INSURANCE COMPANIES SAY DRUG TREATMENT ADEQUATE

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.