The Drug Policy Clinic, taught by Professor Ellen Weber, is working to address Maryland’s heroin and prescription drug problem by helping individuals gain access to health insurance coverage and tackling systemic barriers to drug treatment.
Medical Legal Partnerships
To identify the most pressing consumer issues, the Clinic established medical-legal partnerships (MLPs) at two Baltimore drug treatment programs – Man Alive and Institutes for Behavior Resources in August 2015.
Two student teams assisted patients with problems obtaining Medicaid or private insurance coverage and accessing health care while looking for system-wide standards that could be the source of client problems.
Both teams quickly learned that patients with Medicare coverage face significant barriers accessing drug treatment, particularly methadone maintenance treatment. The teams launched several projects to assist patients, including identifying those who were eligible for programs that reduce the cost of Medicare premiums and prescription drugs.
Student-attorneys Brenda Kathurima and James Cook also conducted training programs about Medicare coverage to help program administrators assist patients and to educate policymakers about the need to secure stable funding for the growing population of patients with Medicare coverage.
Man Alive identified a group of patients who should have been able to use their private secondary insurance policy – often a retiree policy – to cover their drug treatment, but faced administrative barriers imposed by both the Center for Medicare and Medicaid Services (CMS) and private carriers. Student-attorneys Isabel Coello and Mike Martin worked with the clients and the program’s clinical and administrative staff to document treatment and claims histories and then make the case to insurance carriers that the private policies should pay outstanding and future claims.
The team’s efforts have resulted in positive outcomes for each client. The carriers have reimbursed over $4,300 in unpaid claims, some dating back many months, and are now paying all claims without delay. The team has also developed a toolkit that will help treatment programs around the state address these reimbursement issues for their patients.
Discriminatory Reimbursement Decisions
The Clinic has also helped individuals with private insurance challenge discriminatory reimbursement decisions and advocate for better enforcement of the federal Mental Health Parity and Addiction Equity Act (Parity Act). One hospital-based treatment program discovered that a national insurance carrier had repeatedly denied reimbursement for methadone treatment services for patients with both individual and small employer plans sold on the State’s health benefit exchange, a violation of state law.
In the course of his investigation student-attorney Kris Corwin identified plan standards that impose more restrictive utilization review requirements for substance use and mental health treatment than for medical services. The Clinic reported these potential Parity Act violations to the Maryland Insurance Administration, which has launched an investigation of the carrier’s practices.
In the meantime, the carrier admitted, in response to the Clinic’s insurance appeal, that it had incorrectly denied coverage for the client’s methadone treatment. The carrier reimbursed the program $2,700 for the client’s care.
Maryland Medical Assistance Program Compliance
Beginning in September 2014, the Clinic and its partners began to work with the State’s Medicaid officials to develop a comprehensive substance use disorder benefit that complied with the Parity Act. When discussions failed to resolve outstanding benefit problems, the Clinic drafted legislation (HB 1217/SB 899), and worked with partners to advocate members of the General Assembly, which resulted in overwhelming support and passage of the bills during the 2016 legislative session. The State is required to adopt regulations that bring its Medicaid benefit into compliance with federal laws by July 1, 2017, bringing more comprehensive services for the State’s most vulnerable youth and adults.