Lawmakers weigh 30-day treatment bill
Law would require coverage longer stays
BOSTON — Kate Donaghue was living out the all too familiar nightmare of trying to help her son kick his heroin addiction when she made an observation about the provision of detox care in Massachusetts.
"So many of the treatment decisions were not based on evidence-based practices but simply on what insurance would cover or where a bed was available," the Westborough mother told the Committee on Mental Health, Substance Use and Recovery on Monday. She said, "A significant portion of his provider's time is spent trying to get insurance approval or to find a bed."
Quincy Sen. John Keenan and Lowell Rep. Tom Golden have filed similar bills seeking to remove some of the decision-making authority from insurers, mandating they cover 30 days of acute treatment and stabilization services when deemed medically necessary by a patient's treating clinician.
Under a 2014 law, insurers in Massachusetts must provide that type of coverage for at least 14 days.
Keenan's bill has the backing of 26 senators — a majority of the 40-member body — and 63 state reps — or more than one third of the House, Keenan said.
Pittsfield's Tricia Farley-Bouvier and William "Smitty" Pignatelli representing South Berkshire are among the state lawmakers backing the House bill they say is another step in battling drug addiction.
"Going to 30 days is exactly what we need ... and a full spectrum of treatment options," Farley-Bouvier said.
"Thirty days, it should be longer," added Pignatelli. "We're going in the right direction with less influence from insurers and more say for clinicians."
The Lenox Democrat is confident the Legislature can hold off the powerful insurance lobbyists and get a bill to the governor's desk.
"I think we can beat them back," he said. "We're seeing [the opioid crisis] to be a serious issue from the Berkshires to Barnstable."
Standing in opposition to the legislation are representatives from the insurance industry and small businesses who argue the proposed mandate would "exacerbate the access issues for patients and increase costs."
"There is no clinical support for the current 14-day coverage requirement in any recognized medical journal," read a letter from chambers of commerce on the North and South shores, the Retailers Association of Massachusetts and the Massachusetts Association of Health Plans among others. "Instead, nationally accepted criteria establish that each patient is different in terms of their individualized treatment needs and the highest level of intensity is not always the best option."
Association for Behavioral Healthcare President Vic DiGravio said research shows that longer stays in addiction treatment are beneficial and noted that the decision on whether to pursue 30 days of treatment would remain with the doctor and patient under the bill.
"It is not a mandate that every patient receive 30 days of treatment," DiGravio said.
Dr. Michael Bierer, who specializes in addiction at Massachusetts General Hospital and is the president-elect of the Massachusetts chapter of the American Society of Addiction Medicine, urged caution, calling the issue "a little complicated."
"We would hate to suggest that resources should not be devoted to this disorder of substance abuse," Bierer told the committee. "But we don't think the evidence is there yet to say that 'Twenty-nine days is better than 28; 30 is better than 14.'"
Those who have been through the wringer of addiction and recovery told lawmakers that increasing mandated treatment coverage to 30 days would lead to better outcomes.
Chicopee resident Paul Hegarty said that in the early 1980s he regularly consumed an intoxicating mix of dialudid, valium and alcohol while holding down a second-shift job at a factory.
He said the factory owner allowed him to go for a 30-day treatment program. A week or so into the program, Hegarty was "a mess," he said, but after he completed it he never had to go back to detox.
"I believe that I needed that time," said Hegarty, who is in long-term recovery. Borrowing from the language of salespeople, he said, "Cheap can be very expensive."
The business groups said the effects of the relatively new 14-day mandate are being studied by the Division of Insurance and preliminary health plan data indicates that "lengths of stay are increasing, the number of new patients served by these beds is decreasing, and readmissions are increasing, meaning that patients are staying longer in these beds than they may need and are being readmitted more frequently, which limits the ability of new patients from accessing these beds."
The groups urged the committee to delay action on the legislation until the division's analysis is complete.
"Those who are opposed to this bill will tell you, 'Hey the 14 days isn't working. We've had backups in the system. So why should we continue on to cover up to 30 days?' " Keenan said. "Well what's happening is at day 14 many of those treatment providers ... are making a determination that people who are at that stage are not ready to be discharged, that they need additional treatment so they hold them longer."
Lawmakers last year mandated coverage of long-term antibiotic treatment of Lyme disease and treatment of the physical deformities caused by early drugs given to HIV patients.
Fentanyl, heroin and prescription painkillers remain a major public health challenge for state policymakers. The state confirmed the deaths of 1,465 people last year were caused by opioids and estimated the drugs were to blame in an additional roughly 500 deaths.
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