Academic journal article Care Management Journals

Parity Not Perfect: Making Sense of Substance Addiction Equity for Case Managers

Academic journal article Care Management Journals

Parity Not Perfect: Making Sense of Substance Addiction Equity for Case Managers

Article excerpt

In October of 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act became a law. It represents a groundbreaking change in substance abuse treatment policy because it redistributes the bulk of costs for substance abuse treatment from the federal government to group health plans. The law required that employee and public insurances that cover health or surgical care also provide comparable terms of coverage and treatment limitations for substance abuse. This article considers shift within the context of a popular substance abuse motto that "reform is progress but not perfect." Specifically, it examines policy implications and their impact on consumers, insurers, providers, and case managers.

Substance abuse is a problem that has been prevalent in the United States for more than two centuries. Research shows no indication that the problem is decreasing. According to the Substance Abuse and Mental Health Service Administration (SAMHSA) and Office of Applied Studies (2008), more than 22 million people reported having a substance-related disorder. These problems have an impact on an individual's life, his or her family, and the community at large (National Institute on Drug Abuse [NIDA], 2006).

The costs of substance abuse affect more than just the person using drugs or alcohol. The government estimated that in 2002, substance abuse cost the United States more than $180 billion. These costs are distributed across all aspects of society. These include increased health care costs, productivity losses, premature deaths, as well as costs of related crimes to law enforcement and criminal justice agencies (Office of National Drug Control Policy [ONDPC], 2004). The state and federal governments pay for approximately half of the costs associated with substance abuse and dependence, whereas the remaining costs are shouldered by private insurance, victims, persons who abuse drugs and alcohol, and other members of their households (NIDA, 2006).

Treatment for persons with substance use disorders can be cost effective. Studies prove that treatment can reduce health care and criminal justice costs (Thaler & Sunstein, 2003). Along with improved health and social functioning, other benefits include improved family relationships, mental health, and employment (Cartwright, 2000; Jofre-Bonet & Sindelar, 2004). Successful substance abuse treatment also reduces work-related problems (Jordan, Grissom, Alonzo, Dietzen, & Sangsland, 2008). Not only may the number of problems decrease, but the severity of work-related problems may also decrease including absences, tardiness as well as interpersonal conflicts, and lost productivity (Jordan et al., 2008).

It is not surprising that treatment is at the forefront of national substance abuse policy. In October of 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act became law. This was part of the Troubled Asset Relief Program (TARP) and went into effect in October 2009. It represents a groundbreaking shift in insurance legislation because it required employee and public insurances that cover health or surgical care to provide comparable financial requirements and treatment limitations for mental health and substance abuse. Although not mandating insurance coverage for substance abuse, the law specified the coverage requirements for group plans that include substance abuse (Shern, Beronio, & Harbin, 2009).

This new law has potentially wide-reaching impact on stakeholders in substance abuse treatment, which consists of consumers, providers, insurers, and case managers. Some members of this treatment community draw inspiration from a saying, "practice not perfect" that describes attempts at recovery that are welcomed but not ideal. This article applies that approach to the examination of addition equity and considers this reform as progress but not perfect. The premise of this article is that while the act represents progress, not all implications result in improved service delivery and access to care for consumers. …

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