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Chapter 3—Washington State's Plan

In Washington State's case, the legislature determined the covered population: all State residents were to be covered by July 1, 1999. As noted in Chapter 1, however, the legislature provided only general guidance regarding the benefit package and eligible providers. The State Division of Alcohol and Substance Abuse's Chemical Dependency Issue Investigation Group (CDIIG) undertook the task of formulating recommendations for chemical dependency treatment benefits and providers (the CDIIG's report is included as Appendix A). The CDIIG addressed four main questions:

1. What chemical dependency treatment modalities should be included in the benefit package?

The CDIIG recommended residential and outpatient treatment modalities—with various degrees of intensity and duration and chemotherapies, such as methadone treatment—for inclusion in the benefit package. The group recommended coverage for detoxification, but as part of emergency medical care rather than as part of treatment. It also recommended long-term residential care (up to 1 year). The Health Services Commission is being pressured from other quarters to exclude all long-term health care services. This pressure, which is directed principally at nursing-home care, may eventually result in exclusion of long-term substance abuse treatment as well.

2. What caps or limits ought to be placed on chemical dependency treatment benefits?

The CDIIG argued against caps or limits on the duration of total benefits, although it did consider limits on certain expensive modalities. The group concluded that case management is more effective than overall limits in controlling costs and that caps or limits may be counterproductive because they deny adequate treatment to the more severely addicted patients.

Despite the CDIIG's recommendation, it became apparent that the Health Services Commission might insist on caps anyway. The State modified its actuarial study to include an analysis of the effect of caps on rates.

3. What organizations and individuals should be eligible providers?

The CDIIG argued that the State should certify eligible providers, as it currently does for most non-medically directed programs. The most contentious issue was whether hospitals should be excluded altogether as chemical dependency treatment providers because of their high cost. The plan that CDIIG finally recommended retained hospital-based providers, assuming that case management would limit their use.

4. How much should patients be required to pay?

The CDIIG recommended that copayments for chemical dependency treatment benefits be the same as those for medical/surgical benefits.

Last Updated 11-7-02