Healthcare reform may improve access to substance abuse treatment

Substance abuse treatment rates rose when states enacted parity legislation preventing payers from limiting substance abuse coverage more than they do for other conditions, according to a study published online in this month's issue of JAMA Psychiatry.

The study measured the effect of state-level parity laws on state-aggregate substance abuse treatment. Researchers found that "by expanding the scope of parity to public insurance programs, the [Affordable Care Act] will reach a much larger population and may lead to an unparalleled growth of the substance abuse disorder treatment rate in the private and public sectors."

Yet the long-term clinical benefit of increased therapy remains to be seen, according to MedPage Today.       

The ACA expanded federal parity legislation first passed in 2008. Before then, 26 states had enacted their own substance abuse treatment parity laws. Some required full parity, making substance abuse treatment coverage, cost sharing and benefit limits essentially the same as benefit payment requirements for medical and surgical care. Other states required parity only if payers provided any substance abuse treatment benefits. Still, other states required some level of coverage for substance abuse treatment but allowed greater cost sharing on these benefits compared to other conditions, according to the study.

To measure how parity laws affected therapy access, researchers analyzed information from 49 states with available data and found:

  • Full parity and parity only if substance abuse treatment benefits are offered increased the treatment rate by 13 percent and 8 percent, respectively, in all facilities and by 21 percent and 10 percent, respectively, in facilities accepting private insurance.
  • Enactment of any parity law increased the treatment rate by 9 percent in all specialty substance abuse disorder treatment facilities and by 15 percent in facilities accepting private insurance.
  • Parity legislation was linked with decreased utilization by Hispanic/Latino patients by 0.1 points overall and by 0.07 points at facilities accepting private insurance.

Another key question is how insurers will process claims for more substance abuse disorder treatment, especially since current costs for this can exceed $1 billion annually. Lawsuits filed against insurers suggest barriers to benefit payment still exist, including tough-to-meet pre-authorization requirements and medical necessity criteria, FierceHealthPayer previously reported.     

To learn more:
- read the study abstract
- read the Med Page Today article

Suggested Articles

Absent adequate reimbursement for time spent on complex patient care, specialists are finding it harder to sustain their practices.

Tennessee released its proposal to CMS to become the first state to convert federal Medicaid funding into a block grant.

Hospital and health system leaders say a lack of data and confusion around reimbursement are barriers to risk-based payment agreements.