Pension & Benefits News Mental health, substance abuse disorder parity laws pushing service use higher
Tuesday, March 12, 2019

Mental health, substance abuse disorder parity laws pushing service use higher

By Pension and Benefits Editorial Staff

Mental health and substance abuse parity requirements did not substantially increase the out-of-pocket amounts paid by enrollees per outpatient visit, according to the HHS Assistant Secretary of Planning and Evaluation (ASPE). ASPE issued its final report of a ten-year empirical study on the effects of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) (P.L. 110-343), which requires large group employer-sponsored insurers to offer mental health and substance use disorder coverage comparable to medical/surgical services. The study ultimately found that the MHPAEA has had a significant and still growing impact on the utilization of mental health and substances use disorder services without associated increases in reimbursement rates to the providers or increased out-of-pocket costs per service to the enrollees. The impact was strongest in the use of out-of-network substance use disorder services.

Parity. The study assessed the impact of the MHPAEA on the private, large group, employer-sponsored insurance market, focused on its impact on mental health (MH) and substance use disorder (SUD) services. Building on the federal Mental Health Parity Act of 1996, which removed annual and lifetime dollar limits applied to MH coverage, the MHPAEA required that large health plans and health insurers offer comparable benefits for mental health and substance use disorder services and medical/surgical services, extending parity to SUD services and providing a broader array of benefits. Large group employer-sponsored insurance plans can no longer choose to cover only some types of MH/SUD treatments if the same plan covers comparable medical/surgical treatments. Covering MH and USD services now requires comparable coverage in six treatment categories: in-network inpatient, out-of-network in-patient, in-network outpatient, out-of-network outpatient, emergency care and prescription drugs. The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) built on the MHPAEA protections by requiring mental health and substance abuse coverage as part of essential health benefits.

Assessment. The report analyzed population-level effects on any use, frequency of use, spending and reimbursement for outpatient services with expected impact on: access or use of services, total number of MH/SUD visits, overall spending on MH/SUD treatment and reimbursement paid to the provider. Using data from January 1, 2005 through September 30, 2015, the report used interrupted time series regression analysis focusing on outpatient services. Non-behavioral health services were used in lieu of a control group. The population was made up of enrollees younger than 65 years with continuous enrollment in employer-sponsored insurance plans.

The MHPAEA had significant positive effect on any use and frequency of SUD outpatient services and frequency of MH outpatient services. Average spending by insurer and enrollee were positively effected, but the average out-of-pocket amount paid per outpatient visit by the enrollee did not increase. The MHPAEA did, therefore, drive increases in spending because it increased utilization of MH and SUD outpatient services. The impact on SUD outpatient services was particularly strong and significantly higher than on MH services. This effect was not due to the opioid use disorder epidemic. The MHPAEA also resulted in a dramatic shift toward out-of-network providers for SUD outpatient services. There was no evidence that the effects of the MHPAEA are levelling off over time, with the impact, especially on SUD outpatient services continuing to grow.

SOURCE: ASPE Report, February 27, 2019.

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