19-026 Alcohol Misuse: Screening and Behavioral Counseling Interventions
Date: 01/24/19
USPSTF recommends annual alcohol misuse screening in the primary care setting for all adults ages 18 and older
On September 14, 2018, the Department of Health Care Services (DHCS) issued All Plan Letter (APL) 18-014 clarifying the primary care requirements regarding alcohol misuse screening and behavioral counseling interventions. This requirement is consistent with the United States Preventive Services Task Force (USPSTF) recommendations for adults ages 18 and older as part of preventive screening services.
California Health & Wellness Plan (CHWP) is required to cover and pay for an expanded alcohol screening for members ages 18 and older, or at any time the primary care physician (PCP) – or the primary care team – discovers a potential alcohol misuse problem.
PROVIDER REQUIREMENTS
If a member is involved in risky or hazardous alcohol use as identified from the annual alcohol misuse screening process, CHWP requires providers to:
· Offer one, but may offer up to a maximum of three, behavioral health counseling interventions per year. Interventions may be delivered via face-to-face sessions, written self-help materials, computer- or web-based programs, or by telephone.
· When medically necessary, obtain an authorization for additional behavioral counseling interventions over three per year.
· Document all expanded alcohol misuse screenings and medically necessary authorization requests in the member’s medical record.
· Refer members who meet the criteria for alcohol use disorder (AUD) to behavioral health or alcohol use disorder services.
SCREENING TOOLS
One of the following USPSTF validated screening tools must be used by the PCP when screening members for alcohol misuse:
1. Alcohol Use Disorders Identification Test (AUDIT) questionnaire
2. Abbreviated AUDIT-Consumption (AUDIT-C) questionnaire
3. A single-question screening, such as asking, “How many times in the past year have you had:
For women and all adults ages 65 and older | For men |
more than four drinks on any day?” | more than five drinks on any day?” |
The AUDIT and AUDIT-C questionnaires are available from the:
· Substance Abuse and Mental Health Services Administration and U.S. Department of Health and Human Services Health Resources and Services Administration (SAMHSA-HRSA) website at www.integration.samhsa.gov/clinical-practice, then select Screening Tools > Drug & Alcohol Use Screening Tools. AUDIT and AUDIT-C are found under the subheading Drug and Alcohol Use.
· Provider Resources section of the provider website at www.cahealthwellness.com under Manuals, Forms and Resources > More Resource Topics > AMSC Additional Resources and select SAMHSA-HRSA AUDIT and AUDIT-C Screening Instruments. Once in the Screen Tools screen, select Drug & Alcohol Use Screening Tools.
ADDITIONAL INFORMATION
Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. The provider operations manual is available in the Provider Resources section of the provider website at www.cahealthwellness.com.
Providers are encouraged to access CHWP’s provider portal online at www.cahealthwellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact your Provider Relations representative or call 1-877-658-0305.