Evidence shows that substance misuse and high-risk behaviors that begin during childhood and adolescence heighten the risk of developing chronic disease, substance use disorders, and mental health conditions in adulthood.[1]

Early intervention can prevent the escalation of substance use and mental health issues, leading to improved long-term health, resilience, and well-being for young patients.

Providers play a pivotal role in shaping young patients’ futures and addressing challenges related to alcohol, tobacco, anxiety, and depression. Implementing early screening practices, proactively engaging adolescents in discussions about mental health and substance use as early as school age, and having open conversations about lifestyle choices during wellness visits can help create a supportive environment for young patients.

In addition, documentation of early screening in medical records for children, adolescents, adults, and pregnant and postpartum women can be effective in monitoring mental health and substance use. [2]

Our 2027 changes to support early screening

In recognition of current national guidelines and the importance of screening efforts, we are updating our medical record review indicators for 2027. These updates include:

• Aligning our medical record review indicators with evidence-based standards for tobacco, alcohol, and depression screening for youth/adolescents starting at age 11, adults, and pregnant and postpartum women.
• Adding an anxiety indicator for youth/adolescents starting at age 8, adults, and pregnant and postpartum women.

While these indicators take effect in 2027, the changes may impact health care providers’ decisions regarding wellness screenings conducted prior to the beginning of the 2026-2027 school year. 

Early screening for anxiety and depression is highly correlated with preventing the onset of teen substance use, this grace period encourages proactive dialogue rather than reactive care.

We will continue to complete medical record reviews annually to ensure documentation in medical records meets accepted professional standards of documentation and mandatory regulatory, legal, and accreditation standards.

Leading health organizations recommendations

Our 2027 changes align with recommendations from the American Academy of Pediatrics (AAP) and the U.S. Preventive Services Task Force (USPSTF). Both organizations recognize the importance of early intervention.

Resources

These resources about our coverage and processes are available:

• Preventive Care Services (A004) administrative policy: This policy provides information on how anxiety, depression, and maternal depression screenings, as well as behavioral/social/emotional and suicide risk assessments, can be integrated into wellness examinations.
  
  
• Documentation guidelines: For Ambulatory Medical Record Review (AMRR) details, including assessment criteria, visit the Cigna for Healthcare Professionals website at CignaforHCP.com (Resources > Medical Resources > Commitment to Quality > Quality > Medical Record Reviews).

To learn more about depression screening, read Early screening for anxiety, depression and substance abuse can make a significant difference.

[1] Substance Abuse and Mental Health Services Administration (SAMHSA). “Release of the 2024 National Survey on Drug Use and Health: Leveraging the Latest Substance Use and Mental Health Data to Make America Healthy Again.” SAMHSA. 28 July 2025. Retrieved from https://www.samhsa.gov/blog/release-2024-nsduh-leveraging-latest-substance-use-mental-health-data-make-america-healthy-again.

[2] Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum | ACOG