Leveraging the Equity Act and ACA To Improve Access to Addiction Treatment University of Arkansas at Little Rock February 28, 2014

 Treatment Need  Equity Act  Affordable Care Act  Restrictions on treatment  Enforcing the Equity Act  Conclusion Preview

 Prescription drug abuse epidemic  Synthetics, analogs, 3D printing  Marijuana legalization  21.6 million Americans with SUDs  89.6 percent untreated  38,329 overdose deaths in 2010  Stigma Social Structural Treatment Need

Equity Act  Mental Health Parity and Addiction Equity Act of 2008  Amends ERISA, PHSA, IRC  Financial requirements and treatment limits on MH/SUD benefits must be no more restrictive than those applicable to medical/surgical benefits  Group plans only (not small e’or or individual)  CMS, IRS, DOL announced Final Rule in Nov. 2013, effective Jan. 2014

Affordable Care Act  Patient Protection and Affordable Care Act  Intended to expand coverage to six million people with SUDs by 2016  Requires coverage of Essential Health Benefits (EHBs) Small groups Individuals Exchanges Medicaid ABPs  Mental health, SUDs included as EHBs

ACA Expands Parity  ACA directs HHS to ensure balance among EHBs  HHS determined compliance requires applicability of Equity Act standards  Expands parity (Previously just group plans voluntarily offering MH/SUD coverage) Small groups Individuals Exchanges Medicaid (with nuances)

Medicaid Nuances  Equity Act Final Rules created misconception that regs do not apply to Medicaid plans  CMS guidance adopts framework of Equity Act  Medicaid ABPs must comply with Equity Act parity provisions  MCOs must comply with contracts with CMS  CMS guidance set forth specific parity standards applicable to MCOs

Restrictions on Treatment  Certain services never medically necessary  Benefit not required under Equity Act  Harsh prior authorization and fail-first requirements (failure can mean overdose death)  Drastic cuts to reimbursement rates  Weakening baseline medical/surgical coverage  Lifetime limits on maintenance medications

Enforcing the Equity Act  Complaints to state insurance departments (HHS/CMS as a backstop), appeals in state courts  Breach of K claims (Ks state insurers will comply w/ federal/state law)  Medicaid state hearings, class actions  Complaints to DOL (action on 0/160 complaints)  ERISA Recover benefits due Enforce rights Clarify rights  Excise tax + IRS whistleblower

Conclusion  Michael C. Barnes & Stacey L. Sklaver, Active Verification and Vigilance: A Method To Avoid Civil and Criminal Liability When Prescribing Controlled Substances, D E P AUL J. H EALTH C ARE L. (2013).  Michael C. Barnes & Gretchen Arndt, The Best of Both Worlds: Applying Federal Commerce and State Police Powers To Reduce Prescription Drug Abuse. M D. J. H EALTH C ARE L. & P OL ’ Y (2013).  LinkedIn.com/in/michaelcbarnes  Questions?  Thank you