to pull data from the previously completed CARE Act Reporting Document with the same CARE Episode.

The CARE Episode will be ended based on certain CARE or Referral Statuses in the CARE Act Reporting Document associated with that episode. If certain options are selected, the last date of the reporting period of that CARE Act Reporting Document will be entered as the end date for the corresponding CARE Episode.

We will also be adding some alerts if a user attempts to create a CARE Act Reporting Document without completing the prior one. For example, if a user creates a CARE Act Reporting Document using “Initiation” type but the CARE Episode was created based on a referral, the system will alert the user if a “Referral” type CARE Act Reporting Document has not yet been created for this episode.

Outreach & Engagement Tracking

We are exploring methods of tracking this type of information. While this will be a field on the CARE Act Reporting Document, nothing will initialize into this field at this time. We may look to add initializations later, but didn’t want to extend the development time.

Right now, there is a procedure code for “CARE Act – Outreach and Engagement Activity”. We are considering different options for how to separate outreach (attempted contact) with engagement (successful contact). We don’t want to use “show” v. “no-show” because that would remove the activities from the user’s calendar and would require changes to our claiming reports. We considered separating these into different procedure codes, but there are other data points that need to be tracked, including the type of outreach and engagement activity (e.g. sections 3.3.23, 3.3.24, 5.6.1, 5.6.2).

We’re considering creating a custom note type that tracks whether a service was outreach v. engagement and what type it was. We’re also considering adding locations for these options, but don’t want to add locations that aren’t places of service that may be accidentally added to other programs, which would cause billing errors.

CARE Plan/Agreement Radio Button

We are working on adding a radio button at the top of the CARE Plan/Agreement document that will allow users to select whether the document is a CARE Plan or a CARE Agreement.

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  • Last Updated: May 6, 2025