On May 27, 2009 the Supreme Court of Pennsylvania ruled against the Insurance Federation of Pennsylvania and upheld the certification and referral to addiction treatment by licensed physicians and psychologists under Pennsylvania’s Act 106 of 1989. 

Act 106 requires all group health insurance plans to provide comprehensive treatment for alcohol and other drug addiction with access to treatment provided through certification and referral by a licensed physician or licensed psychologist.  The Supreme Court determined that the issue presented in the case was "whether the statutory mandate precludes the application of utilization review for medical necessity and appropriateness of the mandated treatment" and concluded "that managed care plans may not apply utilization review to abrogate or alter the sole statutory prerequisites to obtaining treatment for alcohol and drug abuse, i.e., certification and referral by a licensed physician or licensed psychologist.”

Download the complete decision here: PA Supreme Court Ruling May2009Act_106.pdf (PDF | 113.05 kb)