Bikki Tran Smith1, Kathleen Seaton2, Christina Andrews3, Colleen M Grogan1, Amanda Abraham4, Harold Pollack1, Peter Friedmann5, Keith Humphreys2. 1. a School of Social Service Administration , University of Chicago , Chicago , IL , USA. 2. b Department of Psychiatry , School of Medicine, Stanford University , Stanford , CA , USA. 3. c College of Social Work , University of South Carolina , Columbia , SC , USA. 4. d Department of Medicine , Division of General Internal Medicine, University of Massachusetts-Baystate , Springfield , MA. 5. e University of Massachusetts , Medical School , Springfield , MA , USA.
Abstract
BACKGROUND: Established in 2014, state health insurance exchanges have greatly expanded substance use disorder (SUD) treatment coverage in the United States as qualified health plans (QHPs) within the exchanges are required to conform to parity provisions laid out by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MHPAEA). Coverage improvements, however, have not been even as states have wide discretion over how they meet these regulations. OBJECTIVE: How states regulate SUD treatment benefits offered by QHPs has implications for the accessibility and quality of care. In this study, we assessed the extent to which state insurance departments regulate the types of SUD services and medications plans must provide, as well as their use of utilization controls. METHODS: Data were collected as part of the National Drug Abuse Treatment System Survey, a nationally-representative, longitudinal study of substance use disorder treatment. Data were obtained from state Departments of Insurance via a 15-minute internet-based survey. RESULTS: States varied widely in regulations on QHPs' administration of SUD treatment benefits. Some states required plans to cover all 11 SUD treatment services and medications we assessed in the study, whereas others did not require plans to cover anything at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance regarding how they should be used. CONCLUSION: Although some states have taken full advantage of the health insurance exchanges to increase access to SUD treatment, others seem to have done the bare minimum required by the ACA. By not requiring coverage for the entire SUD continuum of care, states are hindering client access to appropriate types of care necessary for recovery.
BACKGROUND: Established in 2014, state health insurance exchanges have greatly expanded substance use disorder (SUD) treatment coverage in the United States as qualified health plans (QHPs) within the exchanges are required to conform to parity provisions laid out by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MHPAEA). Coverage improvements, however, have not been even as states have wide discretion over how they meet these regulations. OBJECTIVE: How states regulate SUD treatment benefits offered by QHPs has implications for the accessibility and quality of care. In this study, we assessed the extent to which state insurance departments regulate the types of SUD services and medications plans must provide, as well as their use of utilization controls. METHODS: Data were collected as part of the National Drug Abuse Treatment System Survey, a nationally-representative, longitudinal study of substance use disorder treatment. Data were obtained from state Departments of Insurance via a 15-minute internet-based survey. RESULTS: States varied widely in regulations on QHPs' administration of SUD treatment benefits. Some states required plans to cover all 11 SUD treatment services and medications we assessed in the study, whereas others did not require plans to cover anything at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance regarding how they should be used. CONCLUSION: Although some states have taken full advantage of the health insurance exchanges to increase access to SUD treatment, others seem to have done the bare minimum required by the ACA. By not requiring coverage for the entire SUD continuum of care, states are hindering client access to appropriate types of care necessary for recovery.
Entities:
Keywords:
ACA; MHPAEA; health insurance exchanges; qualified health plans; substance use disorder treatment
Authors: Keith Humphreys; Chelsea L Shover; Christina M Andrews; Amy S B Bohnert; Margaret L Brandeau; Jonathan P Caulkins; Jonathan H Chen; Mariano-Florentino Cuéllar; Yasmin L Hurd; David N Juurlink; Howard K Koh; Erin E Krebs; Anna Lembke; Sean C Mackey; Lisa Larrimore Ouellette; Brian Suffoletto; Christine Timko Journal: Lancet Date: 2022-02-02 Impact factor: 202.731