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Christie aims to nix prior authorization for opioid treatment

February 2, 2017
by Joanne Sammer
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New Jersey is among the states moving ahead on new legislation in the battle against opioid addiction. Republican Governor Chris Christie made opioid addiction a key focus of his January “state of the state” address. So far, three related initiatives aim to address the crisis.

The first is broad legislation that advanced Monday, which would mandate that individuals with commercial insurance in the state be eligible for 180 days of inpatient and outpatient substance-abuse treatment. If passed, patients would not have to seek prior authorization before entering addiction treatment and instead could be referred by a physician, psychiatrist or psychologist who deems treatment to be medically necessary. Insurance companies would be able to review the necessity of inpatient treatment after 28 days.

Although demand for treatment among insured patients has been high, getting inpatient treatment approved for coverage has been difficult, Robert J. Budsock, president and CEO of Integrity House in  Newark, N.J., tells Behavioral Healthcare Executive.

“There has been a push to have less inpatient care and more outpatient treatment” among insurers, Budsock says. “There is less risk of a relapse if we can treat the individual inpatient for more than four to seven days until withdrawal symptoms to completely disappear.”

Integrity House, which has 420 licensed beds, faces intense demand for its 390 beds that are designated for low-income patients. However, it has had more difficulty filling the 30 beds available for patients with commercial insurance.

“Prior to these developments, it would be foolish to do any expansions of residential beds because the tide was actually moving the other direction,” toward reimbursement for outpatient treatment, says Budsock. “Our experience is that insurance companies will approve very few days for inpatient treatment.”

Although he hopes the mandate, if passed, will change that, Budsock notes that the mandate only covers about 30% of the privately insured population in New Jersey. He also says that there is still a significant need for access to care for indigent patients and those who do not have coverage that is subject to the governor’s mandate.

The prior authorization legislation has advanced out of committee in both the state senate and the assembly and now goes before the full legislature for a vote. If passed, Christie is expected to sign it into law.

Increase capacity

The second part of the state’s effort in the opioid crisis is a push for greater treatment capacity. Christie followed up the legislative activity by filing a certificate of need that would increase the number of behavioral health beds by 864, an increase of almost 40%. The figure represents 40 adult psychiatric beds per 100,000 adults in the state. Five percent of these beds—which would be a mix of inpatient and outpatient—would be dedicated to serving patients on Medicaid with another 5% for the uninsured.

New Jersey is among the states led by Republican governors who adopted Medicaid expansion under the Affordable Care Act.

The third move includes a proposed five-day limit on opioid prescriptions, which is an attempt to reduce the number of people who become addicted to prescription opioids. Other states, such as Massachusetts, have already enacted similar quantity limits with certain exceptions for cancer pain, for example.

 

Joanne Sammer is a freelance writer based in New Jersey.

 

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