New ObamaCare Mandate for Depression Screening
United States Preventative Services Task Force
Final Recommendation on Depression Screening for Adults
Who: All Adults age 18 or older (including pregnant and postpartum women) covered by insurance under Medicare, Medicaid or private insurance (individual & group plans whether insured or self-insured) who are subject to the Preventive Care requirements of the Patient Protection and Affordable Care Act (PPACA).
When: On January 26, 2016 the recommendation was published online by the United States Preventive Services Task Force (USPSTF) on the website of the Journal of the American Medical Association. HHS has not yet set the required start date, but it likely to be January 1, 2017 or the subsequent following plan date.
What: Depression screening is now recognized as a “USPSTF B recommendation” and therefore is required by the Affordable Care Act to be covered by insurers with no out-of-pocket costs to the patient, as with all preventive care services that receive an A or B recommendation.
Executive Summary: In 2009, the USPSTF recommended screening all adults when staff-assisted depression care supports are in place and selective screening based on professional judgment and patient preferences when such support is not available. In recognition that such support is now much more widely available and accepted as part of mental health care, the current recommendation statement has omitted the recommendation regarding selective screening. The current statement also specifically recommends screening for depression in pregnant and postpartum women.
Screening Tests - Commonly used depression screening instruments include the Patient Health Questionnaire (PHQ) in various forms and the Hospital Anxiety and Depression Scales in adults, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale (EPDS) in postpartum and pregnant women. All positive screening results should lead to additional assessment that considers severity of depression and co-morbid psychological problems (e.g. anxiety, panic attacks, or substance abuse), alternate diagnoses, and medical conditions.
The optimal timing and interval for screening for depression is not known. A reasonable approach might include screening all adults who have not been screened previously and using clinical judgment in consideration of risk factors, co-morbid conditions, and life events to determine if additional screening of high-risk patients is warranted.
The target audience for USPSTF recommendations is primary care clinicians, who provide a wide range of health care services to children and adults. The USPSTF has previously made recommendations on screening for depression in children and adolescents that are already a part of the PPACA preventive care mandates.
Actions: Employers Plan sponsors should consult with their agent, broker, plan consultant, legal counsel, or Human Resources Department to determine if and when any contract changes are required to satisfy the new preventive services requirement for depression screening. They should also assure that their employee notifications properly inform plan participants of any changes. Insurers will need to review their plan offerings to assure compliance.
The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and Chairman of the IHC Editorial Advisory Board. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult legal advisors to determine the laws and regulations applicable to your company. Any opinions expressed within this document are solely the opinion of the individual author.