Ten States to Reimburse Drug Screenings of Medicaid-Eligible Patients

"Medicalizing" the detection and intervention of substance abuse.

by / July 3, 2008

Yesterday, Dr. Bertha K. Madras, deputy director for demand reduction in the White House Office of National Drug Control Policy (ONDCP), announced that 10 states have activated new substance abuse prevention and treatment health codes for screening and brief intervention (SBI) of Medicaid-eligible patients. The 10 states will reimburse doctors, and affiliated medical professionals, who screen their Medicaid-eligible patients for a spectrum of substance-use behaviors and disorders.

The following nine states: Iowa, Maryland, Minnesota, Montana, Oklahoma, Oregon, Tennessee, Virginia and Washington, have activated American Medical Association Common Procedural Terminology codes (CPT) or Centers for Medicaid Services (CMS) HCPCS codes for screening and brief intervention, with a 10th state, Wisconsin, conducting screening and brief intervention as part of a comprehensive package of health services for pregnant women.

These states have taken an historic step in transforming substance abuse in the United States," said Madras. "By 'medicalizing' the detection and intervention of substance abuse, the 10 states recognize the need to de-stigmatize substance abuse, and mainstream preventive services into general medical care. This innovative approach will help diminish the public health burden of substance abuse in their respective state, and catalyze preventive medical procedures in a cost-effective and sustainable manner."

Personalized screening and brief intervention procedures are designed to assess an individual's substance use on a spectrum, and provide immediate interventions or referrals, if necessary. Screenings and brief interventions can be performed in various locations and settings, including in doctor's offices, trauma centers, emergency departments, prenatal and community health clinics, college campuses, and even on the Internet.

"It is estimated that 95.5 percent of the 20 million Americans who harbor a medical diagnosis of abuse/addiction do not seek appropriate levels of care to address their illness/disease," continued Madras. "Additionally, there are millions of risky drug users who could benefit from SBI as a way of preventing adverse consequences, including addiction. SBI has the potential to reach these individuals through an in-person screening, and provide an opportunistic intervention that can dramatically transform lives. SBI has been proven to significantly reduce heavy alcohol and illicit drug use, and expedite specialty treatment for the addicted, if necessary. SBI is slowly but steadily gaining acceptance in the medical and public health arena as a public health approach to prevent and treat substance abuse."

The 10 states now covering SBI services for Medicaid patients join many private and public health providers, including Aetna, and the Federal Employees Health Benefits (FEHB) program. Actually, more than 70 percent of enrollees in the FEHB program are covered by SBI services. CMS has also line-itemed SBI in their annual budget, with a $265 million set-aside, to match state contributions for those that implement the codes for SBI.