Insurance companies say drug treatment adequate
By Lynda Arakawa
Advertiser Capitol Bureau
Hawai'i's two largest health insurers yesterday defended their substance-abuse policies against what appears to be a growing call for extended drug-treatment benefits.
Many discussions about solving Hawai'i's ice problem include recommendations that health insurance companies be required to provide the same level of coverage for drug treatment as they do for other illnesses.
Current law mandates that private insurance companies cover two treatment "episodes" in a person's lifetime, and some critics have said that insurers need to do more.
But officials with the Hawai'i Medical Service Association and Kaiser Permanente told a legislative hearing yesterday that their policyholders get adequate and appropriate drug treatment services.
Jennifer Diesman, manager of government relations for HMSA, said none of HMSA's members has been denied necessary treatment in the past 15 months.
Diesman also said that only 167 private business members have had a second episode of substance-abuse treatment since 1998 and of that group, 12 have received treatment beyond their second lifetime maximum.
"So if we have members who need additional treatment, and they've maxed out on the benefit, we extend the benefit for them," Diesman told the Joint House-Senate Task Force on Ice and Drug Abatement.
Lawmakers invited Diesman and other insurance executives to talk about insurance "parity" — in this case, making drug-treatment benefits the same as for other illnesses — as officials and communities continue to seek ways to battle Hawai'i's ice epidemic.
Diesman said HMSA members, including those who belong to QUEST — a state managed-care program for low-income people — can receive 30 hospital days or 72 outpatient visits, including residential treatment.
She also said the number of HMSA private business members with substance-abuse claims is small — 2,047 people out of a total of about 553,000 members, or less than one-half of 1 percent.
Diesman said it is difficult to say what the impact of insurance parity would be on HMSA and its premiums, given that there is no specific proposal on the table.
But she pointed out that although HMSA voluntarily provides residential treatment for its QUEST members, QUEST contracts with health insurers do not require such treatment.
In that respect, parity would drive up costs, she said.
"If you're going to pass any kind of parity law, you need to do that in the QUEST population, and that means the state has to pay for it," she said.
Diesman and Doug Althauser, Kaiser's chemical dependency program coordinator, said lawmakers should not impose drug-treatment mandates that would take away doctors' ability to determine the best course of treatment.
Althauser said Kaiser evaluates 1,200 to 1,400 members a year for chemical dependency and refers more than 1,000 for treatment. He said that if parity is imposed on the way Kaiser provides services, it likely will mean a revenue loss of at least $100,000.
"Parity is oftentimes represented to the public as a guarantee for long treatment episodes as defined by the public," Althauser said. "It will be inappropriate for the Legislature to take away clinical judgment from a therapeutic relationship by mandating treatment plans such as requiring certain lengths of stay for certain conditions."
But others said requiring parity is essential to helping many people who abuse drugs.
Carey Brown, president of the Hawai'i Chapter of the Employee Assistance Professionals Association, said most medical plans have restricted substance-abuse benefits and can limit the number of services, the level of care and the extent of care for drug abusers.
The legislative task force yesterday also heard an expert say there is not enough evidence to suggest that drug-treatment prisons will be effective, and that such facilities may cause unintended negative consequences.
Gov. Linda Lingle's administration likely will seek construction of at least one 500-bed prison that emphasizes drug treatment. Building correctional facilities for substance-abuse treatment was a campaign issue for Lingle.
UH assistant sociology professor Katherine Irwin said to make a drug-treatment prison effective, the prison must have certain components, including that it have treatment rather than custody as its primary goal. She also said the treatment program must operate independently from other parts of the prison, so that treatment inmates are not in contact with nontreatment inmates.
Irwin said the treatment staff must be outsiders to the prison system and have equal administrative footing with other staff, and that correction and treatment staff members must receive extensive and continuous training. Treatment inmates who are released must receive "aftercare" — such as housing, job training and other support — for at least six months.
Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or at 525-8070.
