|Addiction Treatment Industry Newswire|
|08/08/2014 -ATIN – Massachusetts Gov. Patrick Deval, reacting to overwhelming public pressure as addiction to such drugs as heroin has now become a middle class problem, with addiction seemingly moving into every nook and cranny of society with a flood of celebrity deaths and life fiascos, has signed a bill that essentially mandates that those covered by insurance receive inpatient detox and a period of post-detox rehab lasting at least two weeks, according to published reports. The bill, which is a compromise between a Senate version that wanted 21 days post-detox and a House version with just 10 days, is a mandate essentially because the power to decide who needs inpatient care – the key “medical necessity” endless argument between providers and payors – has been placed with doctors on the ground working for providers instead of laying in the hands of insurance company gatekeepers as it is in the vast majority of states despite passage of numerous federal and local “parity” legislation.|
Pennsylvania Has Similar Legislation
The only other state to have similar legislation that puts decision making powers on medical necessity more in the hands of doctors at providers on the ground is Pennsylvania, which for some time has had a law that empowers docs at the provider level. There is little doubt that Pennsylvania’s legislation has encouraged a burst of treatment entrepreneurialism, especially in locations near the eastern edge of the state near heavily populated states like New Jersey that suffer from a lack of access to inpatient detox and treatment services, with entrepreneurs hoping to catch some cash-pay or out-of-network benefits from out-of-staters while keeping high value detox and treatment beds as full as they can with local Pennsylvania clientele. And in the current environment, and indeed really for decades now, there is plenty of medical necessity to go around in Pennsylvania and, frankly, everywhere in the nation with tiny one percent of total medical expenditures that we as a nation spend on addiction treatment services.
Unlikely to be Widely Duplicated
The legislation signed into law by Gov. Deval is unlikely to widely duplicated throughout the nation, although public pressure is mounting in many states and in places like Ohio you have governors that are sympathetic and have rapidly improving fiscal conditions. In Massachusetts there will likely be a rush by entrepreneurs to open new centers to take advantage of the law and consumers should be aware of the names the highest quality addictions players like Harvard associated McLean Hospital, which has a myriad range of addictions programs that service adolescents all the way through programs for adults. Consumers looking to take advantage of the basic detox and 14 day post-detox rehab services recently mandated by Gov. Deval would likely receive such services, at least initially, at McLean’s main hospital facility in Belmont, MA, about an hour from Boston.
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