**Disclaimer: Intended as a summary and should not be relied upon as legal advice.
“Good Samaritan Law” – Drug Overdose and 911 Immunity
- A person who is experiencing an overdose or a person who, in good faith, seeks or obtains emergency medical assistance for someone experiencing an overdose will not be charged or prosecuted for possession of a controlled substance if the heroin was found by emergency personnel during the process of medical assistance and the recovered amount of heroin is less than 3 grams. “Overdose” means a controlled substance-induced physiological event that results in a life-threatening emergency to the individual who ingested, inhaled, injected or otherwise bodily absorbed the heroin.
- However, a person can be charged if:
- Law enforcement obtained information prior to or independent of the individual seeking or obtaining emergency medical assistance and not obtained as a direct result of the action seeking or obtaining emergency medical assistance. Or
- It is an investigation, arrest, or prosecution for delivery or distribution of heroin, drug-induced homicide, or any other crime.
- A person can be charged with the Class X offense of drug-induced homicide and face a prison term of between 15-30 years at 75% if he/she delivers heroin, even without payment, to an individual and that individual dies as a result of injecting, inhaling, or ingesting that heroin.
- This is unique in that it imposes criminal responsibility for the death of an individual on anyone in the chain of delivery of heroin that was the cause of the individual’s death, even if the deceased was a willing participant in using those drugs.
“Parity Law” – Mental Health Parity & Addiction Equity Act of 2008
- Insurance groups that offer coverage for mental health and substance use disorders in their benefits packages are now required to provide the same level of benefits, treatment or services that they offer for general medical/surgical coverage. This includes equality in providing for out-of-network benefits, financial requirements such as deductibles, co-payments and out-of-pocket expenses as well as treatment limitations such as the number of office visits and days of coverage.
- While these requirements permit aggregate lifetime and annual dollar limits for mental health and substance use disorder services as long as they are equal to the restrictions for general medical/surgical coverage, the Affordable Care Act negates such restrictions by prohibiting lifetime and annual limits on the dollar amount of those mental health and substance use disorder services that are characterized as Essential Health Benefits.
- Insurers typically make decisions to cover or deny coverage for specific mental health and substance use disorder services based on whether that service is “medically necessary” for the patient. These insurers must now share the criteria that they use to make these medical necessity determinations as well as explain the reason for any denial of reimbursement or payment for services for mental health and substance use disorder benefits to the participant or beneficiary upon request.
- These requirements apply to group health plans and health insurance issuers for plan years (or, in the individual market, policy years) beginning on or after July 1, 2014. It does not apply to (1) non-federal governmental plans with 100 or fewer employees, (2) existing small private employers with 50 or fewer employees, (3) Medicare/Medicaid, (4) employer-based plans that request an exemption if they demonstrate that these requirements have increased its health care costs by 2% in the first year or by at least 1% in subsequent years that these requirements apply, and (5) self-insured non-federal government employees.