It’s been 10 years since the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) was passed. The act is a federal law meant to prevent group health plans and health insurers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. Prior to the legislation, addiction and mental health coverage was often capped by healthcare insurance plans at a very low level when compared with other chronic diseases such as diabetes and heart disease.
As we reflect on the past decade since parity became law, we must consider the state of addiction in our country today. We are struggling to address the opioid epidemic, alcohol abuse is on the rise, marijuana is more widely accepted and available, and individuals in crisis are falling prey to predatory marketing practices. These issues, coupled with ongoing misperceptions about substance use disorder, are clear indicators that while we’re taking steps in the right direction, we still have a long road ahead. To achieve parity, we as an industry must remain committed to the following three key areas:
Calling for a continuum of quality care
It’s true that parity has increased insurance coverage for addiction and behavioral health issues. However, a serious disconnect remains in the approach to coverage. A significant amount of funding and reimbursement addresses substance use disorder as an acute issue – focusing primarily on short-term, harm-reduction strategies. Whereas evidence-based research shows that longer-term treatment with a quality continuum of care leads to stronger outcomes.
There are exceptions with some insurance companies, such as Independence Blue Cross, supporting the disease model instead of the Band-Aid approach. However, we need to continue to educate and reassure payers that treating substance use disorder as a chronic disease, on par with other physical illnesses, is an effective strategy that saves both money and, more importantly, lives in the long run.
Demanding enforcement at the federal and state level
Federal and state governments also must put some teeth behind the enforcement of parity. There are many plans that do not provide any coverage for mental and behavioral health, a clear violation of the law. Regulations for substance use treatment providers vary by state – and in some states, regulations are virtually non-existent. Other providers follow the letter of the law in writing their policies and yet fail to pay for the services, bouncing claims or not reimbursing for the amount specified in the policy.
This lack of regulation makes it difficult for families and individuals to identify quality treatment programs, and creates a fertile environment for deceptive business practices, fraud, patient neglect and, ultimately, treatment malpractice.
It’s promising to see the U.S. Senate and the House of Representatives approve $3.8 billion in September to address the opioid crisis. However, the legislation is just the tip of the iceberg and must be implemented in an effective way to make an impact.
Establishing industry standards and outcomes
To achieve parity with the broader healthcare industry, we must hold ourselves accountable to standards and outcomes. If you look across the 12,000 addiction treatment centers in the U.S., there’s no unified standard of treatment adhered to by all. As a result, providers who follow evidence-based treatment protocols with proven outcomes are painted with the same brush as those who use outmoded, ineffective or downright dangerous practices.
Likewise, we must universally act as healthcare providers to adopt the strong clinical diagnostic placement criteria developed by the American Society of Addiction Medicine (ASAM), across the board. The National Association of Addiction Treatment Providers (NAATP) is also developing standards, as are CARF and JCHO at some level. Groups like Shatterproof are working with insurers, for example, to establish the core components every treatment center must provide if insurance companies are going to pay for treatment services.
These critical next steps will define quality addiction treatment to help ensure that individuals with a substance use disorder and their families have the same opportunity for high quality, evidence-based health care that is routinely offered for other chronic diseases.
Doug Tieman is president and CEO of Caron Treatment Centers.