Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final Report. Notes

12/31/2004

  1. Ms. Blasinsky is now at CSR, Inc.

  2. Dr. Patton is now at Westat.

  3. Dr. Barry is now at Yale University School of Medicine.

  4. While at ASPE, Dr. Hennessy initiated the evaluation and served as the initial Government Project Officer. Dr. Hennessy is now at SAMHSA.

  5. The PERT term general medical care is used in this paper to distinguish MH/SA care from other medical and surgical care.

  6. See chapter III, Data Collection for additional information on collection and analysis of FEHB plan benefit information.

  7. The chapter on parity in the FEHB Program that appeared in Mental Health, United States, 2002 reported findings from an earlier, preliminary data analysis on 161 plans continuously participating in the FEHB Program during the first three years (1999 through 2001) of the four-year evaluation period. A subset of these plans exited the FEHB Program in the final year of the evaluation, and were not included in the final analysis prepared for this report.

  8. For a number of additional plans, it was unclear whether the MH/SA cost-sharing burden was higher because these plans required a dollar copayment for general medical services and a percentage coinsurance rate for MH/SA services. These cost-sharing requirements were not directly comparable.

  9. The nine States with parity statutes that apply to substance abuse conditions are Connecticut, Delaware, Kentucky, Maryland, Minnesota, Rhode Island, Utah, Vermont, and Virginia.

  10. HMO-W2 participated in the implementation portion of the evaluation only. It was originally expected that it would also participate in the impact portion of the evaluation. However, the PERT was unable to obtain cost and utilization data for this plan that was comparable to the other selected plans.

  11. The term “managed behavioral health care organization” or MBHO refers to a specialized vendor that manages MH/SA benefits using techniques such as treatment authorization, utilization review, and financial incentives. The terms “MBHO” and “MBHO vendor” are used interchangeably in this report.

  12. This approach was modified for the Association plans that collaborate with the Association to provide Federal Employees Health Benefits (FEHB) coverage to enrollees. They were surveyed with a Parity Reporting Requirement (PRR) at only one point in time (2003). This single PRR administration captured information about changes in plan structure, policy, and procedures in response to the parity policy in 2001 and 2003. In this report, the PERT uses the term Association plans to mean those plans participating in the Association. Note, however, that some Association plans offer multiple products to FEHB enrollees and their parity implementation experience for those other products (e.g., health maintenance organizations) will be reflected in the Other FEHB Plans responses.

  13. Plans that were new to the FEHB program in 2002 were omitted from the data collection because they would be unable to report on pre-parity\ experience.

  14. FEHB health plan benefit design data are publicly available at http://www.opm.gov/insure/health/brochures/index.

  15. Due to the high levels of missing data on these variables, we analyzed only the plans’ decision to carve out, but not changes in any other management activity.

  16. Of the HMOs, OPM designated 126 as community-rated and 12 as experience-rated.

  17. In the years 1999-2001, an Association High Option plan was offered. This plan was eliminated in 2002 and replaced by an Association Basic Option plan. Neither the High Option nor the Basic Option plans were included in most analyses (with the exception of the plan exit analysis) because they were not continuously offered over the study period.

  18. In addition to the 65 fee-for-service local Association plans that comprise the Association Benefit Plan, a number of Association plans offer health insurance to federal employees as HMOs in various parts of the country through the FEHB Program. For the purpose of this analysis, these HMOs are coded as HMO non-Association plans rather than FFS Association plans.

  19. From these results it is inferred--but not known for certain--that those plans that did not change in response to the parity policy (per results of the PRR) likely already had a parity benefit in 2000, so they did not need to change their benefits and thus indicated no change on the PRR.

  20. See chapter I, Background to the Policy of Parity, for descriptive information on MH/SA benefits prior to the FEHB parity policy.

  21. Traditionally, regional community-rated and experience-rated HMO plans have not offered an out-of-network benefit option. In theory, these plans could develop an out-of-network product in response to the parity policy, however, such a trend was not observed in the data.

  22. For results from the full model, see Table III-14. Predicted probabilities in Tables III-12a and 12b correspond to regression results in Table III-14.

  23. Each participant was offered $200 for his or her participation in the two-hour focus group.

  24. In each region, between 20 and 30 providers agreed to participate in the focus groups.

  25. Selection of the nine plans is described in chapter II, Design of the Evaluation. The nine selected plans included seven of the original eight plans that were site visited plus two additional Association plans.

  26. The ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) is the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. The National Center for Health Statistics and Centers for Medicare and Medicaid Services are the Government agencies responsible for overseeing all changes and modifications to the ICD-9-CM.

  27. Note that all other charges connected to the inpatient MH/SA stay were then counted as MH/SA inpatient spending.

  28. These data were previously reported in Tables IV.B.1 through IV.B.9 as part of the before-after-parity adult MH/SA service use and conditional spending analysis.

  29. E.B. Berndt. Trends and Drivers of Expenditures on Psychotropic Drugs in the U.S. Presentation at the NIMH Workshop on Pharmacoeconomics. Data source is IMS Retail and Provider Prescription Audit.

  30. These data were previously reported in Tables IV.J.1 through IV.J.9 as part of the before-after-parity child MH/SA service use and conditional\ spending analysis.

  31. In this evaluation, the ICD-9-CM codes are the same as the Diagnostic and Statistical Manual Version IV ( DSM-IV) codes.

  32. This indicates the beginning of a new clinical episode and interrupts the current episode of service use and treatment.

  33. Due to variations in some of the plans’ claims data file structures, the analytic strategy was best suited to regional fee-for-service plans. It proved particularly difficult to analyze the HMO-NE and FFS-NAT. Thus, these two plans were excluded from the MDD quality analysis. However, we were able to apply the analysis approach to HMO-W1 so there would be at least one HMO plan in the analysis.

  34. Co-occurring psychiatric diagnoses included all ICD-9-CM diagnoses between 290 and 319 with the exception of delirium, organic brain syndromes, dementia, specific developmental delays, mental retardation, schizophrenia and bipolar disorder.

  35. As in the previous section on quality of care for major depressive disorder, variations in some of the plans’ claims data file structures made the analytic strategy best suited to the regional fee-for-service plans. Again, it proved particularly difficult to analyze the HMO-NE and FFS-NAT, as well as HMO-W1. Thus, these three plans were excluded from the SA quality analysis.

  36. Whereas in other analyses in this evaluation adults were defined as age 18 to 65 years, adults were defined slightly differently in this analysis. Here, the age range was expanded downward one year to include 17-year olds and thus obtain a larger sample.

  37. This approach was modified for the FEHB plans in a nationwide fee-for-service association (FFSA), which were surveyed with a modified PRR instrument and at only one point in time, post-parity.

  38. The nominal benefits data was collected from 141 plans reporting in 2000, 2001, and 2003.

  39. This effective benefits data was collected from 60 plans in a nationwide fee-for-service association reporting in 2000, 2001, and 2003.

  40. This effective benefits data was collected from 156 other FEHB plans.

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