Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. 3. Scope of Services


As mentioned earlier, there are “intermediate” behavioral health services -- those that lie between inpatient and outpatient care. Examples of such intermediate services are non-hospital residential treatment, partial hospitalization, and intensive outpatient treatment. However, the IFR did not specify requirements regarding application of parity to these intermediate services. RAND was initially asked to construct an actuarial model of health insurance premiums that could be used to evaluate the impact of alternative levels of inclusion of these specific intermediate behavioral health services on health care costs.

A good actuarial model requires information on health plan characteristics (such as benefits and UM techniques) and enrollee population characteristics and therefore requires linked plan-utilization data. In consultation with ASPE, we chose to use the 2008 MarketScan database available through Thomson Reuters. Using these data we set out to build an actuarial model that could be used by ASPE to understand the impact of alternative levels of inclusion of intermediate behavioral health services on average total plan costs and premiums. However, as we began constructing indicators of intermediate service care utilization, and examining them as well as costs in statistical models, it became evident that an analysis employing a single year of data was insufficient for constructing a reliable model for two reasons: (1) the statistical model estimating average per member per month (PMPM) total plan costs was very sensitive to how utilization of intermediate services, particularly residential treatment, was represented in the model due to the sparseness of these data; and (2) with only a single year of data, we could not adequately control for unobserved factors influencing general health care utilization within each health plan. Nevertheless, descriptive analyses (reported below) provide a picture of the number of health plans providing these intermediate services prior to the implementation of the MHPAEA and the level of utilization of these services within these plans -- which is helpful in considering the effect of applying a parity requirement to the scope of services that health plans cover.

View full report


"mhsud.pdf" (pdf, 669Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®