Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. NOTES

02/27/2019

  1. Stuart EA, McGinty EE, Kalb L, et al. Increased service use among children with autism spectrum disorder associated with Mental Health Parity Law. Health Affairs. 2017; 36(2): 337-345.

  2. For more information on the federal rulemaking process refer to: https://www.federalregister.gov/uploads/2011/01/the_rulemaking_process.pdf.

  3. Wen H, Cummings JR, Hockenberry JM, et al. State parity laws and access to treatment for substance use disorder in the United States: Implications for federal parity legislation. JAMA Psychiatry. 2013; 70(12): 1355-1362.

  4. Barry CL, Huskamp HA, Goldman HH. A political history of Federal Mental Health and Addiction Insurance Parity. Milbank Quarterly. 2010; 88(3): 404-433.

  5. Thalmayer AG, Friedman SA, Azocar F, et al. The Mental Health Parity and Addiction Equity Act (MHPAEA) Evaluation Study: Impact on quantitative treatment limits. Psychiatric Services. 2016. doi: 10.1176/appi.ps.201600110 [epub ahead of print].

  6. Horgan CM, Hodgkin D, Stewart MT, et al. Health plans' early response to federal parity legislation for mental health and addiction services. Psychiatric Services. 2015; 67(2): 162-168.

  7. Ibid.

  8. Goplerud EN. Consistency of Large Employer and Group Health Plan Benefits With Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008. ASPE. 2013. https://aspe.hhs.gov/report/consistency-large-employer-and-group-health-plan-benefits-requirements-paul-wellstone-and-pete-domenici-mental-health-parity-and-addiction-equity-act-2008.

  9. Friedman SA, Thalmayer AG, Azocar F, et al. The Mental Health Parity and Addiction Equity Act evaluation study: Impact on mental health financial requirements among commercial "carve-in" plans. Health Services Research. 2016. doi: 10.1111/1475-6773.12614 [epub ahead of print].

  10. Goplerud EN. Consistency of Large Employer and Group Health Plan Benefits With Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008. ASPE. 2013. https://aspe.hhs.gov/report/consistency-large-employer-and-group-health-plan-benefits-requirements-paul-wellstone-and-pete-domenici-mental-health-parity-and-addiction-equity-act-2008.

  11. Horgan CM, Hodgkin D, Stewart MT, et al. Health plans' early response to federal parity legislation for mental health and addiction services. Psychiatric Services. 2015; 67(2): 162-168.

  12. Mark TL, Vandivort-Warren R, Miller K. Mental health spending by private insurance: Implications for the Mental Health Parity and Addiction Equity Act. Psychiatric Services. 2012; 63(4): 313-318.

  13. Beronio K, Glied S, Frank R. How the Affordable Care Act and Mental Health Parity and Addiction Equity Act greatly expand coverage of behavioral health care. Journal of Behavioral Health Services and Research. 2014; 41(4): 410-428.

  14. Grazier KL, Eisenberg D, Jedele JM, et al. Effects of mental health parity on high utilizers of services: Pre-post evidence from a large, self-insured employer. Psychiatric Services. 2016; 67(4): 448-451.

  15. Stuart EA, McGinty EE, Kalb L, et al. Increased service use among children with autism spectrum disorder associated with Mental Health Parity Law. Health Affairs. 2017; 36(2): 337-345.

  16. Busch AB, Yoon F, Barry CL, et al. The effects of parity on mental health and substance use disorder spending and utilization: Does diagnosis matter? American Journal of Psychiatry. 2013; 170(2): 180-187.

  17. Busch SH, Epstein AJ, Harhay MO, et al. The effects of federal parity on substance use disorder treatment running title: Federal parity. American Journal of Managed Care. 2014; 20(1): 76-82.

  18. National Center on Addiction and Substance Abuse. Guide to Implementation and Enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA) Requirements for Addiction Prevention and Treatment Benefits. 2014. https://www.centeronaddiction.org/sites/default/files/files/8_3%20Guide-to-implementing-and-enforcing-mhpaea-requirements.pdf.

  19. Knopf A. ASAM report on MAT shows egregious parity violations. Alcoholism & Drug Abuse Weekly. 2013. http://www.alcoholismdrugabuseweekly.com/m-article-detail/asam-report-on-mat-shows-egregious-parity-violations.aspx.

  20. ASAM. Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment. 2013. https://www.asam.org/docs/default-source/advocacy/aaam_implications-for-opioid-addiction-treatment_final.

  21. Maksabedian E. The effects of MHPAEA on Access of Medication-Assisted Treatment for Opioid Use Disorders. Addiction Health Services Research Conference. 2016. http://ahsr2016.org/pdf/poster_MAKSABEDIAN.pdf.

  22. Barry CL, Huskamp HA, Goldman HH. A political history of federal mental health and addiction insurance parity. Milbank Quarterly. 2010; 88(3): 404-433.

  23. McGinty EE, Busch SH, Stuart EA, et al. Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services. Health Affairs. 2015; 34(8): 1331-1339.

  24. Kyanko KA, Curry LA, Busch SH. Out-of-network provider use more likely in mental health than general health care among privately insured. Medical Care. 2013; 51(8): 699-705.

  25. Busch SH, Epstein AJ, Harhay MO, et al. The effects of federal parity on substance use disorder treatment running title: Federal parity. American Journal of Managed Care. 2014; 20(1): 76-82.

  26. Ettner SL, Harwood JM, Thalmayer A, et al. The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among "carve-out" enrollees. Journal of Health Economics. 2016; 50: 131-143.

  27. Busch SH, McGinty EE, Stuat EA, et al. Was federal parity associated with changes in out-of-network mental health care use and spending? BMC health Services Research. 2017; 17(1): 315.

  28. We did not incorporate the last quarter of 2015 because the classification system of diseases changed from ICD-9-CM to ICD-10-CM starting in October 2015.

  29. Mark TL, Vandivort-Warren R, Miller K. Mental health spending by private insurance: Implications for the Mental Health Parity and Addiction Equity Act. Psychiatric Services. 2012; 63(4): 313-338.

  30. Stuart EA, McGinty EE, Kalb L, et al. Increased service use among children with autism spectrum disorder associated with Mental Health Parity Law. Health Affairs. 2017; 36(2): 337-345.

  31. Theoretically, parity requirements for comparability could affect general medical/surgical care. But the focus of the comparability analysis starts with behavioral health services. So, for example, if a plan has no NQTLs that apply to MH/SUD, then they do not have to assess possible NQTLs on the medical/surgical side. To date we are not aware of any evidence that plans have increased FRs or QTLs on the medical/surgical side, in order to justify continuing these limits for MH/SUD treatments.

  32. Goplerud EN. Consistency of Large Employer and Group Health Plan Benefits With Requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addition Equity Act of 2008. ASPE. 2013. https://aspe.hhs.gov/report/consistency-large-employer-and-group-health-plan-benefits-requirements-paul-wellstone-and-pete-domenici-mental-health-parity-and-addiction-equity-act-2008.

  33. Mark TL, Yee T, Levit KR, et al. Insurance financing increased for mental health conditions but not for substance use disorders, 1986-2014. Health Affairs. 2016; 35(6): 958-965.

  34. Levit KR, Mark TL, Coffey RM, et al. Federal spending on behavioral health accelerated during recession as individuals lost employer insurance. Health Affairs. 2013; 32(5): 952-962.

  35. Center for Behavioral Health Statistics and Quality. Key Substance Use and Mental Health Indicators in the United States: Results From the 2015 National Survey on Drug Use and Health. HHS Publication No. SMA 16-4984, NSDUH Series H-51. 2016. http://www.samhsa.gov/data/.

  36. McGinty EE, Busch SH, Stuart EA, et al. Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services. Health Affairs. 2015; 34(8): 1331-1339.

  37. Mark TL, Vandivort-Warren R, Miller K. Mental health spending by private insurance: Implications for the Mental Health Parity and Addiction Equity Act. Psychiatric Services. 2012; 63(4): 313-318.

  38. Mark TL, Hodgkin D, Levit KR, Thomas CP. Growth in spending on and use of services for mental and substance use disorders after the Great Recession among individuals with private insurance. Psychiatric Services. 2016;67(5): 504-509.