A FORGOTTEN DRUG AND ALCOHOL LAW

2 Legislators Offer Plans That Will Help Everyone Guaranteed Treatment To
Get It.

In 1986, Pennsylvania passed legislation that was the forerunner of what is
now known as Act 106. It was a benchmark piece of legislation, intended to
ensure that any Pennsylvanian with health insurance could receive drug and
alcohol treatment.

If you've never heard of it, there's a reason for that. Managed care
companies in Pennsylvania have done everything possible to pretend that the
law does not exist. Unfortunately, they've succeeded.

The law states that health insurers must provide these things:

Up to seven days of detoxification services per year.

A minimum 30-day residential stay in a drug and alcohol rehabilitation
facility each year.

A minimum of 30 outpatient visits a year.

The law also provides that if a patient's doctor - rather than a
managed-care company employee sitting in a cubicle far, far away - says
that any of the above treatment is needed, the insurance company is to
provide it.

For the first five years the law was in effect, insurance companies
complied with it. Alcoholics and addicts desperately in need of detox and
long-term rehab got the care they needed. That began changing in the early
'90s, as managed care companies began creating a dizzying labyrinth of
restrictions on detoxification and inpatient rehabilitation services. The
net effect was that Act 106 was gutted to the point of meaninglessness.

One common way Act 106 is flouted is by the insistence that patients must
fail at a lower level of care - such as outpatient treatment - before being
considered for inpatient treatment. This failure requirement is nowhere in
the statute.

Another method is to treat the mandate to provide 30 days of inpatient
treatment a year by parceling it out - not, say, in a continuous 28-day
stay, but in smaller blocks of six days or less per stay. This effectively
renders treatment worthless. It is a perversion of the recovery concept of
"one day at a time" to have inpatient stays doled out practically one day
at a time.

Arbitrarily refusing to treat addictions for certain kinds of drugs, such
as OxyContin, which has swept the country, particularly Philadelphia and
its suburbs, is another tactic. Yet another is to refuse to put people into
detox despite extraordinary high alcohol levels because they haven't
started going into withdrawal yet.

Failing to treat addicts and alcoholics will not result in any societal
savings; someone will have to deal with the wrecked bodies and lives.
Perhaps it will be the prisons. Perhaps it will even be the insurance
companies themselves, paying - and ultimately passing along - the higher
premiums for medical problems caused by delays.

That's what happened to a graduate of a Philadelphia-area law school who
was a partner in a city law firm. Her cries for help went unheeded by a
managed care firm, and she was unable to receive more than a few days'
treatment at a time. Her liver eventually deteriorated and she needed a
transplant. That, and the antirejection drugs she'll need forever, the
insurance company paid for.

It is not as though insurance companies are helpless to control costs. They
can still set premiums for group plans. They can still select the addiction
treatment provider. They can still set rates for treatment program
reimbursements. They can still set annual and lifetime caps on benefits.
All this is possible under the existing law.

On Sept. 18, the state House of Representatives Health and Human Services
Committee held hearings on a series of bills designed to ensure that the
mandates of Act 106 do not go unheeded. One bill, introduced by Rep.
Beverly Mackereth (R., York), would require addiction treatment services to
be reported to the legislature each year by health care providers. Another,
by Rep. George Kenney (R., Phila.) would require insurers to pay for
treatment when ordered to by employee assistance professionals.

Whatever eventually comes out of committee, it is clear that without
continued involvement by numerous branches of government, Act 106 and the
people who need it most will continue to be ignored.

It is time to stop retreating on drug and alcohol treatment. Government
must lead the charge.