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Research Summary

Health Plans’ Requirements for Mental Health and Substance Use Screening

Most health plans cover some treatment for mental health and substance use disorders, but a minority of people who need these services receive them. Limited requirements for screening and identification of these disorders partially explain this treatment gap. 

To estimate the extent of health plans’ requirements for mental health and substance use screening in primary care, researchers analyzed data from a nationally representative survey of health plans in 1999 (n=434 health plans, 92% response rate) and 2003 (n=368, 83% response rate).

  • The proportion of health plans with a screening requirement for mental health or substance use disorders* did not significantly change from 1999 (32%) to 2003 (34%).
  • Among plans with a screening requirement, there was a significant increase in the proportion that required alcohol screening (from 33% in 1999 to 78% in 2003) and drug screening (from 8% to 78%).

Comments:

Health plan mandates and reimbursement for substance use screening would encourage primary care physicians to take a greater role in identifying, managing, and referring patients with substance use disorders. The finding that only one-third of health insurance products in 1999 and 2003 required screening for mental health or substance use disorders highlights missed opportunities to improve detection and intervention. Although tracking adherence to such a requirement might be challenging to insurers, the recent addition of procedure codes for substance use screening and brief intervention promises to provide a mechanism for reimbursement and monitoring in the future.

Peter D. Friedmann, MD, MPH

*Use of a general health screening questionnaire including mental health, alcohol, or drug items and/or a screening questionnaire focused on mental health, alcohol, or drug problems

Reference:

Horgan CM, Garnick DW, Merrick EL, et al. Health plan requirements for mental health and substance use screening in primary care. J Gen Intern Med. 2007; 22(7):930­–936.


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