California Treatment Advocacy Foundation Calls for State to Follow “Pennsylvania Model” in Assuring Adequate Coverage

LOS ANGELES--(BUSINESS WIRE)-- The California Treatment Advocacy Foundation (CalTAF) called today for California to adopt a measure similar to what was done in Pennsylvania as was a way to assure that group health insurance plans include adequate coverage for substance abuse addiction and treatment.

“All individuals should have unencumbered access to the right treatment, in the right setting, at the right time,” said Phillip Greer, executive vice president of CalTAF. “Unfortunately, insurance companies in California have found ways to circumvent the law, and it is our belief that only through insurance reform can barriers to care be eliminated so that individuals can get immediate and affordable access to the treatment they need.”

Pennsylvania’s Drug and Alcohol Insurance Law (Pennsylvania Act 106 of 1989) requires most group health insurance plans to include coverage for addiction treatment. The only prerequisite is certification and referral by a licensed physician or a licensed psychologist. The Act also requires most group health policies to include mandated minimum benefits for treatment of alcohol and drug addiction. These include seven days of detoxification per year, 30 days of non-hospital residential rehab per year, and 60 days per year of full-session visits of outpatient or equal partial hospitalization visits.

“Pennsylvania has provided us a good, sensible model to follow, and it is time for California to take action,” says Greer. “Too many working families with health insurance in our state are unable to access lifesaving substance-use disorder treatment because of unreasonable care guidelines imposed by their health plans. Californians need to stand up and declare the current system unacceptable.”

Greer says that currently some insurers continue to impose “unreasonable deductibles” and co-payments for small groups and individuals while others continue to sell plans without any chemical dependency benefits at all. He says that this is in direct violation of the Wellstone Dominici Equity Act, passed by Congress in 2008. Greer also says that insurance companies have added “care guidelines,” which end up denying patients from receiving treatment at the level of intensity or for an amount of time that is universally accepted as necessary.

“By ignoring the guidelines of both the Substance Abuse and Mental Health Services Administration and the American Society of Addiction Medicine, these insurance companies have made a mockery of the system,” says Greer. “Adopting a law similar to what was done in Pennsylvania would put an end to all of this gamesmanship.”

The California Treatment Advocacy Foundation is dedicated to improving access to effective and affordable chemical dependency treatment throughout the state. Created in 2011 by a group of concerned California-based providers, CalTAF believes that through insurance reform, either voluntary or mandated, barriers to care can be eliminated, thus making it easier for individuals to get access to the treatment and professionals they need. Further information on the work of CalTAF may be obtained by calling 855-254-5222.


for California Treatment Advocacy Foundation
Ross Goldberg, 818-597-8453, x-1
[email protected]

KEYWORDS:   United States  North America  California  Pennsylvania

INDUSTRY KEYWORDS:   Health  Public Policy/Government  Mental Health  State/Local  Philanthropy  Professional Services  Insurance  Foundation  General Health  Managed Care