Medication-Assisted Treatment: How Can You Avoid Discrimination?

How can you protect your Medication-Assisted Treatment (MAT) program from discrimination claims?

Under the ADA, Opioid Use Disorder (OUD) is a recognized disability. For an MAT program, this means that any entity, from an employer to a landlord or even another healthcare provider, that denies service to your patient specifically because they are on MAT may be in violation of federal law. To avoid being pulled into these claims as a “third party” or losing patients due to outside pressure, ensure your clinical notes clearly state that the patient is adhering to a supervised, legal prescription. This helps patients defend themselves against “current illegal use” allegations without legal actions.

Similarly, you can proactively provide patients with “Know Your Rights” materials. When patients understand that their MAT status is protected, they are less likely to be coerced into stopping treatment prematurely, helping them to stay on treatment to prevent relapse.

Discrimination isn’t always a flat refusal of service; sometimes it looks like an insurance company making it impossible to provide care. This is where the Mental Health Parity and Addiction Equity Act (MHPAEA) becomes your program’s best tool.

One of the most common sources of discrimination claims for MAT programs involves referrals to specialized care (like surgery or skilled nursing facilities). If a facility refuses your patient because they are on Methadone or Buprenorphine, they are often citing a “safety risk.” However, a facility cannot have a blanket policy against MAT. If they refuse a referral, ask for the “objective medical evidence” they used to determine your specific patient is a “direct threat.” You can even offer to coordinate with the receiving facility to manage dosing. Showing a high level of clinical oversight makes it much harder for other entities to justify a “safety” refusal.

Next, make sure that you are keeping confidentiality. A breach of confidentiality is often the spark that ignites a discrimination lawsuit. Because MAT is governed by 42 CFR Part 2, the privacy standards are even stricter than standard HIPAA rules. Be meticulous about what information is shared with payers. Ensure you have specific, updated consent forms that authorize the release of SUD-specific information for billing purposes. Also, try to limit the number of staff who can see a patient’s full MAT history. In a discrimination audit, “need to know” is the gold standard.

Finally, to keep your program safe, focus on these three pillars:

• Standardize Your Response: When an insurer denies a claim, don’t just appeal on medical necessity; appeal on parity. Ask: “Is this same restriction applied to a patient with a chronic physical condition?”

• Train Your Front Office: Ensure the staff answering the phones understand that MAT is legal medication. Stigmatizing language over the phone can be used as evidence of a “discriminatory culture” in a lawsuit.

• Advocate via Documentation: Write your notes intentionally and keep confidentiality. Provide the medical evidence needed to prove your patient is stable and capable of performing their daily functions.

Interested in insurance for MAT programs, or for recovery and treatment programs in general? Bitner Henry Insurance has resources for you.