Content by Keyword: Mental Health and Substance Abuse

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Acknowledgements

Overview and Inventory of HHS Efforts to Assist Incarcerated and Reentering Individuals and their Families . Acknowledgements

This report builds on a draft of an inventory of HHS programs for incarcerated and re-entering individuals that was designed and compiled by Diana Merelman in 2009. Her contribution to this current effort is gratefully acknowledged. Appreciation is also extended to the members of the HHS Discussion Group on Incarceration and Reentry for their help
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Overview and Inventory of HHS Efforts to Assist

Overview and Inventory of HHS Efforts to Assist Incarcerated and Reentering Individuals and their Families

Prepared by: Erica Meade and Linda Mellgren The views expressed in this report are solely those of the authors and do not necessarily reflect the views of the Office of the Assistant Secretary for Planning and Evaluation or the U.S. Department of Health and Human Services.
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Short-Term Analysis to Support Mental Health and

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

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APPENDIX 2: PLAN BENEFIT DETAIL AND CONSTRUCTION

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Appendix 2: Plan Benefit Detail and Construction of Measures

Appendix Table A1 (next page) provides a complete listing of available benefit information in the MarketScandata and the number of plans for which these data were available in 2008. The rest of this Appendix describes the construction of specific variables related to benefit design or management of care that were also examined.
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APPENDIX 1: NQTLs EXPERT PANEL MEMBERS

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Appendix 1: Nqtls Expert Panel Members

John Bartlett, M.D., M.P.H.  Senior Advisor  Primary Care Initiative Mental Health Program  The Carter Center Deni Carise, Ph.D.  Chief Clinical Officer, Phoenix House  Adjunct Clinical Professor  Department of Psychiatry  University of Pennsylvania Larry Davidson, Ph.D.  Professor of Psychology  Program for Recovery & Community H
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Summary and Discussion

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

Although this report does not provide estimates of the impact of the MHPAEA on private-sector health insurance plans, it does provide information on the extent of spending on behavioral health services by plans prior to the enactment of the MHPAEA. The MarketScandata provide several insights into how behavioral health services were provided by rel
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Implications of Limited Data for Understanding

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Implications of Limited Data for Understanding Effects on Medical Costs

Typically the best way to resolve the question of whether higher utilization of intermediate services generates higher overall total plan costs given variability in plan benefits and utilization would be to estimate a statistical model that accounts for the other factors plausibly related to total costs. We tried such an approach with these data,
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Average Spending Overall and By Service

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Average Spending Overall and By Service

The construction of annualized PMPM total health care costs is based on all payments made by the plan (or a plan subcontractor in the case of behavioral health carve-outs) for general medical care, behavioral health services, and pharmaceutical claims incurred for enrollees. We calculated PMPM annual costs by summing up all health-related costs to
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Behavioral Health Service Setting Variables

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Behavioral Health Service Setting Variables

There are a number of different indicators that can be used to identify a behavioral health claim occurring in one of the three intermediate care settings of interest, and no one indicator is consistently used by all the plans. We therefore applied rules across a multitude of indicators when we tried to identify residential treatment episodes (and
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Enrollee and Health Plan Characteristics

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Enrollee and Health Plan Characteristics

The main demographic variables we could construct from enrollee information (aggregated up to the region level) were the following: percent male, percent children (i.e., <18 years of age versus 19-65 population), and the Charlson-DeyoIndex, which is a weighted index of 17 chronic illnesses (identified through ICD-9 codes) that are likely to gen
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Variable Construction and Descriptive Statistics

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Variable Construction and Descriptive Statistics

We are interested in understanding whether parity requirements with respect to specific intermediate services could generate excessive costs to the health plan, indicated by higher average PMPM medical costs. To understand this, we need to consider and account for a variety of variables that can also influence average PMPM medical costs, includin
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MarketScan Health Benefits Database

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. MarketScan Health Benefits Database

The MarketScan database provides linked claims data on over 5 million enrollees from 52 employers and 80 different health insurance carriers. The data include individuals with private insurance from across the United States. The data, obtained directly from large employers, include comprehensive claims information (inpatient, outpatient, pharmaceu
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3. SCOPE OF SERVICES

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 par
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Summary and Discussion

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

Here we summarize and discuss the work we conducted to assist ASPE in clarifying implementation of the IFR with regard to the requirement that NQTLs be applied no more stringently for behavioral health care relative to medical care.
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Consultation with Oregon Regulators

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Consultation with Oregon Regulators

Oregon is the only state that has adopted a statute with NQTL provisions similar to the MHPAEA. 6  The Oregon Insurance Division (OID) is the office with responsibility for regulating health plans. We contacted staff at the OID and arranged for an interview about their experience in regulating NQTLs -- providing them with questions in advance.
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Network Management

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

According to the panelists, the number of different kinds of behavioral health providers with hugely different levels and types of training -- which is both more confusing and less regulated than in the general medical arena -- suggests that differential management may be permissible.
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Utilization Management

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

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Medical Necessity Determinations

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Medical Necessity Determinations

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Provider Network Management Practices

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Provider Network Management Practices

The panel discussed how behavioral health providers (in particular some types of substance abuse treatment counselors and psychotherapists) do not have consistent training or credentialing standards across subfields, and there is also considerable variation in licensing standards for these types of providers across states. This discussion sugge
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Utilization Management Practices

Short-Term Analysis to Support Mental Health and Substance Use Disorder Parity Implementation. Utilization Management Practices

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