Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment
Provider Type
- Physicians and Practitioners
- Participating Physician Groups (PPG)
Alcohol and drug treatment services are excluded from Health Net's coverage responsibilities under its Medi-Cal managed care contract. These services are administered by counties and overseen by the State of California.
Health Net, its affiliated health plans and subcontracting providers are available to coordinate referrals for members requiring substance use treatment and services. Members receiving these services remain enrolled with Health Net. Participating primary care physicians (PCPs) are responsible for maintaining continuity of care for the member.
Participating providers must maintain documentation of Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) services provided to members. When a member transfers from one PCP to another, the receiving PCP must attempt to obtain the member’s prior medical records, including those related to preventive services.
Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT)
Consistent with U.S. Preventive Services Task Force (USPSTF) Grade A or B recommendations, AAP/Bright Futures guidelines, and the Medi-Cal Provider Manual, Managed Care Plans (MCPs) must provide alcohol and drug SABIRT services for members 11 years of age and older, including pregnant women. These services may be provided by qualified providers within their scope of practice, including, but not limited to, physicians, physician assistants, nurse practitioners, certified nurse midwives, licensed midwives, licensed clinical social workers, licensed professional clinical counselors, psychologists, and licensed marriage and family therapists.
For minors age 12 and older, substance use disorder (SUD) treatment services, including screening, assessment, intervention, and referral services, are covered without parent or guardian permission.
Screening
Alcohol and drug use screening must be conducted using validated screening tools. Examples include, but are not limited to:
- Alcohol Use Disorders Identification Test (AUDIT).
- CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) for non-pregnant adolescents.
- Cut down, Annoyed, Guilty, Eye-opener adapted to include drugs (CAGE-AID)
- Drug Abuse Screening Test (DAST-10).
- Michigan Alcoholism Screening Test-Geriatric (MAST-G)
- National Institute on Drug Abuse (NIDA) Quick Screen for adults (including alcohol-related questions)
- Parents, Partners, Past and Present (4Ps) for pregnant women and adolescents.
- Tobacco, Alcohol, Prescription medication, and Other Substances (TAPS).
Brief Assessment
When a screening result is positive, validated assessment tools should be used to determine whetheralcohol use disorder (AUD) or substance use disorder (SUD) is present. Validated alcohol and drug assessment tools may be used without first using validated screening tools.
Assessment tools include, but are not limited to:
- NIDA-Modified Alcohol, Smoking and Substance Involvement Screening Test (NM-ASSIST)
- Drug Abuse Screening Test (DAST)-20
- Alcohol Use Disorders Identification Test (AUDIT)
Brief Interventions and Referral to Treatment
For members with brief assessments indicating unhealthy alcohol use, brief misuse counseling should be offered. Members whose assessments indicate probable AUD or SUD must be referred for additional evaluation and treatment, including medications for addiction treatment when appropriate.
Alcohol and/or drug brief interventions include alcohol misuse counseling and counseling a member regarding additional treatment options, referrals, or services.
Brief interventions must include the following:
- Providing feedback to the patient on screening and assessment results.
- Discussing negative consequences and e overall severity of the condition.
- Supporting the patient in making behavioral changes.
- Agreeing on follow-up plans, including referrals to other treatment as appropriate.
Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care
The USPSTF recommends that clinicians screen adults age 18 and older for alcohol misuse and provide brief behavioral counseling interventions to reduce alcohol misuse.
Treatment Referral
Providers are responsible for referring members who meet criteria for alcohol and drug disorders to county drug programs for treatment services. These services are not covered by Health Net.
A list of county contacts for substance use disorder treatment and referrals is available on the DHCS website at DHCS website, under Referral to Treatment.
Documentation Requirements
Member medical records must include:
- The service provided (e.g., screening and brief intervention).
- The name and score of the screening instrument (unless embedded in the EHR).
- The name and score of the assessment instrument, if applicable (unless embedded in the EHR).
- Documentation of any referral made for AUD or SUD treatment, including the destination of the referral.
PCPs must maintain documentation of SABIRT services provided to members. When a member transfers from one PCP to another PCP, the receiving PCP must attempt to obtain the member’s prior medical records, including those pertaining related to the provision of preventive services.