And financial reimbursement is playing a role.
The state insurance department issued a report last month that found that reimbursement by commercial health insurers for "substance use disorder," or SUD, services was "substantially" lower than
And that helps explain why patients often have trouble getting such treatment, according to
"When you have an individual that's seeking treatment, they should be able to receive treatment immediately," she said. "And when there's no workforce and people are at capacity, treatment is limited.
"So particularly now, as we're facing an epidemic, that's a problem."
Low pay is a big part of the shortage, Gray said. "People are coming out of school with significant debt, and they have to take jobs that are going to pay and help them pay off their loans," she said.
"The other important thing to remember is, particularly in our neck of the woods, we live very close to other states that are reimbursing at higher rates, and people are being drawn to those areas."
The state insurance department in November launched a "market conduct examination" in response to complaints by patients and providers that insurers weren't covering critical services. The results are expected to be released soon.
State regulators are looking at how Anthem, Harvard Pilgrim, Cigna, Minuteman and Community Health Options are covering SUD services. They've likened a market conduct exam to "looking under the hood."
A key aspect of their investigation is something called parity.
Gray said parity is key. "It's very important that providers are reimbursed at rates that are comparable to the rates that would be reimbursed to medical and surgical doctors. So when we look at counseling services, they should be parallel with other benefits."
The insurance department doesn't regulate reimbursement rates. But it is tasked with making sure carriers are complying with existing laws, including parity, said
And the department's recent finding that reimbursement rates by commercial insurers for SUD services are lower than
Don't insurers have the right to negotiate the best rates they can with providers?
Sure, says Gray.
But this is all new territory for SUD treatment providers; they're just coming into the world of contract negotiation and billing insurance for coverage, she said. "Some of the rates are lower because some of these benefits are brand new," she said.
What should any of this matter to folks in
"I think the important thing is if their son or nephew or niece or daughter or themselves want to access treatment, treatment should be available," Gray said. "And when we have workforce issues, that people don't want to enter the field because reimbursement rates are so low, treatment's not going to be available for people."
Gray said she thinks insurers here are trying to get it right. "I think that insurance carriers are working hard to try to comply with parity, but there's still more work to be done," she said.
She said a new state law should help.
It mandates that insurance carriers that cover SUD services shall not require prior authorization for short-term inpatient withdrawal management and clinical stabilization services for up to 24 hours.
Alternatively, a carrier can require prior authorization but only if it provides a 24-hour hotline and delivers a clinical decision within six hours.
The law takes effect
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