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A Wiley Periodicals, Inc. publication. wileyonlinelibrary.com

Volume 23 Number 34

September 5, 2011

Print ISSN 1042-1394

Online ISSN 1556-7591

In This Issue...

NASADAD inquiry finds SSA

involvement in DUI/DWI programs . . . See page 3

EEOC sues trucking company

for sidelining driver for alcohol abuse . . . See page 4

From the Field:

Why we ALL need recovery

. . . See page 5

Web-based recovery

support effective, says study . . . See page 7

New York City

schools offer SBIRT . . . See page 7

Multi-year contracts

in future for New Jersey providers . . . See page 8

Florida welfare

drug tests:

98 percent negative

. . . See page 8

© 2011 Wiley Periodicals,Inc.

View this newsletter online at wileyonlinelibrary.com

DOI: 10.1002/adaw.20296HEALTH AND

MEDICAL WRITING

L S

Parity Implementation Coalition requests

federal intervention in Florida BCBS case

Late last month, treatment advocates

asked the federal agencies that over- see the Mental Health Parity and Ad- diction Equity Act (MHPAEA) to in- tervene in Florida, where Blue Cross

Blue Shield of Florida (BCBSFL) has

fired all its contracted addiction and mental health providers. The state's own insurance regulators said at the time that it was not their job to en- force the MHPAEA - but the federal government says that is not the case and has opened an investigation,

ADAW has learned.

Florida addiction providers con-

tracted to BCBSFL found out that not only will their contracts be terminat- ed at the end of November, but that the new managed care carve-out -

New Directions Behavioral Health,

based in Leawood, Kan. - will offer them new contracts at gr eatly re - duced fees. No other contractors in the BCBSFL system appear to have been singled out for this treatment.

The Parity Implementation Co-

alition (PIC) contacted the state's

Office of Insurance Regulation

(OFR) to ask that the MHPAEA be enforced, but the OFR responded in an Aug. 17 letter to the Florida Psy- chological Association that the office "has no jurisdiction with respect to enforcement of federal law." This led to an Aug. 25 letter from the PIC to the secretaries of the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Department of the

Treasury, the three agencies respon-

sible for enforcing the MHPAEA and

See BCBSFL page 2

See Benchmark page 6

by Gary Enos, Contributing Editor

Staff members at Wayside House, a

women's addiction treatment orga- nization in the Minneapolis area, of- ten have found themselves taking pride in doing things differ ently from other centers. It can be good to be an "outlier" if you believe you have a better mousetrap, but the center's executive dir ector empha- sizes that it's also important to know why you're an outlier and if that sta- tus actually is deriving benefits for your clients.

This is why in the past couple of

years Wayside House has moved to- ward a more sophisticated analysis of processes and outcomes in the organization. It is now more active in comparing its numbers to those seen at similarly sized facilities, to get a better sense of the areas where it might need to improve. "We report some outcomes to the state, but that data didn't help us move our services," Wayside House executive director Ellie Skelton told

ADAW. "We often wondered, 'Is this

a favorable outcome vs. that of our peers?'"

Over the past two years, Way-

side House has become involved in a formalized benchmarking initia- tive in partnership with nationally

Treatment Program Profile

Minn. treatment center ratchets up

process of analyzing outcomes

Alcoholism & Drug Abuse Weekly September 5, 2011

2

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher's permission.Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw

the Interim Final Regulations (IFR), requesting that they "intervene in the BCBSFL issue or provide guid- ance on criteria for state and federal intervention in MHP AEA non-com- pliance issues," and "promulgate ad- ditional regulatory guidance as soon as possible on all three of these is- sues to thwart the harmful actions such as this that significantly reduce consumer access to mental health and addiction services, impact be- havioral health consumers and pro- viders alike, and damage the integ- rity of MHPAEA and the IFR." The letter was signed on behalf of the

PIC by Irvin L. Muszynski of the

American Psychiatric Association

and Carol McDaid, principal with

Capitol Decisions.

The DOL, HHS , and Treasury

are going to investigate the situation, but enforcement is the responsibility of the s tate insuran ce department, according to the federal agencies. In a joint e-mail to ADAW, pres s spokesmen said that "state insurance departments are the primary govern- ment enforcer/investigator" with re- spect to health insurance compa- nies. "The three departments wil l 'The three departments will use our normal processes to work with the state and look into these issues.' Department of Labor, Department of Health and Human Services, and Treasury Department

BCBSFL from page 1

use our normal processes to work with the state and look into these is- sues," said the e-mail. "We thank the

Parity Implementation Coalition for

bringing this to our attention."

Molly Narendran, spokeswom-

an for New Directions, after setting a time for an interview with the com- pany's chief medical officer, can- celed plans the night before, send- ing an e-mail that said "we will not be commenting at this time." BCBSFL did not respond to our request for an interview.

Pamela Gr eenberg, president

and CEO of the Association for Be- havioral Health and Wellness (ABHW), a managed behavioral healthcare membership group, did not see the Florida situation as something that happens only in mental health and addiction treat - ment. Although not familiar with the details of the Florida situation -

New Directions is not a member of

the ABHW - Greenber g said she "would equate this to an HMO ter- minating a contract with an entire group practice - let's say a cardiac group practice - and then contract- ing with a new group practice." Pro- vider payment changes "may or may not come with the new contracts," she said.

Non-quantitative

treatment limits

In its letter to the government

agencies, the PIC also r equested clarification on the parity law - specifically the non-quantitative treatment limits (such as having to stay in the network, or failing first in lower levels of care) imposed on ad- diction and mental health treatment by insurance companies. "Managed behavioral health or- ganizations are implementing the

MHPAEA, which includes parity for

standards for provider admission to participate in a network, including reimbursement rates," said Green -

Executive Managing Editor Karienne Stovell

Editor Alison Knopf

Contributing Editor Gary Enos

Production Editor Douglas Devaux

Executive Editor Isabelle Cohen-DeAngelis

Publisher Sue Lewis

U.S./Can./Mex.), $843 (individual, rest of world), $4835 (institutional, U.S.), $4979 (institutional, Can./Mex.), $5027 (institutional, rest of world); Print & electronic: $769 (individual, U.S./Can./Mex.), $913 (individual, rest of the world), $5563 (institu- tional, U.S.), $5707 (institutional, Can./Mex.), $5755 (institutional, rest of the world); Electronic only: $699 (individual, worldwide), $4835 (institutional, worldwide) . Alcoholism & Drug Abuse Weekly accepts no advertising and is supported solely by its readers. For address changes or new subscriptions, contact Subscription Distri- bution US, c/o John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774; (201) 748-6645; e-mail: subinfo@wiley.com. © 2011 Wiley Periodicals, Inc., a Wiley Company. All rights reserved. Reproduction in any form without the consent of the publisher is strictly forbidden. For reprint permission, call (201) 748-6011. Alcoholism & Drug Abuse Weekly is indexed in: Academic Search (EBSCO), Aca- demic Search Elite (EBSCO), Academic Search Premier (EBSCO), Current Abstracts (EBSCO), EBSCO Masterfile Elite (EBSCO), EBSCO MasterFILE Selec t (EBSCO), Expanded Academic ASAP ( Thomson Gale), Health Sour ce Nursing/Aca demic, InfoTrac, Proquest 5000 (ProQuest), Pr oquest Discovery (ProQuest), ProQuest Health & Medical, Complete (ProQuest), Proquest Platinum (ProQuest), Proquest Research Library (ProQuest), Student Resource Center College, Student Resource

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ISBN 978-1-118-02095-1

Alcoholism & Drug Abuse Weekly (Print ISSN 1042-1394; Online ISSN 1556-7591) is an independent newsletter meeting the information needs of all alcoholism and drug abuse professionals, providing timely reports on national trends and develop- ments in funding, policy, prevention, treatment and research in alcohol and drug abuse, and also covering issues on certification, reimbursement and other news of importance to public, private nonprofit and for-profit treatment agencies. Pub- lished every week except for the last Monday in April, the first Monday in July, the last Monday in November and the last Monday in December. The yearly subscrip- tion rates for Alcoholism & Drug Abuse Weekly are: Print only: $699 (individual,

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September 5, 2011 Alcoholism & Drug Abuse Weekly

3

Alcoholism & Drug Abuse Weekly DOI: 10.1002/adawA Wiley Periodicals, Inc. publication. View this newsletter online at wileyonlinelibrary.com

Continues on next page

berg, who said that while the ABHW has some pr oblems with the non- quantitative treatment limits aspects of the IFR, managed behavioral health organizations are complying with the law. "If there is an out-of- network medical benefit under a plan, MHPAEA requires that there be an out-of-network benefit for addic- tion and mental health services as well," she said.

In addition, McDaid and

Muszynski r equested disclosure of

medical and sur gical criteria fr om

BCBSFL. Without information about

how the medical-surgical criteria are established, it's impossible to test whether the mental health-substance abuse criteria are on par - particu- larly when it comes to non-quantita- tive treatment limits. "The PIC fully anticipates that BCBSFL will ignore our requests for disclosure as has been the case with many of the oth- er complaints submitted to the De- partments," stated their letter to the federal agencies.

Limited or no oversight

The Aug. 25 letter also states

there is "limited oversight at the fed- eral level and no oversight in some states" of the MHPAEA. Since last

December when the federal govern-

ment issued "sub-r egulatory" guid- ance on disclosing medical-surgical criteria, the PIC submitted mor e than 150 examples of non-compli- ance with this requirement, accord- ing to the letter.

Based on the regulatory guid -

ance given so far, the letter said, "BCBSFL could have a robust net- work of medical/surgical providers, but drop or significantly reduce their specialty behavioral network and still be in compliance with the IFR."

This is not what Congress intended

when it passed the parity law in

2008, the letter said.

In a June 29 press release an-

nouncing the agreement wit h

BCBSFL, New Directions chief

medical officer Jonatha n Gavras,

M.D., said, "The Mental Health Par-

ity and Addiction Equity Act of 2008 puts pressure on employers to pro- vide quality behavioral health care while continuing to contain costs."

Gavras added that "New Directions

has the exp erience and processes that can aid B CBSF custome rs in these efforts."

And John Quick, President and

CEO of New Directions, said in the

same press release: "This collabora- tion expands our commitment to in- tegrating behavioral health and medical care. We look forward to working together with Blue Cross and Blue Shield of Florida to im- prove behavioral health care for their members while reducing un - necessary costs."

Skepticism from provider

Treatment providers are skepti-

cal about regulators' ability to stop insurance company practices. The major insurance companies sued to stop implementa tion of the parity law, noted John Schwarzlose, CEO of the Betty Ford Center in Rancho

Mirage, Calif. Although the court

dismissed the case, there have been "no changes to adequate reim - bursement and access to treatment for thousands of people in need," he said in an e-mail to ADAW last week, adding, "in many locations the rules and restrictions have got- ten worse." "The only chance that things will really change to allow access to care will be through the courts," said

Schwarzlose. Referring to a recent

development in which a family won a case in which their daughter with a severe eating disorder was denied care, Schwarzlose said the "insurer's response is to hint that they will take this to the Supreme Court." "We should be pleased and proud that parity passed after many, many years of effort," said Schwar- zlose. "But who knows if in the end it will make a difference to people in need." NASADAD inquiry finds SSA involvement in DUI/DWI programs

State alcohol and drug abuse

directors are playing an important role in DWI/DU I treatme nt and prevention, according to a new re- port from the National Association of State Alcohol and Drug Abuse

Directors (NASADAD). This is the

first time NASADAD has looked at this issue - and it's long overdue, said NASADAD ex ecutive director

Rob Morrison.

The paper, prepared with assis-

tance from the Center for Substance

Abuse Tr eatment of the Substance

Abuse and Mental Health Services

Administration, includes the re-

sponses of 50 SSAs (single state authorities), and shows a range of involvement in different areas. "There are 15 million DUI arrests a year, and over 10,000 deaths relat- ed to DUI," said Henrick Harwood, research director for NASADAD. With

DUI now cons idered a si gnificant

public health issue, it makes sense for the SSAs to be involved in state policy when it comes to treatment and prevention, says NASADAD. "Twenty years ago, DUIs were considered a law enfor cement is- sue," Harwood told ADAW last week. Over time, the SSA has been brought in to oversee the health- side, as states have recognized that law enforcement alone isn't enough.

One of the key areas that the

SSAs are responsible for is certifying

the treatment and prevention pro - grams to which DWI/DUI offenders are referred. In some cases, the of- fender is assessed to need formal treatment; in most, however, the of- fender needs only an education program, which is relatively inex- pensive and which is an important part of prevention. "We think it's really important

Alcoholism & Drug Abuse Weekly September 5, 2011

4

It is illegal under federal copyright law to reproduce this publication or any portion of it without the publisher's permission.Alcoholism & Drug Abuse Weekly DOI: 10.1002/adaw

Continues on page 6

Continued from previous page

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