Medicaid Support for Early Identification and Intervention Among Adolescents at Risk of Substance Use Disorders Kirsten Beronio Senior Policy Advisor on Behavioral Health Care Center for Medicaid and CHIP Services Disabled and Elderly Health Programs Group

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Benefit Requires states provide beneficiaries under 21 with periodic screenings to detect physical or mental illnesses (including substance use disorders); States must provide other necessary health care, diagnostic services, treatment, and other measures listed in the Medicaid statute that are medically necessary to correct or ameliorate defects, and physical and mental illnesses and conditions discovered by the screening services; Screenings must be provided at intervals which meet reasonable standards of medical practice; Other health, developmental, or educational professionals who come into contact with the child, e.g., in state special education programs, Head Start and day care programs, the Special Supplemental Food Program for Women, Infants and Children (WIC), can determine an additional screening outside the usual schedule is medically necessary. ( 42 U.S.C. 1396d(r); 42 CFR 441, Subpart B; State Medicaid Manual, Chapter 5 )

Additional Guidance on How Medicaid Programs Can Support Early Identification and Prevention Informational Bulletin: Prevention and Early Identification of Mental Health and Substance Use Conditions (March 2013) https://www.medicaid.gov/federal-policy-guidance/downloads/cib-03-27-2013.pdf Informational Bulletin: Coverage of Behavioral Health Services for Youth with Substance Use Disorders (January 2015) https://www.medicaid.gov/federal-policy-guidance/downloads/cib-01-26-2015.pdf MLN Booklet: Screening, Brief Intervention, and Referral to Treatment (SBIRT) Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/SBIRT_Factsheet_ICN904084.pdf

Medicaid and CHIP Initiatives Supporting Early Identification and Prevention Health Services Initiatives (HSIs) in the Children’s Health Insurance Program (CHIP) Funded through available CHIP allotment for a fiscal year, after costs for administration of CHIP costs 10% cap and state match requirements ( Social Security Act, Section 2105(a)(1)(D)(ii); 42 CFR 457.10 ) Frequently Asked Questions issued Jan 12, 2017 Encourages states to use HSI funds on initiatives to increase screening and treatment for behavioral health care needs https://www.medicaid.gov/federal-policy-guidance/downloads/faq11217.pdf

Medicaid and CHIP Initiatives Supporting Early Identification and Prevention State Medicaid Director Letter: Medicaid Payment for Services Provided without Charge (Free Care) (December 2014) Clarifies that Medicaid reimbursement is available when services covered in the state plan are provided by Medicaid-qualified providers to Medicaid beneficiaries regardless of whether such services are available to other individuals or the community at large free of charge Should encourage more school-based care – including screening and prevention for behavioral health conditions https://www.medicaid.gov/federal-policy-guidance/downloads/smd-medicaid- payment-for-services-provided-without-charge-free-care.pdf