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Alcohol and Drug Screening, Assessment, Brief Interventions and Referral to Treatment

Provider Type

  • Physicians
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Counties Covered

  • Fresno
  • Kern  
  • Kings
  • Los Angeles
  • Madera
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego 
  • San Joaquin
  • Stanislaus
  • Tulare

Alcohol and drug treatment services are excluded from Health Net's coverage responsibilities under Health Net's Medi-Cal managed care contract. These services are 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 services under this program remain enrolled in Health Net. Participating primary care physicians (PCPs) are responsible for maintaining continuity of care for the member.

Alcohol Misuse Screening and Behavioral Counseling

Consistent with U.S. Preventive Services Task Force (USPSTF) Grade A or B recommendations, AAP/Bright Futures, and the Medi-Cal Provider Manual, Managed Care Plans (MCPs) must provide alcohol and drug Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) services for members 11 years of age and older, including pregnant women. These services may be provided by 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.

Screening

Alcohol and drug use screening must be conducted using validated screening tools. Validated screening tools include, but are not limited to:

  • Alcohol use disorders identification test (AUDIT).
  • Alcohol use disorders identification test (Audit-C).
  • Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for non-pregnant adolescents.
  • Cut down-annoyed-guilty-eye-opener adapted to include drugs (CAGE-AID).
  • Drug abuse screening test (DAST-10).
  • Drug abuse screening test (DAST-20).
  • Michigan alcoholism screening test geriatric (MAST-G) alcohol screening for geriatric population.
  • National institute on drug abuse (NIDA) quick screen for adults.
  • The single NIDA quick screen alcohol-related questions can be used for alcohol use screening.
  • NIDA-modified alcohol, smoking and substance involvement screening test (NM-ASSIST).
  • Parents, partners, past and present (4Ps) for pregnant women and adolescents.
  • Tobacco alcohol, prescription medication, and other substances (TAPS).

Brief Assessment

When a screening is positive, validated assessment tools should be used to determine if

alcohol 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. Validated 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 that reveal unhealthy alcohol use, brief misuse counseling should be offered. Appropriate referral for additional evaluation and treatment, including medications for addiction treatment, must be offered to members whose brief assessment demonstrates probable AUD or SUD. 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:

  • Provide feedback to the patient regarding screening and assessment results;
  • Discuss negative consequences that have occurred and the overall severity of
  • the problem;
  • Support the patient in making behavioral changes; and
  • Discuss and agreeing on plans for follow-up with the patient, including referral to other treatment if indicated.

Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care

The USPSTF recommends that clinicians screen adults ages 18 or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse.

The following HCPCS codes may be used to bill for these services:

  • G0442 - annual alcohol misuse screening, 15 minutes
  • G0443 - brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

Code G0442 is limited to one screening per year, any provider, unless otherwise medically necessary. Code G0443 may be billed on the same day as code G0442. Code G0443 is limited to three sessions per recipient per year, any provider, unless otherwise medically necessary.

Treatment Referral

Providers are responsible for referring members who meet criteria for alcohol and drug disorders to a county drug program for services. These services are not covered by Health Net. A list of county contacts for local substance use disorder treatment information and referrals is available on the DHCS website at www.dhcs.ca.gov/services/medi-cal/Pages/SBIRT.aspx, under Referral to Treatment.

Documentation Requirements

Member medical records must include the following:

  • The service provided (e.g., screen and brief intervention);
  • The name of the screening instrument and the score on the screening instrument
  • (unless the screening tool is embedded in the electronic health record);
  • The name of the assessment instrument (when indicated) and the score on the
  • assessment (unless the screening tool is embedded in the electronic health record); and
  • If and where a referral to an AUD or SUD program was made.

PCPs must maintain documentation of 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 pertaining to the provision of preventive services.

Last Updated: 06/16/2022