Integrating care to improve health outcomes for our members, your patients
To further our mission of improving the health and quality of life for our members and your patients, Passport Health Plan has adopted an evidence-based public health initiative to aid in the prevention, identification, and treatment of alcohol and substance use disorders called Screening, Brief Intervention, and Referral to Treatment (SBIRT).
SBIRT is a practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and other substances. SBIRT is provided in a primary care setting to allow opportunities for early intervention with at-risk alcohol and other substance use behavior before more severe consequences occur.
- Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
- Brief Intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
- Referral to Treatment provides those identified as needing more extensive treatment with access to specialty care
Who is the target for SBIRT?
All Passport members are required to have an annual SBIRT screening. SBIRT may be completed by primary care providers including physicians, nurse practitioners, and physician assistants who have completed SBIRT training. The recommended age to begin screenings is 9-years-old.
What is SBIRT?
Screening is a quick, simple method of identifying patients who use alcohol or other substances who are at-risk of or who may already have disorders. The screening instruments provide specific information and feedback to the patient related to his or her alcohol or substance use. The typical screening process involves the administration of validated screening tools. If a patient screens positive on one of the screening tools, he or she is then given a longer alcohol or drug use evaluation, using a standardized risk assessment tool. The screening and risk assessment instruments are easily administered and provide patient-reported information about substance use that any healthcare professional can easily score for the provider to use with the patient.
Passport providers who are implementing the SBIRT into their practices should build the screening instruments into their Electronic Medical Record (EMR) for easy access. Others should train their office staff to assist with the administration of SBIRT to be conducted prior to the provider’s face-to-face review with the patient, such as during registration or routine vitals. Please refer to the training for specifics about administering the SBIRT.
For this age category, there are a number of validated screenings tools available free of charge as part of the standardized SBIRT administration. Following your training, these screening tools will be made available.
- Resources: National Institute on Alcohol Abuse and Alcoholism [NIAAA]
- A Practioner’s Guide: Alcohol Screening and Brief Intervention for Youth (2011 edition for ages 9-18)
- CRAFFT (Car, Relax, Alone, Forget, Friends or Family, and Trouble) including questions about tobacco, alcohol, and drug use
Passport providers have the flexibility to choose which validated tool to use in the SBIRT service. Please see training sites and tools that follow.
For the adult patient, there are a number of validated screenings tools available free of charge as part of the standardized SBIRT administration.
- NIAAA Resources for Providers
- ASSIST Manual / ASSIST Tool
- AUDIT Manual / AUDIT Tool
- Additional resources: SAMHSA
Passport providers have the flexibility to choose which validated tool to use in the SBIRT service. Please ensure you are screening for both alcohol and other substance problems. Please see training sites and tools that follow.
Brief intervention is a time-limited, patient-centered strategy that focuses on changing a patient’s behavior by increasing insight and awareness regarding substance use. Depending on severity of use and risk for adverse consequences, a brief discussion provides the patient with personalized feedback showing concern over drug and/or alcohol use. The topics discussed can include how substances can interact with medications, cause or exacerbate health problems, and/or interfere with personal responsibilities.
Brief intervention is designed to motivate patients to change their behavior and prevent the progression of substance use. During the intervention, patients are:
- Given information about their substance use based on their risk assessment scores.
- Advised in clear, respectful terms to decrease or abstain from substance use.
- Encouraged to set goals to decrease substance use and to identify specific steps to reach those goals.
- Taught behavior change skills that will reduce substance use and limit negative consequences.
- Provided with a referral for further care, if needed.
Brief interventions are typically provided to patients with less severe alcohol and substance use problems who do not need a referral to additional treatment and services. In addition to behavioral health professionals, medical personnel (e.g., doctors, nurses, physician assistants, or nurse practitioners) can conduct these interventions and need only minimal training. In the case of patients with addictions, more intensive interventions may be needed. While medical personnel who have received additional training may conduct intensive interventions, behavioral health professionals often conduct these longer counseling sessions.
Referral to Treatment
In some cases, a more advanced treatment option is necessary and the patient is referred to a higher level of care. The referral to treatment process consists of helping patients access specialized treatment, selecting treatment facilities, and facilitating the navigation of any barriers such as cost of treatment or lack of transportation that would hinder them from receiving treatment in a specialty setting. Handling the referral process properly and ensuring that the patient receives the necessary care coordination and follow-up support services is critical to the treatment process and to facilitating and maintaining recovery.
If the Passport member experiences any difficulties in obtaining a referral or accessing care, please encourage them to contact the Passport Health Plan Behavioral Health Hotline at 1-855-834-5651 or check Passport’s Provider Directory. Our team will assist Passport members in finding a behavioral health provider.
When is SBIRT done?
Passport recommends SBIRT is completed during a visit to a primary care provider annually beginning 1/1/15. This may be completed at the time of a well-child visit or physical when other screenings are completed. It may also be completed when a patient is being seen for a routine visit but has not yet been screened this year.
How is SBIRT reported?
Current Procedural and Terminology Code 99408 may be utilized to report the separate and distinct service provision of the SBIRT for up to 30 minutes of time during the same clinical session (i.e., date of service) as any other Evaluation & Management (E/M) services. Documentation of the administration and results of the SBIRT should be recorded in the clinical record.
Reporting an Extended SBIRT
Current Procedural and Terminology Code 99409 may be utilized to report the separate and distinct service provision of the SBIRT when the service takes in excess of 30 minutes during the same clinical session (i.e., date of service) as any other Evaluation & Management (E/M) service. Documentation of the administration and results of the SBIRT including the reason for the extended visit should be recorded in the clinical record.
Providers should be prepared to demonstrate the completion of a course in the standardized administration of the SBIRT.
As is customary, please follow the standard Medicaid guidelines for documentation. Please denote start/stop time or total face-to-face time with the patient (since codes are time-based).
Specific for SBIRT, please document:
- Reason for encounter and any relevant history;
- Assessment, patient response to service, clinical impression, and diagnosis (only if appropriate as this is an universal screening and may not be appropriate);
- Date and legible identity of provider;
- Plan of care including any referrals to treatment or planned follow-up; and
- Sign all services provided/ordered.
Reporting of Passport Provider Participation
Levels of participation by Passport providers in the administration of the SBIRT will be summarized and shared quarterly with Passport providers and also with the Kentucky Department of Medicaid Services and Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID), as required.
Providers are required to complete training for the standardized administration process of the SBIRT prior to implementing in their practice.
Free on-line training course: https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5vcmcvdmlld2FydGljbGUvODMwMzMx&ac=401
Providers are not limited to participation in this training course. Other training courses are available either on-line or in-person, some resources are free of charge, others may have a nominal fee. Providers may participate in other trainings in the standardized administration of SBIRT. Providers will need to keep a certificate of completion on-file for the completion of the training.
- Search for SBIRT at http://ireta.org/what-we-do/training/
For Emergency Departments
- Substance Abuse and Mental Health Services Administration
SBIRT Screening Tools
Please make sure you have completed SBIRT training and have a certificate on file before administering any of the following tools: