Manejo de Cuidado
Unhealthy Alcohol Use in Adolescents and Adults Tip Sheet
Members 11 years and older who are screened for unhealthy alcohol use in primary care settings and providing persons 18 years and older engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use in the measurement year.
Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information refer to the 2021 and 2022 CBI Technical Specifications.
Note: Alcohol screening and treatment services are reimbursed outside of regular capitated rates. For both capitated and non-capitated Alliance providers, the Alliance will reimburse 150% of Medi-Cal rates to our contracted providers.
FQHCs may want to review how these payments effect State reconciliation cost reporting. FQHC / Rural Health Center tip: Do not bill the Alliance for more than what Medi-Cal allows to avoid repayment.
Patient medical records must include:
- The service provided, for example: 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)
- If a referral to an alcohol or substance use disorder program was made
The brief intervention (G0443 or H0050) may include an initial intervention, a follow-up intervention and/or a referral; and can take place on the same date of service as the initial screening (G0442, H0049 or acceptable LOINC codes) or on subsequent days. Brief interventions may be offered in-person, by telephone, or by telehealth modalities.
Screening is only reimbursable with a validated screening tool. Example tools include:
- Alcohol Use Disorders Identification Test - Concise (Audit-C).
- CRAFT (Car, Relax, Alone, Friends, Forget, Trouble) is a well-validated substance use screening tool for non-pregnant adolescents that can be self-administered or be completed by a patient and as an interview tool administered by a provider. Information is available at http://crafft.org/.
- CAGE (Cut-Annoyed-Guilty-Eye) is a simple screening questionnaire to identify people with potential problems with alcohol. Two “yes” responses are considered positive for males; one “yes” is considered positive for females.
- Michigan Alcoholism Screening Test Geriatric (MAST-G) alcohol screening for geriatric population.
- Parents, Partner, Past and Present (4Ps) for pregnant women and adolescents.
- Single-question screening, such as asking, “How many times in the past year have you had 4 (for women and all adults older than 65 years) or 5 (for men) or more drinks in a day?” as aligned in the Staying Healthy Assessment.
- Tobacco, Alcohol, Prescription medication and other Substances (TAPS).
When a screening is positive, providers should use an appropriate validated assessment tool like the Alcohol Use Disorders Identification Test (AUDIT).
The Alliance will reimburse providers who provide services for unhealthy alcohol use. Unhealthy alcohol use screening and behavioral counseling services may be provided on the same day as other Evaluation and Management (E&M) services. A pre-screen or brief screen is not reimbursable.
|Code Type||Code||Code Description|
|LOINC||88037-7||(Men 18 years and older): How often have you had five or more drinks in one day during the past year|
|LOINC||75889-6||(Women 18 years and older & Older Adults): How often have you had four or more drinks in one day during the past year|
|LOINC||75624-7||Screening tool: AUDIT|
|LOINC||75626-2||Screening tool: AUDIT-C|
|HCPCS||G0442||Annual alcohol misuse screening, 15 minutes|
|HCPCS||G0443||End date June 30, 2021: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes|
|HCPCS||H0049||Start date June 9. 2020: Screening for 11yrs+: Alcohol and/or drug screening|
|HCPCS||H0050||Start date July 1, 2021: Treatment for 18yrs+: Alcohol and/or drug services, brief intervention, per 15 minutes|
Primary care providers and integrated practice models with Behavioral Health therapists may offer alcohol misuse screenings. Alcohol misuse screening services performed by Behavioral Health therapists under the same clinic NPI are eligible for CBI payment. Claims submitted to Beacon will not qualify for CBI payment. Beacon may not reimburse for these services since they are intended to be a primary care service.
Data for this measure will be collected using claims or provider data submissions via the Data Submission Tool (DST) on the Portal del Proveedor.
- Run a report from your Electronic Health Record (EHR) system; or
- Manually compile patient data (Example: Download your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).
This measure allows providers to submit initial alcohol screenings or brief counseling/treatment from the clinic EHR system or paper records to the Alliance by the DST contractual deadline. This includes screenings and or brief interventions that were completed before the member was eligible for Medi-Cal or during a gap in coverage, but the member must be 11 years or older at the time. To submit, you may upload data files to the DST on the Portal del Proveedor. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Portal del Proveedor.
The American Academy of Pediatrics’ (AAP) Bright Futures recommends:
- Youth aged 11 years and older should be screened for alcohol and other drugs (AOD) use at each annual preventive health visit.
- Providers begin with open ended questions about substance use at home, school, and by peers before progressing to open-ended questions about personal use. See the Alcohol Screening and Brief Intervention for Youth A Practitioners Guide for more details.
- Reviewing the adolescent’s environment for risk and protective factors for the development of alcohol or drug use and abuse.
- Creating opportunities for confidential discussion between the adolescent and provider.
- Utilize an Adolescent SBIRT Implementation checklist to get started.
- CDC Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use a Step-by-Step Guide for Primary Care Practices.
- Screening Workflow: