Reimburse for MH/SUD screenings during annual exams
Recommendation
Congress should enact legislation requiring all providers to provide and all health plans to reimburse for evidence-based mental health and substance use disorder (MH/SUD) screening during annual well-child and adult physical exams. This should include an Adverse Childhood Experience (ACE) component in addition to Screening, Brief Intervention, and Referral to Treatment (SBIRT).[1][2]
Background/summary
Annual screenings are critical components of prevention and early intervention of mental health and substance use disorders (MH/SUDs).[1] Early identification and treatment lead to better outcomes in overall health and may lessen long-term disability.[3] Key screenings include the Adverse Childhood Experiences (ACE) assessment and Screening, Brief Intervention, and Referral to Treatment (SBIRT). ACEs refer to traumatic events of abuse, neglect, or household challenges experienced by age 18.[4] Routine screenings provide an opportunity for the prevention, early detection, and intervention of the long-term effects of ACEs, may prevent and reduce the accumulation of ACEs, and improve the assessment and treatment for related health conditions.[5]
SBIRT delivers early intervention and treatment services through universal screenings that are comprehensive and integrated into primary care for persons at risk for or with substance use disorders.[6][7][8] Studies show that greater use of SBIRT is associated with larger decreases in substance use and that an essential factor in program sustainability is availability of funding.[8] While there are legal requirements to provide such screenings under certain health coverage (e.g. mandatory screenings as part of the Medicaid EPSDT benefit for children), health care providers should perform and health plans should reimburse for routine, evidence-based mental health screenings like those focused on ACEs and substance use disorders.[1]
citations
1. The Kennedy Forum. Navigating The New Frontier of Mental Health and Addiction: A Guide for the 115th Congress. Last Updated January 2017.
2. Office of the Surgeon General, U.S. Department of Health and Human Services. Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. Last Updated 2021.
3. National Alliance on Mental Illness (NAMI). Mental Health Screening. Last Accessed July 23, 2023.
4. ACEs Aware, University of California ACEs Aware Family Resilience Network (UCAAN). ACE Fundamentals. Last Accessed July 23, 2023.
5. ACEs Aware, University of California ACEs Aware Family Resilience Network (UCAAN). Benefits of Screening for ACEs. Last Accessed July 23, 2023.
6. Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services. Screening, Brief Intervention, and Referral to Treatment (SBIRT). Last Updated August 12, 2022.
7. Babor, Thomas F., Bonnie G. McRee, Patricia A. Kassebaum, Paul L. Grimaldi, Kazi Ahmed, Jeremy Bray. “Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse.” National Institutes of Health, National Library of Medicine, National Center for Biotechnology Information, Substance Abuse, Volume 28, Issue 3. Last Updated 2007.
8. Babor, Thomas F., Frances Del Boca, Jeremy W Bray. Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice, National Institutes of Health, National Library of Medicine, National Center for Biotechnology Information, Addiction, Volume 112, Supplement 2. Last Updated February 2017.