OPM adds substance abuse services to federal health plan

Federal employees now will receive expanded coverage under their health plans to receive screening and treatment for substance abuse, the Office of National Drug Control Policy announced on Monday.

More than 5.6 million federal workers will benefit from the added coverage, under which health plans will reimburse doctors who screen their patients for a full spectrum of substance abuse behaviors, including illicit drug use and alcohol and prescription drug abuse or addiction, and then provide appropriate treatment.

The procedure, called screening and brief intervention, aims to break the cycle of drug and alcohol abuse and addiction. It involves a constructive dialogue between doctors and patients about the harms of substance abuse, addiction risks and strategies to help patients achieve sobriety. Health care professionals then refer patients to an appropriate level of care or specialty treatment, according to ONDCP.

The 2007 National Survey on Drug Use and Health found that more than 20 million Americans met the clinical definition of substance abuse or addiction. The survey estimated that 95.5 percent were unaware of their problem or did not seek treatment or interventions from health care professionals.

The Office of Personnel Management asked carriers participating in the Federal Employees Health Benefits Program to review new American Medical Association codes for screening short-term intervention for alcohol and substance abuse. Physicians use the codes to report and bill health insurance plans for their services.

OPM said at least 70 percent of federal employees participate in health plans that will recognize the codes for their claims processing systems when medical professionals deliver those services.

The personnel agency also has included language to expand coverage for the procedure in its 2008 call letter to federal health plans. Health insurance carriers are not required to cover the procedure.

Dr. Bertha Madras, deputy director for demand reduction at ONDCP, said on Tuesday that including the procedure in federal health plans could generate interest among all health insurance carriers. "Targeting federal employees is always very useful," she said. "It emphasizes that this is a very important feature for the health and well-being of patients."

Madras said the first step was ensuring that all physicians had the proper training to perform the SBI procedure. The screening, which will take place during routine visits to the doctor, is not voluntary for patients, she said, because symptoms of substance abuse are not always physically visible and most people are not likely to volunteer information on the subject.

The coverage will be available to active and retired federal employees and their families who participate in health plans that provide the coverage. Madras said the procedure will prove particularly beneficial to retirees, as growing evidence indicates that substance abuse, particularly of prescription drugs, is becoming more common among older people.

"Federal employees who are concerned about themselves or family members should request that their physician be engaged in this issue," Madras said, "so that the physician, the insurer, as well as the patient, all partner to try to alleviate this enormous public health burden."