Six months into her role as president and CEO of the National Association of Addiction Treatment Providers (NAATP), Karen Carpenter-Palumbo faces not only the challenge of leading a national organization, but of leading it into the unknown territory as addiction treatment providers, health insurers, and consumers alike struggle toward realizing landmark national health reforms.
While national implementation of healthcare reform is years away, implementation of the Mental Health Parity and Addiction Equity Act of 2008, which took effect on Jan. 1 is in full swing.
Or, at least it should be, says Carpenter-Palumbo, who is completing plans for a nationwide series of member meetings from October 2011 to February 2012. A primary objective of the meetings is to survey NAATP’s 300-plus member organizations about what many perceive to be slow and inconsistent action by insurers to implement parity’s requirements. This, many believe, thwarts parity’s promise of expanded access to mental health and addiction treatment.
“The implementation of parity is a paramount concern to all of our members,” says Carpenter-Palumbo, noting that, “while passage of the parity regulations was a tremendous feat nationally, the question now is: ‘Are the parity regulations being implemented per the intent of the law, and are they being implemented evenly across the country?’”
Her reply: “I think it’s clear that parity is not being implemented in the way that it was intended to be. “Parity,” she explains, “was crafted to ensure that, if you have an addiction—a chronic brain disease— you have the same ability to access treatment as if you had a chronic illness such as diabetes. But our members and many seeking addiction treatment don’t see parity being administered in that way. There are a lot of complaints out there, in every area of the country. It’s our responsibility to go out there, understand them, and document them.”
One issue, she is certain, is that “there are thousands of insurance companies across the country and they all have utilization management policies. While parity allows for utilization management, we’ve got to make sure that the standards used by insurers reflect nationally-accepted criteria for addiction care.” But there’s a problem: “These policies are not open and public, and they should be,” she says, adding that NAATP members are often frustrated in their efforts because “there’s no transparency in what insurers are doing.”
And, she adds, sometimes insurers get off the track: “I recently spoke to an insurance company that was using a medical necessity criterion of “danger to self or others” to make coverage decisions regarding addiction treatment. I told them, ‘That’s not a standard that’s associated with addiction treatment—that’s a standard associated with determining the need for inpatient treatment of a mental illness.’ There was nothing there having to do with addiction. But that’s the kind of conversation that each NAATP member ought to be having locally and regionally.”
To capture all of that member information, Carpenter-Palumbo has worked with NAATP board, staff, and member representatives to “craft a survey and get the specifics, region by region, place by place.” When completed, the survey promises to be a powerful tool.
But, she makes clear, the purpose of the tool isn’t about leverage. Instead, it’s about understanding. The former executive vice president of a New York state health insurer (and, of course, former commissioner of New York State’s Office of Alcoholism and Substance Abuse Services),
Carpenter-Palumbo sees the challenge of parity from all perspectives. She believes “that everyone wants and intends to implement the law properly, but it’s clear that a lot of communication and exchange is needed as to how we believe that should happen.”
Ultimately, she says, “the goal is to collaborate, to partner, to educate and exchange with insurers. If our members identify insurers that are implementing parity in a truly excellent way, it’s our job to find them, recognize what they’re doing, and celebrate their efforts to make parity work.” Yet, she adds, the opposite is also true: “if we have to, we’ve got to be prepared to challenge situations where parity is not working right and prepared to work with payers to get it right.
“It’s about following through on our mission—getting people the access, level, and quality of care that they deserve. Parity has to bring about true equity in treatment.”
NAATP member meeting schedule
October 20-21 2011:
Rosecrance Griffin Willamson Campus
Sponsored by Rosecrance and Fairbanks
November 10-11, 2011:
CeDAR, the Center for Dependence, Addiction, and Rehabilitation at the University of Colorado
Sponsored by CeDAR
November 16-17, 2011:
Father Martin’s Ashley
Havre de Grace, Md.
Sponsored by Father Martin's Ashley
Jan 11-12, 2012:
New Directions for Women
Costa Mesa, Calif.
Sponsored by New Directions for Women and NTS
February 17, 2012:
Talbott Dunwoody facility
Sponsored by Talbott and Ridgeview