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More than two-thirds of state health-insurance plans eligible for federal subsidies violate federal treatment requirements for addiction disorders, says the National Center on Addiction and Substance Abuse.
The center surveyed addiction treatment benefits offered among 2017 Essential Health Benefits benchmark plans and found that none, including Kentucky, offered comprehensive addiction-treatment benefits.
Kentucky, which has a greater addiction problem than most states, otherwise fared well in the report. The report said it was one of only five states with a sufficient description of substance-abuse benefits in its approved plans, and one of only nine that did not violate the law that requires parity for behavioral-health coverage.
The report cites benchmark plans, which determine the minimum level of benefits available to those covered in state exchange plans, frequently “excluded or not explicitly covered benefits” related to residential treatment and the use of methadone as therapy.
“Addiction is a chronic disease that often goes untreated, and when patients can’t access addiction treatment it can lead to disability and premature death,” Lindsey Vuolo, associate director of health law and policy at CASA, told Steven Ross Johnson of Modern Healthcare. “We’re really calling on states to amend their plans to comply with the law.”
The Patient Protection and Affordable Care Act requires insurance providers to cover essential health benefits, which include providing behavioral-health services and substance-use-disorder treatment at parity with medical care.
Despite regulations that require coverage of addiction treatment without restrictions, the law does not specify which substance-abuse-disorder benefits should be covered, leaving that decision up to the states.
The law requires policies to cover at least one addiction treatment medication in each of four classes: anti-craving, opioid reversal, opioid dependence treatments and tobacco cessation.
The report found that 45 percent of plans proposed for 2017 are in violation by not providing coverage for an addiction treatment medication in each of the classes.
Half of the plans also violated requirements by not covering anti-smoking services, which include screenings, up to eight counseling sessions per year and one 90-day treatment of any anti-smoking medication approved by the Food and Drug Administration.
Calls for more comprehensive coverage of addiction treatment services have increased over the past few years as the number of drug overdose deaths have reached record levels. More than 28,000 people died in 2014 from overdoses involving opioid drugs, including heroin, Johnson notes.
Last year, the federal government suggested including coverage of the full range of approved medication-assisted treatments as part of the essential health benefits to ensure greater access. The proposal faced opposition from insurers and pharmacy benefit managers and was ultimately struck down.