Updated Coverage and Reimbursement for Adverse Childhood Experiences (ACEs) Screenings for Medicaid Members

Provider Requirements

To administer and bill for ACEs screenings, providers must:

• Be licensed or be under the supervision of a licensed provider who is enrolled as a New York State Medicaid provider
• Have the appropriate training and experience to screen for ACEs and provide trauma-informed care

The following table outlines the approved providers and categories of service:

ACEs Screening Requirements and Process

Given the nature of ACEs, providers and practices should ensure that they have the capacity to evaluate and treat children who screen positive for ACEs before starting standardized screenings. Additionally, screenings for ACEs are always voluntary, to minimize the risk of retraumatizing the individual and/or family. To ensure a safe, empowering environment for the child and family, the provider should be trained in trauma-informed care practices.

Recommended Screening Tools

The use of a research-based tool is required when screening for ACEs to be eligible for NYS Medicaid reimbursement. Healthcare practices should adopt the tool that meets the needs of their populations and clinical workflows.

Example of recommended screening tools include:

• Child: Pediatric ACEs and Related Life Events Screener (PEARLS)
• Adult: Adverse Childhood Experience Questionnaire for Adults

More information and resources around ACEs screenings can be found in the More Information section of this document.

ACEs Screening Process

The following outlines the required process for administering ACEs screenings:

1. Administer ACEs screenings using a research-based tool
2. Review the screen results along with the member
3. Document if the screening tool resulted in a positive or negative result

Note: Individual ACEs do not need to be recorded

Positive Screen Results: If the screen is determined positive for ACEs, as determined by the provider, providers must:

1. Develop a treatment plan in partnership with the member or parent/caregiver 
2. Make referrals to appropriate resources, such as mental health providers or community-based organizations, for any needs identified or requested as a result of the screening

Billing Requirements

Healthfirst’s billing policy for ACEs screenings aligns with NYS Billing Guidelines and is outlined in the table below:

*Clinician to determine if an ACEs screening is positive.

More Information

• Screening for Adverse Childhood Experiences and Trauma | Center for Health Care Strategies
• Learn About Screening | ACEs Aware
• Adverse Childhood Experiences | New York State Office of Child Welfare and Community Services
• Expanded Reimbursement for Adverse Childhood Experiences Screening | New York State Medicaid Update | September 2024

Questions?

If you have any questions, please contact your Network Account Manager, or call Provider Services at 1-888-801-1660, Monday to Friday, 8:30am-5:30pm.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”).