Recently many insurance companies have been auditing addiction treatment facilities. These audits can be a significant drain on facilities’ resources. They also have the potential to violate the Employee Retirement Income Security Act of 1974 (“ERISA”) and The Mental Health and Addiction Parity Act. [Read more…]
In 2016 Congress overwhelmingly voted to pass the Comprehensive Addiction and Recovery Act of 2015 (the “Act”) in response to the growing prescription painkiller and heroin epidemic faced by many communities in the United States. House Speaker Paul Ryan stated that this is one of the few areas of law where there is enough bipartisan support to pass legislation.
The Act tells the Department of Health and Human Services (HHS) to form a Pain Management Best Practices Inter-Agency Task Force, which will develop best practices for pain management and prescribing of pain medication. The Act also directs the HHS to form a Task Force on Recovery and Collateral Consequences to identify collateral consequences for individuals with controlled substance criminal records and determine whether these consequences unnecessarily inhibit persons in recovery both professionally and personally.
The Act authorizes the Attorney General to make grants to: state and local governments, law enforcement agencies, nonprofit organizations, Indian tribes, community organizations, pharmaceutical companies, pharmacies, narcotic treatment programs, hospitals, long-term care facilities, and veterans groups for several purposes, which mostly revolve around treating overdoses, addiction, and prescription drug abuse. The Act provides funding for first responder training on the administration of naloxone, a drug which can counter the effects of an opioid overdose. The Act expands funding and options for alternatives to incarceration for non-violent drug offenders, with a special focus on veterans and family-based substance abuse treatment programs.
Aside from treatment, the Act focuses on prevention by authorizing federal grant money for drug education and substance use prevention programs in high schools, colleges, and community organizations. The Act also prohibits the Department of Education from using the conviction of a controlled substance crime to disqualify applicants from receiving Federal Student Aid.
In North Cypress Medical Operating Co. v. CIGNA Healthcare 781 F.3d 182 (5th Cir. 2015) the Fifth Circuit Court of Appeals ruled against insurer Cigna, finding that out-of-network providers have the standing to sue for ERISA violations in federal court and patients have the right to receive ERISA and Preferred Provider Organizations (PPO) discounts. [Read more…]