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Abstract

Objective:

The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) sought to improve access to behavioral health care by regulating health plans’ coverage and management of services. Health plans have some discretion in how to achieve compliance with MHPAEA, leaving questions about its likely effects on health plan policies. In this study, the authors’ objective was to determine how private health plans’ coverage and management of behavioral health treatment changed after the federal parity law’s full implementation.

Methods:

A nationally representative survey of commercial health plans was conducted in 60 market areas across the continental United States, achieving response rates of 89% in 2010 (weighted N=8,431) and 80% in 2014 (weighted N=6,974). Senior executives at responding plans were interviewed regarding behavioral health services in each year and (in 2014) regarding changes. Student’s t tests were used to examine changes in services covered, cost-sharing, and prior authorization requirements for both behavioral health and general medical care.

Results:

In 2014, 68% of insurance products reported having expanded behavioral health coverage since 2010. Exclusion of eating disorder coverage was eliminated between 2010 (23%) and 2014 (0%). However, more products reported excluding autism treatment in 2014 (24%) than 2010 (8%). Most plans reported no change to prior-authorization requirements between 2010 and 2014.

Conclusions:

Implementation of federal parity legislation appears to have been accompanied by continuing improvement in behavioral health coverage. The authors did not find evidence of widespread noncompliance or of unintended effects, such as dropping coverage of behavioral health care altogether.

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Information

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Go to Psychiatric Services
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Cover: Decorative Landscape, Hot Morning Sunlight, by Charles Burchfield, 1916. Transparent watercolor on white wove paper with color notations in graphite. Edward W. Root bequest, Munson-Williams-Proctor Arts Institute, Utica, NY. Photo credit: Munson-Williams-Proctor Arts Institute/Art Resource, New York City.

Psychiatric Services
Pages: 396 - 402
PubMed: 29334882

History

Received: 28 April 2017
Revision received: 10 August 2017
Revision received: 27 September 2017
Accepted: 20 October 2017
Published online: 16 January 2018
Published in print: April 01, 2018

Keywords

  1. Insurance
  2. Managed care
  3. Health care reform
  4. Substance abuse
  5. Mental health policy

Authors

Details

Dominic Hodgkin, Ph.D. [email protected]
Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Constance M. Horgan, Sc.D.
Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Maureen T. Stewart, Ph.D.
Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Amity E. Quinn, Ph.D.
Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Timothy B. Creedon, M.A.
Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Sharon Reif, Ph.D.
Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Deborah W. Garnick, Sc.D.
Except for Dr. Quinn, the authors are with the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Quinn is with the Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Notes

Send correspondence to Dr. Hodgkin (e-mail: [email protected]).
This study was presented in part at the Addiction Health Services Research annual conference, October 16, 2015, Marina del Rey, California; at the American Society of Health Economists annual conference, June 14, 2016, Philadelphia; at the Academy Health annual research meeting, June 27, 2016, Boston; at the National Institute of Mental Health Conference on Mental Health Services Research, August 2, 2016, Bethesda, Maryland; and at the annual meeting of the American Public Health Association, October 31, 2016, Denver.

Competing Interests

Dr. Reif received funding from the Association for Behavioral Health and Wellness to prepare a white paper on health plan responses to the opioid epidemic. The other authors report no financial relationships with commercial interests.

Funding Information

National Institute on Alcohol Abuse and Alcoholism10.13039/100000027: R01 AA01086
National Institute on Drug Abuse10.13039/100000026: P30 DA035772, R01 DA029316

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