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New provider coalition fights for parity

May 26, 2016
by Julie Miller, Editor in Chief
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A group of addiction treatment centers in California is launching the Addiction Treatment Advocacy Coalition (ATAC), a not-for-profit entity that aims to drive parity enforcement and improved coverage of addiction services by insurance companies. Membership will be expanded nationwide over the next 90 days.

Stampp Corbin, president of the coalition and CEO of Convalo Health, says the need for political and legislative advocacy is great because there is no one agency that exclusively governs the interface between treatment centers and insurers. To iron out details in care delivery and reimbursement structures, providers need to have the ear of state departments of insurance, departments of labor and, in the case of California, the Department of Managed Health Care. And each state is different.

“Then there is the legislative route—it’s longer,” Corbin tells Behavioral Healthcare. “That’s where you lobby Congress or your state assembly to create legislation that is beneficial to the industry in a sense that it will increase access to treatment and affordability.”

Although it’s not the preferred option, Corbin says the coalition would also consider “mass-action” lawsuits in which members could pool their resources to fight for appropriate reimbursement in court. In California, there have been cases in which an insurer has reduced out-of-network rates for residential facilities by 90%, citing a usual-and-customary rate for subacute care.

“When you talk about that kind of rate, they say they’ll pay $200 a day for a bed, when we have to have nurses, and there needs to be a certain level of care we provide,” Corbin says. “They pay for a person to go to a medically assisted facility at thousands of dollars a day, but then try to say we are subacute care and not medical, and they pay $200 a day.”

Corbin says it's obviously not reasonable to deliver care at $200 a day. New York state has set a precedent in which insurers use a transparent, independent data provider to benchmark usual-and-customary rates, according to Corbin, and he believes other states should create the same guidance without treatment centers having to lobby for it or invest in legal actions.

Coalition members do not want to take a combative stance, but rather, they want to work in conjunction with insurers to create fair reimbursement that complies with parity regulations and offers value for the patient. Educating consumers on what parity means to them will also be a priority for ATAC.

Rising need

Corbin says the coalition will address parity in a unique way. At ATAC’s first meeting, more than 100 people from 50 treatment organizations showed up to discuss the issues.

“What we are doing is very specific,” he says. “We are advocating politically and potentially legally. If this was being done already, I would not have to form this coalition. No one is paying attention to the legislation that is going on. No one is paying attention to the issues that are going on with our insurance partners.”