By OPEN MINDS Circle
On August 10, 2021, the California Department of Health Care Services (DHCS) released new guidance to the state’s Medicaid managed care plans (MCPs) about using diagnostic codes to collect data on the incidence and prevalence of social determinants of health (SDOH) affecting Medicaid beneficiaries. SDOH are consumer’s needs for non-medical good and services that if unmet are likely to affect the consumer’s health outcomes. DHCS issued a list of 18 DHCS Priority SDOH Codes, based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM).
The codes must be incorporated into all coding and billing guidance and templates developed for MCP network provider organizations, subcontractors, enhanced care management (ECM), and in-lieu of services (ILOS) provider organizations. DHCS expects MCPs to develop processes to regularly document SDOH, but did not require MCPs to create new or change their policies and procedures. DHCS further expects MCPs to support training to contracted network provider organizations and subcontractors on the use of DHCS Priority SDOH Codes. DHCS said MCPs should work closely with their network provider organizations, subcontractors, ECM, and ILOS provider organizations to promote screening and reporting of the DHCS Priority SDOH Codes.
|
California DHCS Priority Social Determinants Of Health Codes | |
| Code |
Description |
| Z55.0 | Illiteracy and low-level literacy |
| Z59.0 | Homelessness |
| Z59.1 | Inadequate housing (lack of heating/space, unsatisfactory surroundings) |
| Z59.3 | Problems related to living in residential institution |
| Z59.4 | Lack of adequate food and safe drinking water |
| Z59.7 | Insufficient social insurance and welfare support |
| Z59.8 | Other problems related to housing and economic circumstances (foreclosure, isolated dwelling, problems with creditors) |
| Z60.2 | Problems related to living alone |
| Z60.4 | Social exclusion and rejection (physical appearance, illness, or behavior) |
| Z62.819 | Personal history of unspecified abuse in childhood |
| Z63.0 | Problems in relationship with spouse or partner |
| Z63.4 | Disappearance & death of family member (assumed death, bereavement) |
| Z63.5 | Disruption of family by separation and divorce (marital estrangement) |
| Z63.6 | Dependent relative needing care at home |
| Z63.72 | Alcoholism and drug addiction in family |
| Z65.1 | Imprisonment and other incarceration |
| Z65.2 | Problems related to release from prison |
| Z65.8 | Other specified problems related to psychosocial circumstances (religious or spiritual problem) |
DHCS selected these codes based on an assessment of existing MCP code utilization, and by determining where MCPs and their provider networks and subcontractors may have the greatest impact on identifying and addressing beneficiary SDOH. The coes will be submitted with other encounter data through the existing encounter data reporting mechanisms for all covered services for which the MCPs have financial responsibility.
The effort to collect SDOH data is part of the DHCS California Advancing and Innovating Medi-Cal (CalAIM) proposal that includes a population health management initiative to improve beneficiary health outcomes. The initiative is focused on managing member risk and need through whole person care approaches while focusing on and addressing SDOH, and DHCS recognizes that consistent and reliable collection of SDOH data is vital to the success of the initiative.
For more information about the SDOH Priority Codes, contact: Bambi Cisneros, Acting Division Chief, Managed Care Quality and Monitoring Division, California Department of Health Care Services, Post Office Box 997413, MS 4410, Sacramento, California 95899-7413; 916-449-5000; Fax: 916-449-5005; Website: https://www.dhcs.ca.gov/services/Pages/ManagedCareMonitoring.aspx