Medicare May Cover Screening for Depression, Alcohol Abuse

The addition of annual depression and alcohol screenings to Medicare's package of preventive benefits will improve the ability of primary care physicians to address the mental health needs of their patients, APA Medical Director James H. Scully Jr., M.D., said in a letter to the Centers for Medicare and Medicaid Services (CMS) in August.

Scully noted in his comments on CMS's new proposals that many individuals with mental health concerns initially seek treatment from their primary care physician due to continued inequities in insurance coverage or the still pervasive stigma associated with mental illness and its treatment.

"APA strongly endorses these proposed annual screenings," said Julie Clements, deputy director for regulatory affairs in APA's Department of Government Relations. "They empower primary care providers to play a more active role in the diagnosis and treatment of mental health and substance use disorders."

In mid-July, CMS released two memorandums related to the health care of Medicare beneficiaries, the first of which proposed annual depression screenings in primary care settings that have "staff-assisted depression-care supports" in place to assure accurate diagnosis, effective treatment, and follow-up. CMS defines these supports as consisting, at minimum, of on-site staff who can advise the physician of screening results and who can facilitate and coordinate referrals to mental health treatment.

In his letter to CMS, Scully emphasized the importance of psychiatric consultation following any positive depression screenings and called on the agency to ensure "appropriate" reimbursement of primary care physicians who conduct screenings, discuss results with patients, and make referrals for mental health care. Scully's letter also incorporated previous regulatory comments on depression screenings submitted by APA in March. Those comments included the recommendation that Medicare beneficiaries be screened annually for depression regardless of whether staff-assisted care supports are in place, with individuals screening positive provided referrals to other physicians capable of conducting complete evaluations.

CMS's second memo proposed inclusion in Medicare preventive services of annual alcohol screenings followed by up to four brief, in-person counseling sessions a year for individuals screening positive.

The agency specified that these screenings would be made available to beneficiaries who misuse alcohol (including pregnant women), "but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence."

Scully said that APA endorses this proposal too, noting that APA members believe the availability of screening and counseling will particularly benefit high-risk drinkers who often do not satisfy the criteria for receiving substance abuse services but would likely be responsive to brief interventions by primary care physicians. Additionally, Scully said that APA "strongly" urges CMS to cover only those alcohol screenings that use a structured screening test. Scully also asked for clarity on how primary care physicians will be reimbursed for any needed alcohol-related counseling sessions.

APA's letter to CMS is posted at <www.psych.org/MainMenu/AdvocacyGovernmentRelations/GovernmentRelations/RegulatoryComments/Depression-Alcohol-Misuse-Comments.aspx?FT=.pdf>.