Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis.
Insurance barriers to substance use disorder treatment after passage of mental health and addiction parity laws and the affordable care act: A qualitative analysis.
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DOI：
10.1016/j.dadr.2022.100051
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发表时间：
2022-06
期刊：
影响因子：
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通讯作者：
Christenson, Erika
中科院分区：
文献类型：
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作者：
Dickson-Gomez, Julia;Weeks, Margaret;Green, Danielle;Boutouis, Sophie;Galletly, Carol;Christenson, Erika
ACA和平等法在增加获得SUD治疗方面的承诺尚未实现。医疗补助不包括三个州的所有MOUD或SUD治疗水平。医疗必要性被用作拒绝SUD治疗的标准。提供者报告说，医疗补助和其他保险的收费有很大的行政负担。历史上，在美国使用毒品（PWUDs）的人没有保险的可能性更高。《平价医疗法》、保罗·韦尔斯通和皮特·多梅尼奇健康平等和成瘾平等的通过预计将增加对物质使用障碍的治疗。到目前为止，很少有研究与物质使用障碍（SUD）治疗提供者进行定性研究，关于医疗补助和其他保险覆盖SUD治疗后，通过ACA和平价法。本文件填补了这一空白，报告数据与治疗提供者从三个州，康涅狄格州，肯塔基州，和威斯康星州，不同的ACA的实施深度访谈。每个州的研究小组对提供SUD治疗的关键知情人进行了深入的半结构化访谈，包括行为健康住宅或门诊计划的提供者，办公室丁丙诺啡提供者和阿片类药物治疗计划[OTP，即美沙酮诊所]（康涅狄格州n = 24，肯塔基州n = 63，威斯康星州n = 63）。主要的受访者被问及他们对医疗补助和私人保险如何促进或限制获得药物治疗的看法。所有的采访逐字转录和分析的关键主题使用MAXQDA软件使用协作的方法。这项研究的结果表明，ACA和平价法增加SUD治疗机会的承诺仅部分实现。三个州的医疗补助计划和私人保险在所涵盖的SUD治疗类型方面存在很大差异。肯塔基州和康涅狄格州的医疗补助计划都没有涵盖美沙酮。威斯康星州的医疗补助不包括住院或强化门诊治疗。因此，这里研究的州都没有提供ASAM推荐的治疗SUD的所有水平的护理。此外，SUD治疗有几个定量限制，如允许的尿液药物筛查或访视次数。供应商抱怨说，许多治疗需要事先授权，包括MOUD像丁丙诺啡更多的改革是必要的，使SUD治疗提供给所有谁需要它，这样的改革应考虑定义阿片类药物使用障碍的治疗标准参考循证实践，而不是试图与任意定义的医疗标准的平等.
The promise of the ACA and parity laws in increasing access to SUD treatment has not been realized. Medicaid does not cover all MOUD or SUD treatment levels in each of the three states. Medical necessity is used as a criterion to deny SUD treatment. Providers report significant administrative burden to billing medicaid and other insurance. People who use drugs (PWUDs) in the United States historically have had a higher probability of being uninsured. Passage of the Affordable Care Act, the Paul Wellstone and Pete Domenici Health Parity and Addiction Equity was expected to increase access to treatment for substance use disorder. Few studies to date have conducted qualitative research with substance use disorder (SUD) treatment providers regarding Medicaid and other insurance coverage of SUD treatment following passage of the ACA and parity laws. The present paper fills this gap by reporting data from in-depth interviews with treatment providers from three states, Connecticut, Kentucky, and Wisconsin, that differ in implementation of the ACA. Study teams in each state conducted in-depth, semi-structured interviews with key informants who provided SUD treatment, including providers of behavioral health residential or outpatient programs, office-based buprenorphine providers and opioid treatment programs [OTP, i.e. methadone clinics] (n = 24 in Connecticut, n = 63 in Kentucky and n = 63 in Wisconsin). Key informants were asked for their perceptions on how Medicaid and private insurance facilitates or limits access to drug treatment. All interviews were transcribed verbatim and analyzed for key themes using MAXQDA software using a collaborative approach. Results from this study suggest that the promise of the ACA and parity laws to increase access to SUD treatment has only partially been realized. There is wide variation among the three states’ Medicaid programs and among private insurance in the types of SUD treatment that is covered. Neither Kentucky's nor Connecticut's Medicaid covered methadone. Wisconsin Medicaid did not cover residential or intensive outpatient treatment. Thus, none of the states studied here provided all levels of care that the ASAM recommends for treating SUD. Further, there were several quantitative limits placed on SUD treatment such as number of urine drug screens or visits allowed. Providers complained that many treatments required prior authorizations, including MOUD like buprenorphine More reform is needed to make SUD treatment accessible to all who need it. Such reforms should consider defining standards for opioid use disorder treatment with reference to evidence-based practices, not be attempting parity with an arbitrarily defined medical standard.