Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Preface


The Interim Final Rules (IFR) implementing the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 went into effect on July 1, 2010. This report describes the findings from short-term studies commissioned by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the U.S. Department of Health and Human Services (HHS) and undertaken by the RAND Corporation. These studies were focused on two issues in the IFR, where HHS felt that further research would be useful in informing the implementation of the MHPAEA. The two issues are the use of “non-quantitative treatment limitations” (NQTLs) by self-insured employers, insurers, health plans and managed behavioral health organizations and the identification of a “scope of services” in behavioral health to which parity applies.

The findings reported here on NQTLs are based on interviews with managed behavioral health industry experts, deliberations of an Expert Panel convened by the HHS Substance Abuse and Mental Health Services Administration, consultations between ASPE and RAND staff, and a discussion with state regulators in Oregon, which is the only state that has adopted a statute with NQTL provisions similar to the MHPAEA.

The findings on “scope of services” reported here are based on descriptive analyses of linked plan and utilization data from the MarketScan Health Benefits Database for the year 2008. The original purpose of analyzing these data was to generate a model of annualized per member per month (PMPM) total cost so that the model could be used to assess the extent to which these costs were sensitive to alternative scenarios for coverage of three types of “intermediate” behavioral health services (i.e., intensive outpatient visits, partial hospitalization, and residential treatment). Careful scrutiny of the data, however, revealed there was insufficient variation in spending on these key services across health plans in the MarketScan database, which would be necessary in order for us to build a reliable model. However, the linked data provide insights into the provision of these intermediate services by health insurance plans prior to the implementation of the MHPAEA. The findings are helpful in considering the effect of applying a parity requirement to the scope of services that health plans cover.

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