Mental & Behavioral Health Screening Updates Tips, tools, and reimbursement guidance

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1 Mental & Behavioral Health Screening Updates Tips, tools, and reimbursement guidance

2 Recent Changes in Screening Rules 2 Autism Spectrum Disorder (ASD) Screening for Toddlers Mental Health Screening for Adolescents Substance Use Screening for Adolescents

3 Recent Changes in Screening Rules 3 Check the Texas Medicaid Provider Procedures Manual (TMPPM) for changes: ons_provider_manual.aspx

4 Autism Spectrum Disorder

5 ASD Screening for Toddlers 5 Checkups are key opportunity to screen. Screening required at 18 months and 24 months, or at 30 months if not completed sooner. ASD screening should be performed in conjunction with other developmental surveillance or screening done at 18 and 24 months. Perform a screening any time a parent or provider expresses concern.

6 M-CHAT: Required for ASD Screening 6 M-CHAT and M-CHAT R/F (revised with follow-up) are screening tools to assess risk for ASD in toddlers. Both are free to providers and available online. Download M-CHAT: Download M-CHAT R/F:

7 M-CHAT: Required for ASD Screening 7 Can be completed by a parent before checkup and scored in less than two minutes. Available in Spanish, Vietnamese, and other languages.

8 Developmental Screening: Ages & Tools 8 Screening Ages Developmental Screening Tool Autism Screening Tools 9 months Ages and Stages Questionnaire (ASQ) or Parents Evaluation of Developmental Status (PEDS) N/A 18 months ASQ or PEDS M-CHAT or M-CHAT R/F 24 months ASQ or PEDS M-CHAT or M-CHAT R/R 3 years ASQ, Ages and Stages Questionnaire: Social-Emotional (ASQ:SE), or PEDS N/A 4 years ASQ, ASQ:SE, or PEDS N/A

9 Ensure that Screening Occurs 9 Standardized screening must be completed if a patient missed a screening or there is no record of screening. If additional screening is required, a provider must document the rationale for additional screening. Screening completed without a required screening tool is not a payable benefit. Additional screening is not covered. Screening may be performed outside checkup.

10 Reimbursement for ASD Screening 10 ASD screening is procedure code with modifier U6. Screening is limited to once per day, per patient, by the same provider/provider group. Reimbursement will be denied unless a THSteps preventive checkup, exception-to-periodicity checkup, or follow-up checkup was reimbursed for the same date of service by same provider.

11 Referring Young Patients with ASD 11 Children birth through 35 months must be referred to ECI within seven days, even if they are also referred to a specialist. To refer to ECI, call Texas Department of Assistive and Rehabilitative Services (DARS). Call or visit the DARS website:

12 Referring Young Patients with ASD 12 Children 3 years and older should be referred to the school district s special education program. Refer patients to a specialist and provide anticipatory guidance.

13 Mental Health Screening for Adolescents

14 Adolescent Mental Health Screenings 14 As of November 1, 2015, mental health screening using one of the following tools is required once for patients 12 through 18 years: Pediatric Symptom Checklist (PSC-35) Pediatric Symptom Checklist for Youth (Y-PSC) Patient Health Questionnaire (PHQ-9) Car, Relax, Alone, Forget, Family or Friends, and Trouble Checklist (CRAFFT 2.0)

15 Adolescent Mental Health Screenings 15 Mental health screening tools are free to providers and and available online. Download tools:

16 Reimbursement for Mental Health Screening 16 Mental health screening separately reimbursable using procedure code For reimbursement, one of the four validated, standardized screening tools must be used. Reimbursement will be denied unless a procedure code 99384, 99385, 99394, or was submitted on the same date of service by same provider.

17 Substance Use Screening for Adolescents

18 Reimbursement for SBIRT 18 As of July 1, 2016, Texas Medicaid covers SBIRT in the medical office for adolescents to help prevent or curtail substance use. Providers can be reimbursed for using SBIRT during checkups for patients 10 through 20 years of age. Must be conducted by a trained staff member.

19 Reimbursement for SBIRT 19 SBIRT Procedure Code Description Limitations H0049 Alcohol and/or drug screening 2 per year Alcohol and/or substance abuse structured screening and brief intervention services 4 per year Reimbursement requires documentation of screening results, patient-centered care plan, and start and stop time of sessions.

20 Training for SBIRT 20 Health-care providers must complete four hours of SBIRT training. Proof of training completion must be maintained in accessible manner at provider s office. Training resources are available from the federal Substance Abuse and Mental Health Services Administration (SAMHSA).

21 Training for SBIRT: Eligible Staff 21 Physicians (MD and DO) Registered nurses Advanced practice nurses Physician assistants Licensed clinical social workers Licensed professional counselors Certified nurse midwives Psychologists

22 Validated Screening Questionnaires 22 Recommended questionnaires for adolescents include: CRAFFT 2.0 ASSIST DAST-10 AUDIT CAGE Or, validated binge drinking questionnaire

23 Referring for Substance Use Treatments 23 Adolescents who drink alcohol or use illicit drugs weekly or more frequently have a high probability of substance use disorder. These adolescents need to be seen by a specialized behavioral health provider. Cognitive behavioral therapy, group therapy, or detox programs may be necessary. Know your local substance use specialists.

24 Documenting Checkup Components 24 All federal- and state-mandated checkup components must be documented to qualify for reimbursement. Any THSteps checkup component not completed must be documented with the reason it was not completed. Medical records must contain documentation of screening tools, results, and referrals. THSteps child health clinic record forms are optional but helpful in documenting checkup components.

25 Helpful Resources 25 Texas Health Steps Provider Information website: Texas Medicaid Provider Procedures Manual (TMPPM): s_provider_manual.aspx

26 Thank you!