Abstract
The federal government is strongly committed to the early identification (screening) of individuals with substance use disorders (SUDs) and the provision of clinically appropriate brief interventions for nondependent users of alcohol and drugs (i.e., persons with alcohol or drug abuse disorders) as well as referral to specialty addictions treatment for those with dependence (alcohol or drug addiction). However, limited third-party reimbursement of healthcare providers (particularly primary care and emergency department professionals) poses significant implementation barriers and sustainability challenges for projects, including State grantees that have been awarded Screening, Brief Intervention and Referral to Treatment (SBIRT) Program funding through the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment (CSAT). Although the Centers for Medicare and Medicaid (CMS) authorized Medicaid program reimbursement for screening and brief intervention (SBI) services to begin in 2007, few providers realize that before state Medicaid offices can begin reimbursement for these services, states must submit State Plan Amendment requests to CMS for approval. Further, before states can submit State Plan Amendment requests, they must first obtain legislative approval for state appropriations to support the state's portion of the expense of delivering the new services (the State's “Medicaid match”). States can leverage these requests by demonstrating that SBI services are effective and cost-effective, and that they lead to measurable cost offsets. This column is adapted from a SAMHSA-funded Medicaid reimbursement manual developed to help SBIRT grantees make cogent arguments for these state-level changes (Fornili & Alemi, 2007).