LOS ANGELES--(BUSINESS WIRE)-- The California Treatment Advocacy Foundation (CalTAF) today called upon state regulators to make sure that meaningful and enforceable guidelines for the treatment of substance abuse are included in the essential health benefits (EHB) package being developed in conjunction with healthcare reform.
The goal of the Patient Protection and Affordable Care Act is to ensure that all Americans have access to quality, affordable health insurance. To achieve this, the law guarantees that health insurance plans offered in the individual and small group markets, both inside and outside of state-run exchanges, offer a comprehensive package of items and services, known as “essential health benefits.” These benefits will include preventive, diagnostic and therapeutic services in at least ten categories of care, which are defined as “essential” and “equal to the scope of benefits provided under a typical employer plan.”
Last week, the Department of Health and Human Services (HHS) deferred the establishment of the specific essential health benefits to the states – announcing that each state, rather than the federal government, would define which medical benefits insurance companies will have to offer consumers starting in 2014. This approach was developed with significant input from the public as well as reports from the Department of Labor, the Institute of Medicine and research conducted by HHS.
“The inclusion in the essential health benefits package of meaningful requirements for substance abuse treatment will help do away with the gamesmanship that sadly continues to engulf this issue,” said Phillip Greer, executive director of CalTAF. “For far too long health insurance companies have imposed barriers that reduce access to much-needed chemical dependency treatment by selling policies with deductibles and co-payments that were much higher than for any other illness. Most recently these insurance companies have imposed care guidelines that keep patients from receiving treatment at the level of intensity or for an amount of time that is universally accepted as necessary. It’s time these games stop.”
Toward that end, CalTAF last month called upon California to adopt a measure similar to Pennsylvania’s Drug and Alcohol Insurance Law (Pennsylvania Act 106 of 1989) that 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.
“Too many working families with health insurance in California are unable to access lifesaving substance-use disorder treatment because of unreasonable guidelines imposed by their health plans,” said Greer. “The development of essential health benefits provides a wonderful opportunity for state regulators to assure all individuals have unencumbered access to the treatment they need.”
Greer said the he and CalTAF would welcome the chance to work with the state in the development of an essential health benefits package that would be fair to all concerned and would be consistent with both the Wellstone Dominici Addiction Equity Act and other national standards of care as prescribed by the medical profession.
The California Addiction 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 at www.caltaf.org.
for California Treatment Advocacy Foundation
Ross Goldberg, 818-597-8453, x-1
KEYWORDS: United States North America California
INDUSTRY KEYWORDS: Practice Management Health Public Policy/Government Healthcare Reform Mental Health Other Health Professional Services Insurance General Health Managed Care