Four not-for-profits have joined forces to fight for compliance for parity in addiction treatment and insurance — the National Center on Addiction and Substance Abuse, Legal Action Center (LAC), Partnership for Drug-Free Kids and Treatment Research Institute. The first initiative of the group, called the Addiction Solutions Campaign (ASC), will be securing insurance coverage for addiction treatment, which consumers are assured under the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Enforcement of the MHPAEA has failed to close the treatment gap, especially as the opioid epidemic is adding to the demand.
“At a time when effective treatment for opioid addiction in the U.S. is so desperately needed, lack of transparency is one barrier that can be immediately removed if insurers make information about covered services more transparent to consumers, and regulators demand this transparency before allowing plans to be sold,” said Paul Samuels, director and president of the LAC and spokesman for the ASC. “It is clear today that even as 144 Americans die every day from a drug overdose related death, we are still struggling to address an unprecedented epidemic of substance use disorders, and that the requirements of the Parity Act are still not being met,” said Samuels. “The current enforcement system is flawed and some families are paying the ultimate price. Families often don’t know what their coverage is, or how or where to complain.” In fact, enforcement of the MHPAEA has been dependent on “complaining,” with family members and patients having to notify regulators about violations, and engage in burdensome processes to get coverage, according to the ASC.
Specifically, the ASC recommends:
- Plans should be required to submit their internal analyses to demonstrate that coverage is compliant with the Parity Law, including identification of all specific limitations on benefit scope or access to services, such as preauthorization requirements or ‘’fail-first” policies.
- As part of review for parity compliance, regulatory agencies should evaluate the scope of prescription drug coverage for mental health and substance use disorder treatment and utilization management requirements.
- Regulatory agencies should develop model contracts that fully describe substance use and mental health benefits, align standards with Parity Act requirements and inform consumers of their rights under the law.
- Regulatory agencies should enhance the provider community’s capacity to identify potential Parity Act violations and advocate for plan compliance in network adequacy and rate-setting standards.
The National Center on Addiction and Substance Abuse, Legal Action Center and Treatment Research Institute analyzed documents from seven small-group, large-group and employer-sponsored plans in New York and Maryland. The research was funded by Indivior. For the executive summary of the report, go to https://drugfree.org/wp-content/uploads/2017/06/Executive-Summary-Parity-Final-6-20-17.-REV-6-15.pdf.