Regulatory Pathways to Promote Treatment for Substance Use Disorder or Other Under-Treated Conditions Using Risk Adjustment

46 J. L. Med. & Ethics 945 (2018)

5 Pages Posted: 11 Oct 2018 Last revised: 12 Mar 2019

See all articles by Matthew B. Lawrence

Matthew B. Lawrence

Pennsylvania State University, Penn State Law; Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics

Date Written: September 19, 2018

Abstract

This Commentary provides a legal analysis of the extent to which changes proposed by scholars to promote care for substance use disorder or other under-treated illnesses through risk adjustment could be implemented administratively, without legislation, in federal risk adjustment systems: Medicare’s privatized component, Medicare’s pharmaceutical component, and the individual and small group market. As the Commentary explains, federal laws governing risk adjustment provide broad discretion to regulators and can reasonably be interpreted to permit (or in the case of Part C even compel) full and final implementation through the administrative process of almost all of the changes that scholars have proposed.

Keywords: Health Insurance, Addiction, Mental Health, Mental Illness, Parity, Risk Adjustment, Substance Use Disorder, Law

JEL Classification: I13, K23

Suggested Citation

Lawrence, Matthew B., Regulatory Pathways to Promote Treatment for Substance Use Disorder or Other Under-Treated Conditions Using Risk Adjustment (September 19, 2018). 46 J. L. Med. & Ethics 945 (2018). Available at SSRN: https://ssrn.com/abstract=3252036 or http://dx.doi.org/10.2139/ssrn.3252036

Matthew B. Lawrence (Contact Author)

Pennsylvania State University, Penn State Law ( email )

150 South College Street
Carlisle, PA 17013
United States

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics ( email )

1875 Cambridge Street
Cambridge, MA 02138
United States

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