• Medicaid Policies for Alcohol SBI Reimbursement

      Smith, Oliver; Hanson, Bridget; Porter, Rebecca (Center for Behavioral Health Research and Services, 2017)
      The purpose of this report was to review existing reimbursement policies by state Medicaid agency, including the District of Columbia (D.C.), in order to understand similarities and differences associated with financial compensation for alcohol screening and brief intervention (SBI) services. Alcohol SBI is an evidence-based practice known to help reduce atrisk alcohol consumption among patients who drink too much. 1 Although alcohol SBI was designed to be a population-based approach to address unhealthy alcohol consumption, its current utilization is limited. 2 Implementation of the practice into routine clinical care remains a challenge at the health system level even with support from federal resources (e.g., SBIRT: Screening, Brief Intervention, and Referral to Treatment). One way to encourage the uptake of alcohol SBI/SBIRT among providers is to ensure that the service is reimbursable by third-party payers. However, reimbursement opportunities vary by state and payer, and in some locations are non-existent. Information about the current status of policies will assist in the development of policies and incentives to encourage healthcare providers and systems to submit claims for alcohol SBI/SBIRT and potentially increase the routine uptake of the service in clinical care.
    • Physical Assessment of Children With FASD: Evidence Based Practice

      Waller, Tabitha (University of Alaska Anchorage, 2015-12-01)
      Fetal Alcohol Spectrum Disorder (FASD) is the leading preventable cause of developmental delay worldwide. Early diagnosis and intervention are vital to the prevention of secondary disabilities for those with FASD. Current diagnostic guidelines fail to identify the many physical malformations associated with prenatal alcohol exposure and recommendations for diagnostic differentials vary between guidelines. A critical appraisal of the literature and review of current guidelines was conducted to create an evidence-based physical anomaly checklist and differential diagnostic table. The critical appraisal consisted of 27 articles and resulted in 85 physical anomalies associated with prenatal alcohol exposure. The review of current guidelines resulted in five guidelines and four supportive articles that identified 20 different genetic disorder differentials and four exposure related differentials. A Plan-Do-Study-Act (PDSA) quality improvement model was used to implement education on the reference tools and encourage practice implementation in a North American FASD diagnostic team. All providers directly participating in the diagnosis of FASDs must be aware of the many physical anomalies associated with prenatal alcohol exposure and should have a working knowledge of potential differential diagnoses. The physical anomaly checklist and differential diagnoses tables help to provide this information in a clinically practical way.