--> New Laws for Addiction Treatment Parity Likely to Impact Billing and Treatment Organizations in 2021 - RecoveryView - Behavioral Health Community

New Laws for Addiction Treatment Parity Likely to Impact Billing and Treatment Organizations in 2021

Avea Solutions, a revenue cycle management software provider, has expanded its leadership team to include the appointment of Brian Takeo Smith as Chief Operating Officer. Takeo Smith has been with the company since 2019 and brings over a decade of experience to the new position, including his stint as Regional Operations Director for Da Vita Kidney Care. He also served over eight years in the US Navy. CEO of Avea Solutions, Bed Dittman commented on Smith’s promotion, “It is truly amazing what you can accomplish with the right team. With the elevation of Brian to Chief Operating Officer, Avea is well positioned to expand our operations into serving the behavioral health community in new ways for 2021 and beyond.” 

Smith’s promotion is well placed considering 2021 will usher in California’s new parity law, Senate Bill 855 (Wiener). The bill will implement vast enforcement requirements that will finally make state and national parity rules a reality. The bill requires that if medically necessary mental health or substance use disorder services are not available in-network within the geographic and timely access standards set by network adequacy law or regulation, an insurer must arrange for the provision of out of-network services that, to the maximum extent possible, meet the network adequacy standards, and cover the out-of-network services subject to in-network cost sharing. It also prohibits coverage limitations and exclusions for medically necessary services because the services should be or could be covered by a public entitlement program, including, but not limited to, special education or an individualized education program, Medicaid, Medicare, Supplemental Security Income, or Social Security Disability Insurance. The bill additionally addresses assessment methods used by commercial insurance plans to bring them into line with requirements provided in the states county systems of care by stating that, for a primary diagnosis of a substance use disorder in adolescents and adults, the ASAM Criteria developed by the American Society of Addiction Medicine must be used for placement decisions.

Just as Avea Solutions sought to provide and make it easier for behavioral health treatment centers to obtain billing software tailored specifically for them, the recent passage of SB 855 aligns with these goals. The California Consortium of Addiction Programs and Professionals (CCAPP) helped lobby for the bill’s success due to its importance to securing legitimate access to care and reimbursement for services in California’s treatment system. In Counselor Magazine, Vice Chair & Legislative Chair of CCAPP Michael Prichard stated, “Coverage cannot be denied based on insurer’s determinations that mental health and substance use disorder care are not medically necessary.”  SB 855 requires that health plans must provide coverage for medically necessity treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions. It also requires health plans and insurers to cover medically necessary treatment for all mental health and substance use disorders. "SB 855 gives state regulators expansive new tools for addressing parity violations and ending insurance abuses in the substance use disorder arena," said Sherry Daley, CCAPP Vice President of Governmental Affairs & Corporate Communications. "This legislation literally changes the rules to provide just treatment to clients and providers seeking to access care and be reimbursed for providing it." Avea Solutions originally tailored their business to help meet billing requirements specific to behavioral health treatment centers after recognizing that most billing software available to treatment centers is intended solely for traditional medical providers. Avea Solutions and CCAPP believe that health care coverage and treatment for mental health and substance use disorders must be administered to the same level as physical coverage. Appropriate billing software is one key to achieving this goal. 

Health care parity for mental health and substance use disorder is a necessity. No person should be denied a proper level of care or insurance coverage based on the particular health condition they have. According to the National Alliance on Mental Health, “Mental health parity describes the equal treatment of mental health conditions and substance use disorders in insurance plans. When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes then they must offer unlimited visits for a mental health condition such as depression or schizophrenia.” Point being, the same level of benefits should be given equally to anyone at all times. Likewise, mental health and substance use disorder treatment centers should be getting the same attention and resources as all other facilities in the healthcare field. 

Andrew D. Kessler, founder and principle of Slingshot Solutions, a consulting firm that specializes in behavioral health policy, stated, “The passage of the Domenici/Wellstone Parity act in 2008 was a huge victory for SUD advocates. It was decades in the making. That victory was further solidified by the Affordable Care Act of 2010, which established that all behavioral health services offered by providers covered by the act would be subject to parity. Yet there’s more work to be done - many providers still do not comply with the law, and many court cases are currently being litigated that will impact how much force the law has. It’s unfortunate that we still need to advocate for the issue over a decade later, but until the spirit of the law is completely fulfilled, we’ll continue our work.” The fight for mental health and substance use disorders parity in the health care field has been a long road, but with advocates such as those at CCAPP and Avea Solutions, anything is possible.  

Avea Solutions has a bright future as they continue to grow and offer their unique products to behavioral health treatment centers. The company’s goal is for greater expansion in 2021 as they continue to help make billing easier for behavioral health treatment centers. Their desire is to help make the business side of treatment centers run more smooth so that the treatment centers can spend more time with their patients. 

Sources

Avea Solutions. “Avea Solutions Appoints New Chief Operating Officer.” Avea Solutions. press release, November 19, 2020

California Legislative Information. “Bill Text – SB-855 Health coverage: mental health or substance use disorders.” California Legislative Information. Accessed December 9, 2020. http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200SB855 

CCAPP. “California Consortium of Addiction Programs and Professionals.” CCAPP. Accessed December 8, 2020. http://www.ccapp.us   

National Alliance on Mental Health. “What is Mental Health Parity?” NAMI. Accessed December 10, 2020. http://www.nami.org/Your-Journey/Individuals-with-Mental-Illness/UnderstandingHealth-Insurance/What-is-Mental-Health-Parity 

Office of Governor Gavin Newsom. “Governor Newsom Signs Bills to Expand Access to Quality

Behavioral Health Care for all Californians & Help Homeless Californians Suffering Extreme

Mental Illness on Our Streets & Sidewalks.” Office of Governor Gavin Newsom. press release, September 25, 2020  

Prichard, Michael. “Changing Systemic Discrimination for Behavioral Health Disorders.” Counselor Magazine, October 1, 2020.  http://www.counselormagazine.com/en/2020/changing-systemicdiscrimination-for-behavioral-health-disorders. 

 

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