Evaluating barriers to addiction treatment

McGrath

10 years after the passage of the Parity Law

By Lauren McGrath

What if there were a public health epidemic claiming more young adult lives in the United States than any other disease? What if this same epidemic was driving historic declines in American men (between 25-54 years of age) from entering the workforce; and if our manufacturing sector was considering ending drug testing because not enough workers could pass a screening? Or, if the morbidity rates of this disease were equivalent to a commercial airliner crashing every single day, for the rest of the year, across America?

What if this crisis was also displacing a record number of children and infants from their parents, landing them in foster care, without a time frame for reunification? And, lastly, what if a person —  someone’s daughter or parent or spouse — who has been struggling with addiction decides it’s finally time to seek help, but cannot obtain coverage for their treatment? Where will they turn?

National Epidemic

Our country is now faced with this kind of national epidemic. Known as the opioid crisis, it is responsible for driving up mortality rates, displacing children, and threatening the American economy. There is not one silver-bullet solution to this crisis, but we do know that access to evidence-based treatment, housed in a full continuum of care similar to other chronic disease models, can lead patients toward recovery and healing. Yet, even today, as we hear and see all too often, having insurance does not guarantee access.

The envisioned intent behind this law is simple: that a patient with insurance and in need of behavioral healthcare services can obtain evidence-based treatment, and that the providers offering those services will be reimbursed for administering them.

Ten years ago, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) with the goal of reducing barriers to mental health and addiction treatment services. The law stipulates that group health plans provide mental health or substance use disorder benefits that are on par with medical/surgical benefits. This includes annual and lifetime dollar limits, co-pays and deductibles, treatment limitations, prescription formularies, and out-of-network coverage.

In 2010, the law was expanded to apply to those with individual health insurance coverage as well as Medicaid, Medicare, and CHIP. Due to the lack of meaningful enforcement and implementation of the law, in December 2016 lawmakers passed the 21st Century Cures Act, which included yet one further provision: that federal regulators develop guidance to ensure full and faithful implementation of the parity law.

The envisioned intent behind this law is simple: that a patient with insurance and in need of behavioral healthcare services can obtain evidence-based treatment, and that the providers offering those services will be reimbursed for administering them.

Yet, today, nearly ten years after the passage of this law, there remains ongoing debate as to whether those struggling with a brain disorder — such as severe depression, eating disorders, and/or addiction — receive comparable coverage and access to services, as compared to those seeking to address other chronic illnesses, such as diabetes or high blood pressure.

Insurance companies often sight workforce shortage gaps as one of the main barriers plaguing access to quality care.

 

Making Strides

It’s not all bleak news. Some immense strides have occurred in the realm of parity and addictions treatment. Namely, elected officials at the state and federal level, and on both sides of the aisle, have made tackling the opioid crisis a top priority. This past fall, the President publicly declared the opioid epidemic a public health emergency, and his commission, chaired by Governor Chris Christie, released a report outlining recommendations to lawmakers to better address the crisis.

Amidst the content of the commission’s report on the opioid crisis, there is very clear language around parity, with commissioners noting, “At this point, the largest outstanding issue is treatment limits. Patients seeking addiction treatment, including MAT, are often subjected to dangerous fail-first protocols, a limited provider network, frequent prior authorization requirements, and claim denials without a transparent process.”

Patients seeking addiction treatment, including MAT, are often subjected to dangerous fail-first protocols, a limited provider network, frequent prior authorization requirements, and claim denials without a transparent process.

 

On the heels of the commission’s report calling upon Congress and federal regulators to take further action on parity, Milliman, one of the world’s largest actuarial consulting firms, issued a parity brief that identified strong and inequitable discrepancies between behavioral health and medical benefits, including narrowed networks and increased out-of-pocket costs for patients as well as decreased rates for providers in certain instances.

This information is believed to be the tip of the iceberg, as we currently lack a standardized, nationwide tool for tracking and assessing parity. Providers and consumers argue that, if we dig deeper, the discrepancies are likely to be vast. Insurance companies often sight workforce shortage gaps as one of the main barriers plaguing access to quality care.

Room for Improvement

As a nation, we can do better to ensure those struggling with addiction and mental health services receive timely, life-saving care. At the state and national level, we can start by implementing standardized tools for tracking parity. Several states have already done this or are looking toward this.

Once we have a process for tracking parity, we need actionable federal and state guidance for analyzing claims data and other coverage benefits as well as accountability mechanisms in the event parity is not addressed.

Achieving full and faithful implementation of the parity law is a critical step in safeguarding access to evidence-based treatments, and ultimately stemming the tide in our nation’s opioid crisis.

-Lauren McGrath is vice president of National Policy at Centerstone America.

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