14
doc • Spring 2014
Kentucky
Expanding Substance Abuse
Treatment, but Restricting Physicians
By Anne-Tyler Morgan
In November of 2013, the
Obama Administration
announced that insurers
would be required to cover
mental health and substance
abuse disorders in the same manner as physical conditions. Though the Mental Health
Parity and Addiction Equity Act was signed
into law by President George W. Bush in 2008,
the Obama Administration’s announcement
served as the first big push for enforcement
since the law’s passage. By making treatment
for mental health and substance abuse an
“essential benefit” under the Affordable Care
Act, exchange plans marketed to individuals
and small groups must now include this service. Secretary of Health and Human Services
Kathleen Sebelius called the change the
“largest expansion of behavioral health coverage in a generation.” Are Kentucky physicians
prepared for it?
When it comes to the treatment of substance
abuse, physicians in this state already have
their work cut out for them. Kentucky has
long been known for its prescription drug
abuse epidemic. Physicians have worked hard
in recent years to combat the problem. In
2013, the number of Kentucky deaths from
controlled substances actually fell for the first
time in a decade.1 Despite these efforts, the
intersection of new and existing law is making
it more difficult for physicians to help this atrisk population.
First, more patients will actively seek help for
their substance abuse disorders, creating a
greater demand for these services. Governor
Steve Beshear’s decision to expand Medicaid
eligibility in Kentucky to 138% of the Federal
Poverty Line means that some Kentuckians
will be able to receive professional treatment
as part of their Medicaid coverage for the first
time.
Second, stringent federal regulations make it
impossible for physicians to simultaneously
care for a large number of patients in their
fight against substance abuse. Physicians often
treat prescription drug addicts with Suboxone,
an effective narcotic medication for the treatment of opioid addiction; however, the Drug
Abuse Treatment Act of 2000 prevents a physician from treating more than 100 patients
at a time with this medication. This patient
cap not only makes it economically difficult
for a physician to operate an addiction-only
practice, but could also lead to the disparaging
result of turning away individuals who need
help.
Not only are physicians restricted as to the
amount of patients they see, but the current
fee schedule makes it economically unfeasible
to treat Medicaid patients’ substance abuse
issues. A large number of substance abusers
have lost their financial footing in the wake
of their addiction, thereby qualifying them
for Medicaid. The Kentucky Department
of Medicaid pays merely $21.53 for most
substance abuse treatments. Physicians literally cannot afford to see these patients, much
less provide them with other services such as
counseling and treatment plan development,
which are crucial to recovery.
Because Medicaid reimbursement is low in
this area, some physicians might consider
providing only non-Medicaid addiction
recovery services (thereby generating necessary income) in conjunction with their fulltime Medicaid practice. There is significant
risk, however, in wearing these two hats,
as Medicaid and non-Medicaid providers’
responsibilities differ in many ways.
The establishment of substance abuse treatment as an essential health benefit, paired
with the expansion of Kentucky’s Medicaid
eligibility, should benefit Kentuckians struggling with addiction, but who is going to
help the physicians? With patient caps,
unreasonably low reimbursement rates, and
the cost of compliance, physicians may soon
decide to forego providing recovery services.
Unfortunately, substance abuse coverage may
not translate to substance abuse services for
many Kentuckians.
About the Author
Anne-Tyler Morgan is an Associate of McBrayer,
McGinnis, Leslie & Kirkland, PLLC. Ms.
Morgan concentrates her practice in hea