Performance Improvement 2013-2014. How Can Services for Mental Health and Substance Use Disorders Be Made Comparable to Other Health Services?

01/01/2014

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) requires that if mental health and substance use disorder (MH/SUD) insurance benefits are provided, any limitations on those benefits must generally be comparable to limits on benefits for medical and surgical care. Coverage of MH/SUD services has often been more limited than most other health services. This project performed research and collected information used in developing the regulations that implemented the 2008 Act. An expert panel studied how the broad array of health care management policies and practices designed to contain costs of health care known as “non-quantitative treatment limitations” could be made comparable. These include, for example, medical necessity definitions and utilization management practices.

The study estimated the extent to which relatively generous employer covered MH/SUD services in 2008 included intermediate level services, including partial hospitalization, residential treatment, and intensive outpatient services. Behavioral health services accounted for $12, or 4.6 percent of total per member per month (PMPM) costs. The vast majority of the cost for behavioral health was for behavioral health prescriptions ($7.46). Services for non-hospital residential treatment, partial hospitalization, and intensive outpatient treatment represented a very small fraction of the average total plan cost in 2008 ($2.40 per member per month costs or 0.9 percent).

Report Title: Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation, http://aspe.hhs.gov/daltcp/reports/2012/mhsud.shtml
Agency Sponsor: OASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: John Drabek, 202-690-6443
Performer: Rand Corporation
Record ID: 10059 (February 8, 2012)

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