Health Plans’ Early Response to Federal Parity Legislation for Mental Health and Addiction Services

Abstract

Objective In 2008 the federal Mental Health Parity and Addiction Equity Act (MHPAEA) passed, prohibiting U.S. health plans from subjecting mental health and substance use disorder (behavioral health) coverage to more restrictive limitations than those applied to general medical care. This require d some health plans to make changes in coverage and management of services. The aim of this study was to examine private health plans’ early responses to MHPAEA (after its 2010 implementation), in terms of both the intended and unintended effects. Methods Data were from a nationally representative survey of commercial health plans regarding the 2010 benefit year and the preparity 2009 benefit year (weighted N=8,431 products; 89% response rate). Results Annual limits specific to behavioral health care were virtually eliminated between 2009 and 2010. Prevalence of behavioral health coverage was unchanged, and copayments for both behavioral and general medical services increased slightly. Prior authorization requirements for specialty medical and behavioral health outpatient services continued to decline, and the proportion of products reporting strict continuing review requirements increased slightly. Contrary to expectations, plans did not make significant changes in contracting arrangements for behavioral health services, and 80% reported an increase in size of their behavioral health provider network. Conclusions The law had the intended effect of eliminating quantitative limitations that applied only to behavioral health care without unintended consequences such as eliminating behavioral health coverage. Plan decisions may also reflect other factors, including anticipation of the 2010 regulations and a continuation of trends away from requiring prior authorization.

The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?

“…Also, generalizability of findings is limited by the representativeness of the convenience sample used for this study, however the number and diversity of employers whose plan-years are studied here increase confidence about the samples’ representativeness. Finally, MHPAEA led to other benefit design changes; parity eliminated limits on the number of visits or days of inpatient care covered by the plan, reduced use of prior authorization, and expanded provider networks (Horgan et al, 2016; Goplerud, 2013; Thalmayer et al, 2016). These changes likely reduced cost-sharing for SUD treatment beyond the changes captured by this study.…”

“…One study used plan benefit data to examine the effects of MHPAEA on specialty MH financial requirements (Friedman et al, 2016). Another study surveyed plans to examine the effects of MHPAEA on measures of BH financial requirements, but did not distinguish between benefits for specialty MH and SUD (Horgan et al, 2016). A third study examined the effects of MHPAEA on use of limits for specialty MH as well as SUD care (Thalmayer et al, 2016).…”

Federal Parity and Spending for Mental Illness

“…We then identified the subset of children with mental health diagnoses who had expenditures at or exceeding the 85th percentile of the total mental health spending distribution summed over the 2 preparity years 20,21 parity provisions were only enforced for plans renewed on or after July 1, 2010, which, for most plans, was January 1, 2011. In the interim, plans had to make only a good faith effort to comply and did not yet have to implement other components of parity, such as those aspects related to NQTLs.…”

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014

“…Yet, even if insured, managed care policies often require copayments or other cost-sharing, which in the past have been higher for SUDs than for general medical care (Horgan et al 2016; Oliva et al 2011). Public and private insurers also commonly use managed care techniques, such as prior authorization or treatment limits, which may affect access to treatment services or medications.…”

“…Public and private insurers also commonly use managed care techniques, such as prior authorization or treatment limits, which may affect access to treatment services or medications. MHPAEA was designed to eliminate disparate cost-sharing and utilization management techniques, compared to general medical care, thus improving access to SUD treatment over time (Horgan et al 2016). …”