Collection of Social Determinants of Health Data – DHCS APL 21-009
California’s Department of Health Care Services’ (DHCS) Advancing and Innovating Medi-Cal (CalAIM) program is a multi-year program to improve health outcomes and quality of life for Medi-Cal beneficiaries through broad delivery system, program, and payment reform. Population Health Management (PHM) is an initiative of CalAIM that identifies and manages member risk and need through whole person care approaches while focusing on and addressing Social Determinants of Health (SDOH).
As part of the CalAIM data collection process, this All Plan Letter provides guidance on using DHCS Priority SDOH Codes to collect reliable SDOH data in order to overcome the data collection challenges. DHCS’s 25 SDOH Codes are intended to assist providers in identifying health, social and risk needs, as well as care planning and coordination. This will also help DHCS evaluate population health at a statewide level. As with any evaluation, consistent and reliable coding data is key for allocating resources to meet the demonstrated need. This is an opportunity for providers to highlight how frequently social determinants of health impact members’ health so that future resources can be appropriately and equitably allocated.
While the DHCS encounter data system accepts and allows for providers to use all ICD-10-CM SDOH codes, DHCS seeks to prioritize the use of a set of 25 pertinent SDOH codes to maximize the capture of SDOH data.
DHCS Priority SDOH Codes
|Z55.0||Illiteracy and low-level literacy|
|Z58.6||Inadequate drinking-water supply|
|Z59.1||Inadequate housing (lack of heating/space, unsatisfactory surroundings)|
|Z59.3||Problems related to living in residential institution|
|Z59.48||Other specified lack of adequate food|
|Z59.7||Insufficient social insurance and welfare support|
|Z59.811||Housing instability, housed, with risk of homelessness|
|Z59.812||Housing instability, housed, homelessness in past 12 months|
|Z59.819||Housing instability, housed unspecified|
|Z59.89||Other problems related to housing and economic circumstances|
|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 APL 21-009 Key Requirements
- Network providers, including behavioral health, Enhanced Case Management, and Community Supports providers, must regularly document SDOH, particularly the 25 DHCS Priority SDOH Codes referenced above.
- Staff in the provider’s office other than a primary care provider (PCP) may document and code SDOH.
- Consistently code using the 25 DHCS Priority SDOH Codes and any other applicable ICD-10-CM SDOH codes.
- Document during the Initial Health Assessment.
- Document in any subsequent visit when staff become aware that a code is applicable.
- Consider training staff other than a PCP to document and code SDOH, emphasizing the DHCS Priority SDOH Codes.