Performance Improvement 2004. Evaluation of the Effects of the Vermont Parity Act

01/01/2004

In 1997, Vermont enacted parity legislation that requires health plans to provide coverage for the treatment of “mental health conditions” and prohibits rates, terms, or conditions that impose a greater financial burden for access to treatment for mental illness than for physical illness. Vermont’s parity law is more comprehensive than most others, and therefore, offers a unique opportunity to learn about the actual effects of a full parity mandate. Some of the questions to be addressed in this evaluation included: What mandates governed MH/SA benefits prior to parity? Were there identifiable public/private cost shifts? Has improved commercial reimbursement provided increased flexibility for use of funds from non- commercial sources (e.g., have dollars been redirected to prevention programming)? Do consumers report improved access and fewer barriers to MH/SA services as a result of the law? This study reflected experiences during the first 2 to 3 years of parity in Vermont; it is possible that a longer study period might yield different results. Further, the study was limited to a single State, and results may not be generalizable to other States in which the mix of providers or services differs. The study shows that increased use of managed care helped make parity affordable in Vermont, but may have reduced access and utilization for some services and beneficiaries. Limited knowledge of the law complicated implementation for employers, providers, and consumers. Vermont stakeholders recommended that more attention be paid to education and other proactive efforts to better prepare for a change of this magnitude.

http://www.mentalhealth.samhsa.gov/publications/allpubs/sma03-3822/default.asp

PIC ID: 7728
Agency Sponsor: SAMHSA-CMHS, Center for Mental Health Services
Federal Contact: Buck, Jeffrey, 240-276-1959
Performer: Mathematica Policy Research, Inc., Plainsboro, NJ

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