Provides relative to medical necessity determinations related to substance use disorders. (8/1/20)
The enactment of SB 213 will significantly influence state healthcare laws, particularly in how insurers determine the necessity of treatments for substance use disorders. By aligning with established medical criteria, the bill seeks to enhance the consistency and reliability of treatment evaluations across various insurance providers and healthcare institutions. This could lead to improved access to necessary treatments for individuals facing substance abuse issues, potentially resulting in better health outcomes overall.
Senate Bill 213 focuses on medical necessity determinations related to substance use disorders. The legislation aims to standardize criteria for assessing the medical necessity of treatments for those suffering from substance use disorders by adopting the appropriate patient placement criteria established by the American Society of Addiction Medicine. The bill ensures that no additional criteria beyond those specified by this professional body can be used for such determinations, which could streamline the approval process for treatment plans.
The sentiment around SB 213 appears to be largely supportive, especially among healthcare providers and advocates for substance use disorder treatment. Proponents argue that the bill represents a progressive step toward addressing addiction treatment needs more effectively and uniformly. However, there may also be concerns regarding the limitations this bill places on broader interpretations of medical necessity that might be beneficial in unique cases not covered by standardized criteria.
Notable points of contention surrounding SB 213 include potential pushback from healthcare insurers and other stakeholders who may feel constrained by the stipulation to use only the established criteria from the American Society of Addiction Medicine. Additionally, discussions regarding the adequacy of these criteria in meeting the diverse needs of all patients with substance use disorders could arise, particularly regarding cases that require more individualized approaches.