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Are providers positioned to flourish under health reform?

July 3, 2012
by Gary A. Enos, Editor
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Leaders resume their call for reaching a larger treatment population
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The importance of achieving a victory in the courts on health reform cannot be diminished, but in the days following the U.S. Supreme Court’s decision on the Affordable Care Act (ACA), addiction field leaders are trying to turn the provider community’s attention to its level of preparation for success in the health reform era.

A traditionally leading voice for redesigning addiction service systems sees numerous opportunities for treating individuals who have never been priority one in the specialty treatment sector—those who do not meet clinical criteria for addiction but still tax other service systems because of their harmful levels of substance use.

A. Thomas McLellan, PhD, CEO of the Treatment Research Institute (TRI) and former deputy director of the Office of National Drug Control Policy (ONDCP), emphasizes that these individuals will have access to care via the ACA’s requirement that health plans’ essential benefits packages include services for the full range of substance use disorders.

“This is the beginning of a new era in prevention, early intervention and office-based care for patients who are not addicted—but whose drinking, smoking, and use of other substances is harming their health and compromising the effectiveness of the care they are receiving for other illnesses and conditions,” McLellan said in a statement issued the day after the Supreme Court’s decision was announced.

For years at national conferences of addiction professionals, McLellan has urged treatment organizations to venture beyond the most severe cases in the design of their services, stating that most programs have been structured to meet the needs of only a small percentage of the individuals they could be reaching.

Other individuals and organizations in the field have been commenting on the ACA decision by citing other unfinished business of significance to the treatment community. A statement last week from NAADAC, The Association for Addiction Professionals discusses how Congress’s 2008 adoption of insurance parity legislation helped advocates in subsequently having a positive impact on the health reform debate. “Final regulations implementing the [parity] law are still needed, and NAADAC will continue to advocate for final parity regulations that provide strong protections for consumers, in accordance with congressional intent,” the association writes.

NAADAC adds that it “also will remain focused on growing and developing the addiction professional workforce in the 21st century, and increasing federal and state funding levels for addiction treatment and research programs.”

The comments of most field leaders clearly indicate that while they consider last week’s decision to be a significant victory for persons with substance use disorders, attention now must turn to several unanswered questions about health reform’s implications. For example, parity between coverage of substance use treatment and other chronic conditions could result in difficulty in accessing coverage for non-hospital residential treatment, a level of care unique to substance use treatment, says Deni Carise, PhD, who oversees clinical services at Phoenix House.

“Because insurance will be more resistant to covering intensive residential treatment, the substance abuse community must expand and adapt its programming to fit into this new system,” says Carise.