Screening for Depression and Follow-Up Plan Tip Sheet

Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information refer to the CBI Technical Specifications.

Medical records must document:

• The name of the depression screening tool. If this is positive, documentation of the follow-up plan (must be on the same date as the positive screen). The date of the encounter and screening must occur on the same date of service and the name of the tools must be documented in the medical record.

Documented follow-up plans can include:

• Additional screening at the same encounter as the initial positive screen (additional screen alone does not count toward a valid follow-up intervention to an initial positive screen). Examples are: additional evaluation or assessment for depression such as psychiatric interview or evaluation, assessment for bipolar disorder.
• Suicide risk assessment (e.g. Beck Depression Inventory or Beck Hopelessness Scale).
• Referral to a practitioner who is qualified to diagnose and treat depression (e.g. psychiatrist, psychologist, social worker, mental health counselor).
• Referral to a program or other mental health service (e.g. family or group therapy, support group, depression management program, other service to treat depression).
• Pharmacological intervention.
• Other interventions or follow-up.

Screening is only reimbursable with a validated screening tool. Screening tools do not need to be sent to the Alliance and must be maintained in the patient’s medical record. Example tools include:

Members will be excluded from the measure if they have an active diagnosis of depression or bipolar disorder that starts prior to the start of the encounter and is still active at the start of the encounter (examples include but not limited to: major depressive disorder, vascular dementia with behavioral disturbance, dysthymic disorder, postpartum depression, other mental disorders complicating pregnancy, bipolar disorder.

To view applicable diagnosis codes for the exclusion, see the CBI Technical Specifications.

A beneficiary that does not meet the numerator criteria and meets the following exception criteria will be removed from the measure denominator:

• Beneficiary refuses to participate.
• Beneficiary is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the beneficiary’s health status.
• Situations where the beneficiary’s cognitive capacity, functional capacity, or motivation to improve may impact the accuracy of results of nationally recognized standardized depression assessment tools. For example: certain court-appointed cases or cases of delirium.

The Alliance will reimburse providers who provide depression screening, and if warranted, a follow-up plan documented on the date of the positive screen.

Data for this measure will be collected using claims. To find gaps in data:

• Run a report from your Electronic Health Record (EHR) system.
• Manually compile patient data (Example: Download the CBI report on the Provider Portal and compare to EHR).

• Complete screening annually in addition to clinical judgment, consideration of risk factors, comorbid conditions, and member life events (e.g. pregnancy).
• For those with a history of depression, screen at each visit.
• Medical Assistant administers initial depression screen and documents results.
• Screen patients at least once during the perinatal period for depression and anxiety symptoms.
• Screen for postpartum depression at the infant’s one, two, four, and six-month well-child visits and beyond.
• Utilize collaborative care interventions involving multifaceted care team approaches (e.g. primary care physician, case manager with mental health background, psychiatrist, etc.).
• Implement a call back program for reaching out to patients with positive screens to keep engagement.
• Refer Alliance members to Care Management services, including Complex Case Management and Care Coordination, by calling Case Management at 800-700-3874, ext. 5512.
• Refer Alliance members to Enhanced Care Management (ECM) Services and Community Supports through the Alliance Provider Portal, email ([email protected]), mail or fax, or by phone at 831-430-5512.
• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.

• Alliance Kev Pab Kho Cwj Pwm website
• Carelon Primary Care Provider (PCP) Referral Form
• Carelon Care Management Referral Form