Director’s Corner—Winter 2009-2010

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Director’s Corner—Winter 2009-2010 2021-03-05T14:02:36+03:00

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Director’s Corner—Winter 2009-2010

The What and Why of Parity Legislation

As we move through the holidays and winter, there is a great deal of publicity and political maneuvering occurring in an attempt to hammer out a comprehensive health care reform bill for our country. Less obvious is that this will also become the vehicle for the enactment of the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008. This sweeping legislation is intended to improve access to mental health and addiction treatment. A basic overview of the Wellstone/Domenici Parity Bill is as follows:

What?

The Parity Bill requires that employers and insurance companies who offer employee insurance plans must include substance use disorder (SUD) and mental health (MH) services as part of the minimum benefit package. Furthermore, when an employer and insurance company offer mental health and substance use services, these must be treated in the same manner as other medical conditions. This would likely mean that some of the restrictive standards used by insurance companies to authorize or deny treatment for addiction and/or mental health services would be eliminated, unless these same standards are used for other illnesses or diseases. Sharon Chambers

The legislation would also require that the criteria an insurer or managed care company are using to approve or deny substance use or mental health treatment must be made available to the public. To date, this information has been protected or deemed proprietary information by insurance companies and not available to the public or treatment providers. As a result, neither patients nor treatment providers have a clear understanding of what an individual’s policy will cover.

Why?

Here is where I will try to be both factual and an advocate for access to treatment for those still suffering from untreated, or undertreated, addiction and mental health issues, even though they have insurance. Addiction and mental health issues remain stigmatized in our society and certainly people suffering with these health issues have not had the same kind of support or treatment as those suffering from other chronic conditions. This really struck home with me during our luncheon a year ago. I was returning to work from a year of treatment for cancer, and everyone was incredibly supportive of me and asked about my health. Yet so many of the women who were, and are, at Residence XII experience so much shame from the stigma of their disease. Addiction is also a disease, a disease like cancer, diabetes or heart disease, and one that affects as many, or more, Americans than each of those diseases.

How does this shame and stigma manifest itself? Some insurance companies already treat mental health and substance use as they would any other illness. But I have also seen people suffering from the disease of addiction sitting in treatment center lobbies for up to eight hours because they must be on-site before their insurance company will begin the required preauthorization. There is no guarantee that they will be admitted because the insurers have not had standardized or published criteria. Treatment may be denied all together, or outpatient treatment (rather than residential treatment) may be required for someone who has just gotten out of a hospital detoxification program and has neither sober support nor any real chance of sobriety on their own. Some insurers routinely require outpatient treatment, and a patient must fail in this program before any other treatment will be approved. Some companies will authorize full day treatment programs but refuse to pay for overnight or residential care, despite the fact that the person may live several hours from the treatment facility and daily commuting is not a realistic option. These decisions, in my opinion, reflect an emphasis on cost containment rather than quality patient-centered care. I cannot imagine any other chronic condition like diabetes, heart disease or cancer being treated in this manner.

I believe that these inconsistent treatment coverage practices and the impact on people needing treatment are the “why” behind the Wellstone/Domenici Parity Bill. It is legislation that is overdue and legislation which needs to be applied to all patients who are in need of mental health and substance use treatment. Although it has been argued that this bill will raise insurance premiums by a small amount, those arguments pale when compared to research which shows that for every $1.00 invested specifically in addiction treatment, there is positive cash offset of $7.00 to $12.00 to our society. Criminal justice costs are reduced, employee absenteeism drops and productivity increases, workplace accidents decrease, emergency room visits decline, and there are fewer medical visits and related hospitalizations. As a treatment provider, employer, and taxpayer, I believe the relatively small cost for enhanced coverage and treatment is well worth it!

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