Treating addiction like any other illness
By M. Christine Macbeth and Jennifer Michaels, M.D.
On Oct. 1, a potentially transformative new law went into effect that could dramatically increase access to vital addiction treatment and services across Massachusetts.
The law requires commercial insurers and insurers under MassHealth managed care entities to pay for critical life-saving measures like detox services, covering addiction the way they would any other life-threatening medical condition. Insurers are mandated to pay for up to 14 days of inpatient care as well as follow-up recovery services from licensed alcohol and drug counselors.
This move is as historic as it is far-reaching since it eliminates the practice of “prior authorization,” which has always been one of the biggest roadblocks to long-term addiction treatment. Going forward, the treating clinicians — not the insurance companies — will be the ones who determine if a treatment program or abuse-deterrent drug is “medically necessary” for the patient.
In general, insurance coverage for addiction has been limited to brief medical detox services, which are necessary but are little more than a Band-Aid on a much larger wound. Detox is a prelude to recovery; it eradicates drugs or alcohol from the system, but it doesn’t eradicate the underlying disease of addiction or its root causes.
Long-term addiction treatment makes sense as evidence demonstrates the longer an individual engages in treatment, the more likely he or she will be successful in recovery. For too long individuals and families have faced a revolving door scenario, cycling through detox services and emergency room visits when crucial follow-up recovery services were not available or covered by insurance.
Even though the 20-year-old Mental Health Parity Act has mandated equality in health care coverage for both behavioral and physical health services, coverage for addiction treatment has been grossly inadequate. This new law will hopefully address these short-term gaps in the system, and demonstrate a long-term commitment to early intervention and treatment.
As treatment providers, we understand that the path to recovery is not the same for everyone. Issues that coexist with addiction are diverse, meaning some may require 14 days inpatient while others would benefit more from a day treatment program, or a combination of the two. This new law will enable us to work more efficiently with patients to provide the personalized programs and quality of care that works best for them. Patients suffering from the disease of addiction may require inpatient treatment as a necessary respite from the environment where they “used.” Estranged family members may find relief in knowing their loved ones are safe, off the streets and receiving evidenced based care.
Massachusetts is in the grip of an alarming public health crisis where drug addiction has stolen futures, devastated families, and destabilized communities. According to the Massachusetts Department of Public Health, the rate of unintentional deaths due to opioid overdoses has ballooned from 10 percent to nearly 19 percent from 2012-2014.
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