SBIRT: A validated practice to recognize teens who need help for substance abuse is a benefit of Texas Medicaid

A recent survey of pediatricians found that only a minority of pediatricians used validated screening tools for substance abuse screening, and most relied on clinical impressions. Studies have found that only one-third of adolescents excessively using alcohol were detected when pediatricians relied on clinical impressions. A revised policy statement and a new clinical report from the American Academy of Pediatrics (see additional resources below) contain updated guidance, including screening tools and intervention procedures in support of universal Screening, Brief Intervention and Referral to Treatment (SBIRT) practices for adolescent substance abuse in routine health care.

Texas Medicaid covers SBIRT. It has changed benefit criteria for SBIRT effective for dates of service on or after July 1, 2016. Key changes are listed below:

• The initial screening session can occur in the emergency department, office, home, outpatient hospital and other appropriate settings.
• SBIRT is now a benefit for members 10 to 21 years of age AND adults 21 and older.
• Providers will be required to complete four hours of SBIRT training prior to delivering SBIRT.
• Texas Medicaid has identified two new procedure codes, H0049 and 99408, which will be used for delivering SBIRT services.
• Procedure code H0050 will no longer be a benefit other than at Chemical Dependency Treatment Facilities (CDTFs).

Per Texas Medicaid, SBIRT services can be performed by the following providers: Physicians, registered nurses (RNs), advanced practice nurses (APRN), physician assistants (PA), psychologists, licensed clinical social workers (LCSW), licensed professional counselors (LPC), certified nurse midwives (CNM), outpatient hospitals, federally qualified health centers (FQHC) and rural health clinics.

Training for Providers

Providers that perform SBIRT must be trained in the correct practice method and will be required to complete at least four hours of training. Proof of completion of SBIRT training must be maintained in an accessible manner at the provider’s place of service.

Information regarding available trainings and standardized screening tools can be found through the Substance Abuse and Mental Health Services Administration (http://www.integration.samhsa.gov/clinical-practice/sbirt/training-other-resources)

 Reimbursement

SBIRT is a benefit of Texas Medicaid when billed using the following procedure codes:

Additional resources are available at:

http://www.txhealthsteps.com/cms/?q=node/209

http://www.integration.samhsa.gov/clinical-practice/sbirt/training-other-resources

http://pediatrics.aappublications.org/content/138/1/e20161210

http://pediatrics.aappublications.org/content/138/1/e20161211

For more information, view the TMHP message here or contact TCHP Provider Relations at 1-800-731-8527.

Lia Rodriguez MD FAAP
Medical Director