Federal Parity Law Associated With Increased Probability Of Using Out-Of-Network Substance Use Disorder Treatment Services

McGinty, Emma E.; Busch, Susan H.; Stuart, Elizabeth A.; Huskamp, Haiden A.; Gibson, Teresa B.; Goldman, Howard H.; Barry, Colleen L.

doi:10.1377/hlthaff.2014.1384

Cited by 78 publications

(33 citation statements)

References 21 publications

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“…McGinty et al (McGinty et al, 2015) used 2007-2012 insurance claims data from members covered by large self-insured employers from the Truven Health MarketScan Commercial Claims and Encounters Database. Looking within a sample of people who used substance use disorder services, they used an interrupted time series design to determine that MHPAEA was associated with an increased probability of using out-of-network SUD services, with an increased average total spending on out-of-network SUD services, and with an increased average number of out-of-network outpatient SUD visits.…”

Section: Literature Reviewmentioning

confidence: 99%

“…We examine all forms of treatment (inpatient, intermediate and outpatient) and we examine all BH services instead of focusing on SUD treatment only (Busch et al, 2014; McGinty et al, 2015). We also use four years of post-MHPAEA data to account for long-term effects and account for the impact of the IFR provisions (e.g., parity in NQTLs) in addition to the original MHPAEA provisions.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Lastly, but perhaps most importantly, we analyze data for “carve-out” patients. Earlier studies either focused exclusively on carve-in patients (Busch et al, 2014) or had an unknown mix of carve-in and carve-out enrollees (McGinty et al, 2015). For two reasons, MHPAEA may have differentially affected carve-out and carve-in plans.…”

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

Ettner

Harwood

Thalmayer

et al. 2016

Journal of Health Economics

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Interrupted time series with and without controls was used to evaluate whether the federal Mental Health Parity and Addiction Equity Act (MHPAEA) and its Interim Final Rule increased the probability of specialty behavioral health treatment and levels of utilization and expenditures among patients receiving treatment. Linked insurance claims, eligibility, plan and employer data from 2008-13 were used to estimate segmented regression analyses, allowing for level and slope changes during the transition (2010) and post-MHPAEA (2011-13) periods. The sample included 1,812,541 individuals ages 27-64 (49,968,367 person-months) in 10,010 Optum “carve-out” plans. Two-part regression models with Generalized Estimating Equations were used to estimate expenditures by payer and outpatient, intermediate and inpatient service use. We found little evidence that MHPAEA increased utilization significantly, but somewhat more robust evidence that costs shifted from patients to plans. Thus the primary impact of MHPAEA among carve-out enrollees may have been a reduction in patient financial burden.

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

Ettner

Harwood

Thalmayer

et al. 2016

Journal of Health Economics

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“…15 McGinty et al found that MHPAEA was associated with increased access to, use of, and total spending on OON SUD services between 2007 and 2012, but did not consider in-network utilization or expenditures, and limited to users of SUD services, not all members. 16 Grazier et al found an association between MHPAEA and increases in outpatient mental health service use among high utilizers, but only studied data from one employer, and only considered changes between 2009 and 2010. 17 …”

Section: Introductionmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act Evaluation Study

et al. 2017

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Objective The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA’s impact on BH expenditures and utilization among “carve-in” enrollees. Method We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008–2009), during (2010), and after (2011–2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual and family psychotherapy); intermediate care utilization (structured outpatient; day treatment; residential); and inpatient utilization. Results MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits (respective immediate increases of: $1.05 [p=0.02]; $0.88 [p=0.04]; 0.00045 visits [p=0.00]), and individual psychotherapy visits (immediate increase of 0.00578 visits [p=0.00] and additional increases of 0.00017 visits/month [p=0.03]). Conclusions MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; e.g., in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act’s inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.

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“…Also, that study's main outcomes focused on SUD treatment, rather than all BH treatment. McGinty et al (2015) found that MHPAEA was associated with increased access to, use of, and total spending on out-of-network SUD services between 2007 and 2012. Although this study highlights a notable effect of MHPAEA, its focus on out-of-network care overlooks in-network care, which likely accounts for the majority of MH and SUD treatment.…”

Section: Introductionmentioning

confidence: 99%

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

Friedman

Harwood

et al. 2017

Journal of Substance Abuse Treatment

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Background: The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between behavioral health and medical health insurance benefits among the commercially insured. This study determines whether MHPAEA was associated with increased BH expenditures and utilization among a population with substance use disorder (SUD) diagnoses. Methods: Claims and eligibility data from 5,987,776 enrollees, 2008–2013, were obtained from a national, commercial, managed behavioral health organization. An interrupted time series study design with segmented regression analysis estimated time trends of per-member-per-month (PMPM) spending and use before (2008–2009), during (2010), and after (2011 — 2013) MHPAEA compliance. The study sample contained individuals with drug or alcohol use disorder diagnosis during study period (N = 2,716,473 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual, group and family psychotherapy, and structured outpatient care); intermediate care utilization (day treatment; recovery home and residential); and inpatient utilization. Results: Starting at the beginning of the post-parity period, MHPAEA was associated with increased levels of PMPM total and plan spending ($25.80 [p = 0.01]; $28.33 [p = 0.00], respectively), as well as the number of PMPM assessment/evaluation, individual psychotherapy, and group psychotherapy visits, and inpatient days (0.01 visits [p = 0.01]; 0.02 visits [p = 0.01]; 0.01 visits [p = 0.03]; 0.01 days [p = 0.01], respectively). Following these initial level changes, MHPAEA was also associated with monthly increases in PMPM total, plan, and patent out-of-pocket spending ($2.56/month [p = 0.00]; $2.25/month [p = 0.00]; $0.27 [p = 0.03], respectively), as well as structured outpatient visits and inpatient days (0.0012 visits/month [p = 0.01]; 0.0012 days/month [p = 0.00]). Conclusion: MHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization. These increases, while modest in magnitude, are larger in magnitude than increases detected among a sample of all enrollees (i.e. not only those with SUD diagnoses).

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Federal Parity Law Associated With Increased Probability Of Using Out-Of-Network Substance Use Disorder Treatment Services

Cited by 78 publications

References 21 publications

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees

The Mental Health Parity and Addiction Equity Act Evaluation Study

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

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