Crowley, Serpa bill would require expanded coverage for substance abuse treatment
Legislation filed at the request of Attorney General Peter F. Kilmartin would provide that insurance companies must cover at least 90 days of residential or inpatient services for mental health and/or substance abuse disorders.
Sponsored by Sen. Elizabeth A. Crowley (D-Dist. 16, Central Falls, Pawtucket) and Rep. Patricia Serpa (D-Dist. 27, West Warwick, Coventry, Warwick) the legislation, (2016-S 2510, 2016-H 7625) would amend section 27-38.2-1 (“coverage for the treatment of mental health and substance abuse disorders”) to provide that insurers must cover at least ninety (90) days of residential or inpatient services for mental health and/or substance-use disorders for American Society of Addiction Medicine (“ASAM”) levels of care 3.1 and 3.3. ASAM level of care 3.1 provides clinically managed low-intensity residential services and level 3.3 provides clinically managed population-specific high-intensity residential services. The coverage contemplated by this act would be based on the individual’s treatment plan and progress and in accordance with section 27-38.2-3 (“medical necessity and appropriateness of treatment”).
“We have too many people dying in our state from overdoses and this is in part because the brutal and harrowing cycle of addiction cannot be broken without effective medical care ,” said Senator Crowley. “It is morally wrong to put these people back on to the street to fight their addiction on their own due to monetary insurance reasons. If we want our children, friends, and loved ones to stop dying from overdoses, we need to ensure that they receive the proper medical treatment without being refused by the insurance companies.”
Rhode Island, on some level, has recognized mental health and substance abuse disorder parity since 1994. However, Attorney General Kilmartin believes the State needs to make sure that parity is justly acknowledged by insurance providers. It is well known in this State, and across the country, that one of the biggest barriers to recovery is access to necessary treatment. In fact, many have suffered relapses, because they were released from inpatient treatment far earlier than they were ready for. This is most disturbing in those suffering from heroin and prescription opiate use disorders as this when they are most vulnerable to overdose.
“As long as the prescriber or doctor is making diagnosis recommendations that are consistent with the standards of the American Society of Addiction Medicine, we should not be releasing patients back in to society before they are ready,” said Representative Serpa. “Years of mental or societal instability can often not be undone in a two-week hospital stay. We end up spending more money by releasing these individuals back to society before they are ready. They are often re-admitted for worse or more serious offenses. Getting it right after the first round of treatment increases that person’s chances of becoming a citizen who can function and work in society.”
The National Institute of Drug Abuse Principles of Drug Addiction Treatment states:
“Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.”
“Unfortunately, Rhode Island has been in the eye of the storm of heroin and fentanyl overdoses. While the State has made great strides in providing naloxone, increasing recovery coaches in our emergency rooms, and prosecuting drug traffickers, I believe that we are overlooking essential pieces to this complex problems, and those are appropriate substance abuse education and providing necessary treatment to those suffering from substance use disorders,” said Attorney General Peter F. Kilmartin. “It is my sincere belief that to truly address the substance use and overdose epidemic that is shattering the lives of families across our State, we must honestly the face the truth that enough is not being done to educate regarding the dangers of substance use and to provide the necessary services and treatment for those suffering from this disease.”
For more information, contact:
Daniel Trafford, Publicist
State House Room 20
Providence, RI 02903