Policy Information Exchange

News Feature
By Bob Curley

Nevada has become the latest state to pass a measure repealing its Uniform Policy Provision Law (UPPL), which addiction-treatment advocates say presents a major barrier to effective screening of patients for alcohol and other drug problems in hospital emergency rooms.

The bill, sponsored by Assemblywoman Sheila Leslie (D-Reno), is currently awaiting the signature of Gov. Kenny Guinn.

Leslie's bill bars insurers from denying insurance claims solely because the victim of an accident was intoxicated at the time of the injury. UPPL laws were originally enacted decades ago to cut down on alcohol-related insurance claims, but they have had the practical impact of discouraging emergency-room doctors from asking patients about their alcohol use, out of fear that they could be forfeiting insurance reimbursement for treatment. The laws also have hindered adoption of brief intervention and screening for alcohol and other drug problems in emergency room, which advocates say is highly effective in preventing future injuries and costs to the healthcare system.

Nevada's AB-63 was approved by the state Senate on May 26; the House had approved the bill in April. The measure does allow insurers to deny coverage in cases where their customers either attempt or commit a felony. However, an amendment that would have allowed insurers to exclude coverage if a patient had a blood-alcohol level over .08 percent or certain levels of illicit drugs in their system was left out of the final version of the bill. "That would have made things even worse than they were, by putting doctors in the position of being law enforcement," said Denise L. Everett, Demand Treatment coordinator in Reno, Nevada and a key backer of the UPPL-repeal effort.

Everett said most lawmakers were very receptive to arguments that repealing the UPPL was fundamentally a consumer-protection issue, and not about personal responsibility. To support her case, Everett frequently referred to the story of a woman from Washington state who broke her ankle during a dinner out with her husband and was denied insurance coverage for the injury -- an anecdote she found on the website of Ensuring Solutions.

For those hung up on the personal-responsibility issue, Everett stressed that screening in emergency rooms offered alcohol and other drug users the opportunity to get help and defeat their addictions.

Everett credited Leslie, a board member of Join Together of Northern Nevada and a longtime advocate for human and social services, for her tireless advocacy of the UPPL-repeal measure. Myron Gomez, M.D., head of the trauma department at Washoe Medical Center, was also a key witness in the legislature, relating the story of how Washoe physicians had abandoned a voluntary addiction-screening program after insurers had denied some large claims based on the UPPL law.

A 2001 amendment to the original UPPL model law drafted by the National Association of Insurance Commissioners (NAIC) -- originally developed in the late 1940s -- prohibits insurers from denying coverage to patients on the grounds of intoxicant use. Everett said the NAIC amendment was included in her information packets to lawmakers, along with position statements from Physicians and Lawyers for National Drug Policy and the American College of Surgeons. Larry Gentilello, M.D., who has led the national campaign to repeal UPPL laws, was helpful in getting residents and others to email, write, and call Nevada lawmakers in support of AB-63, Everett said.

In March, the Washington state legislature repealed its UPPL law, making it the fifth state to do so since the NAIC revised the model law; Nevada now joins Washington, Iowa, Maryland, North Carolina, and Vermont in repealing its UPPL law.

Such laws remain on the books in 36 other states, however. States currently considering repealing their UPPL laws include California (SB573), Rhode Island (H5778 and S0779), and Texas (HB949). In 2004, California Gov. Arnold Schwartenegger vetoed a UPPL reform bill passed by the legislature, saying that "coverage of services for injuries incurred due to alcohol and drug use should be available, but not mandated."

The Missouri Institute of Mental Health provides the Policy Information Exchange (PIE) as a service to the mental health community.  The Institute places documents into the PIE database that are examples of sound policy research, have high policy relevance, or have been judged to be of special interest to the mental health community. The Institute does not necessarily agree with the policy positions stated in documents in the PIE database.