“Our mission is to provide clarity on compliance and standards for the addiction treatment world. Confusion about licensing, operations and reimbursement are fundamental challenges facing the industry,” said Harry Nelson, J.D. As Chair of the Board of the American Addiction Treatment Association (AATA), Nelson draws on 23 years of experience solving legal and regulatory problems for healthcare industry clients.
“In many respects, addiction treatment and, more broadly, behavioral health, were siloed off from the rest of healthcare for a long time. They weren’t covered by health insurance like medical care and had their own ecosystem that wasn’t good for patients or providers. It wasn’t until awareness of addiction and mental health as a disease – rather than a moral failing –started shifting. That change in public perception played a key role in the enactment of the 2008 Mental Health Parity Act.” The MHPAEA prohibits health insurance carriers from discriminating against coverage of mental health and substance use disorders relative to coverage of medical conditions.
Although Nelson began as a lawyer for hospitals and medical groups, in the early 2000s, he began working closely with a handful of addiction treatment-focused physicians and mental health professionals. Some had come to addiction medicine after personal struggles with addiction, and had retrained in order to be able to help support patients in recovery. His work with these doctors grew to encompass representation of treatment centers and outpatient programs they were working with. “At the time, the common theme we heard from many addiction treatment providers was that they were pleasantly surprised finally to meet lawyers who understood their unique issues.”
“Many of our clients in the addiction treatment community have been drawn to our focus on practical problem-solving. Effective long-term results have been in short supply in addiction treatment, leading many providers to experiment with innovative models and integrations of resources. For lawyers who aren’t familiar with the distinctive regulatory and reimbursement landscape, the safest answer is often to tell clients ‘no’. But what clients are looking for is for someone to tackle the much more difficult question of ‘how’ to do things safely and legally. That’s been our differentiator.”
The desire to offer resources widely available to a larger segment of the addiction treatment community spurred Nelson’s leadership role in AATA, which has been led by Executive Director Gina Meyer since January 2016. Meyer’s goal was not to “reinvent the wheel” where other organizations were already doing valuable work, but instead to collaborate and support the advancement of standards on business, compliance, and clinical issues. “AATA has been thrilled to find trusted partners in organizations like the California Consortium of Addiction Programs and Professionals (CCAPP), the Florida Association of Recovery Residences, and industry convener C4 Recovery Solutions,” commented Meyer. We are working on collaborations to advance certification and credentialing programs that will set the standards for the important work being done in addiction treatment over the next decade.” In order to facilitate the significant infrastructure of researchers, writers, and clinicians to build 50-state expertise, AATA elected a for-profit structure. “Our goal is to build a sustainable set of tools and resources that we can make available at an attractive value proposition for addiction treatment programs and professionals,” said Meyer.
Examples of issues where AATA has played an active role to date include reducing confusion around medication management practice and urine drug testing. “Medication management is an area where government analysts were applying different standards and residential treatment centers were struggling to understand what the law required. We were able to articulate practical standards that have been well-received in Sacramento and have given the industry direction,” said Meyer.
Another positive example of AATA’s role has been its publication of a Patient Financial Responsibility Toolkit, which has received glowing reviews from treatment centers, some of which had inadvertently gotten themselves into trouble as a result of confusing standards. “Well-intended people think they are helping families by waiving copays and coinsurance,” said Nelson. “But insurance companies are accusing them of committing fraud. There was a need for someone to step into the void and close the gap between the real financial pressure on families needing addiction treatment and the insurance industry’s legitimate desire for adherence to contractual requirements. The Toolkit offers unprecedented clarity so that programs can know what actions are reasonable to take.”
AATA initially launched its web-based resources in California, Florida, New York and Arizona, and has now grown its presence to ten states. “We are on our way to a national footprint over the next 12 to 18 months,” said Meyer.
What does AATA see for the future? Nelson described his goal as solving problems before disasters occur: “Most of the times, people hire lawyers after a ‘disaster’ has occurred, in the thick of a crisis with a government agency, a patient’s family, or a payor. Sometimes the issue is fraud and abuse. In many cases, we come in after a tragedy where a patient died. With AATA, our goal is to empower addiction treatment providers not to wait and to provide effective resources to support effective strategic action.”
Of late, the biggest issue on which members have sought guidance from the AATA has been the future of the Affordable Care Act. “The political upheaval of the past six months has generated a massive amount of unpredictability,” said Nelson. To begin to address the confusion and in particular the anxiety from providers worried about what is ahead, Nelson and AATA board member Rob Fuller co-authored a book published in January 2017 and available on Amazon, entitled “From ObamaCare to TrumpCare: Why You Should Care.” The book has received positive reviews from legislators in Washington, D.C. and Sacramento for a clear, even-handed assessment of the challenges facing U.S. healthcare.
“I grew up hearing the constant refrain from my parents that ‘if you’re not part of the solution, you’re part of the problem,” said Nelson. “The best part about helping to grow AATA with addiction programs and professionals is having a tangible way to be part of the solution.”
Learn more about AATA here: http://www.addiction-tx.com/