HB 100

Abstract

The denial by private and public health benefit administrators of adequate coverage for substance abuse treatment has been identified as a major source of failed treatment efforts by persons addicted to controlled substances. These denials have also been identified as a cause of the shortage of adequate treatment facilities in Delaware. This Act seeks to ensure that persons with private and public insurance coverage have the ability to insist that they receive the substance abuse coverage to which they are entitled by law and by their insurance plans. It does so by (1) allowing the Department of Justice to provide legal assistance where appropriate to persons seeking benefits from the state’s Medicaid program, traditional health plans, or from employer-funded health benefit plans (which are exempt from state regulation), (2) requiring the state’s Medicaid program and private insurance carriers to provide notice to persons who are denied substance abuse treatment of the possibility of legal assistance in challenging those claim denials, and (3) permitting the Department of Justice to use funds in its Consumer Protection Fund to offset the cost of providing medical and legal expertise to DOJ and the Department of Insurance for the purpose of assisting persons with controlled substance addictions who are seeking treatment. This Act contains a sunset provision so that the General Assembly can assess the impact of its provisions on private and public health care costs and effective treatment of substance abuse before making its provisions permanent.