Psychiatric Services has published a study examining the impact of the 2001 implementation of substance abuse parity in the Federal Employee Health Benefit Program (FEHBP). Examining health plan spending and treatment utilization, the study reviewed data from six FEHBP health plans between 1999 and 2002. Comparing FEHBP plans with similar plans not offering substance abuse treatment at parity, the authors found that parity did not significantly impact substance abuse treatment utilization. However, the study found that individuals receiving substance abuse treatment in plans with parity incurred an average of $101.09 less in out-of-pocket expenses than did similar individuals in non-parity plans. The authors conclude that parity successfully lowered individuals’ costs without increasing plan costs.

Azzone, V., et. al. (2011). Effect of insurance parity on substance abuse treatment. Psychiatric Services,  62:129-134. doi: 10.1176/appi.ps.62.2.129. http://psychservices.psychiatryonline.org/cgi/content/abstract/62/2/129 

Authors: Azzone, V., Frank, R., Normand, S. T., and Burnam, A.

On September 6, the Los Angeles Times published an article examining the impact of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) on health insurance plans.  The article outlines the law’s requirements and projects the impact they will have on beneficiaries’ out-of-pocket (OOP) costs, suggesting that the MHPAEA will likely reduce the OOP costs of those who use MH/SUD services and increase OOP costs for those who do not use them.

From the article:

The Mental Health Parity and Addiction Equity Act of 2008, by some estimates, could affect the health coverage of approximately 113 million Americans. Exactly how it will affect them, though, will vary widely.

The purpose of the law, which went into effect in July, is to create equal coverage between medical/surgical services and mental healthcare services. The legislation requires group insurance plans to offer the same deductibles, copayments, frequency of treatments and days of outpatient services.

Full Article: Mental health parity act may affect your medical benefits 

Los Angeles Times. (2010).  Mental health parity act may affect your medical benefits. Worth, T.

In conjunction with the Health Research & Educational Trust (HRET), KFF released the 2010 Employer Health Benefits Survey, finding that employers are increasingly shifting health costs to their employees.  The survey found that employees’ share of family health coverage increased 14 percent since 2009, while total premiums rose only 3 percent over the same period.   KFF noted that worker contributions for health insurance premiums rose 47 percent since 2005 while premiums and wages rose 27 percent and 18 percent respectively over the same period.  In addition, the survey found that 31 percent of firms with more than 50 employees made changes to their behavioral health benefits in response to the Mental Health Parity and Addiction Equity Act (MHPAEA).  Most eliminated coverage limits to comply with the law.  In addition, 5 percent of those that changed their behavioral health benefits elected to eliminate the benefits completely.

From the report: Employers play a significant role in health insurance coverage – sponsoring health benefits for about 157 million nonelderly people in America1 – so their opinions and experiences are important factors in health policy discussions. Employers were asked how they view different approaches to containing cost increases and about employer health plan practices, such as changes in response to the Mental Health Parity and Addiction Equity Act, review of quality indicators, and whether they shopped for (or switched to) a new health plan.

Full report: 2010 Employer Health Benefits Survey (PDF | 9.138MB)

Kaiser Family Foundation.  (2010).  2010 employee health benefits survey.

Biometrics published a study examining the impact of MH/SUD parity in federal employee beneifts on spending and utilization.  The authors found that parity did not dramatically increase spending or service utilization, but suggest that some groups of beneficiaries may benefit more from parity than others.

Neelon, B., et. al.  (2010).  A bayesian two-part latent class model for longitudinal medical expenditure data: assessing the impact of mental health and substance abuse parity.  Biometrics.  

Authors: B. Neelon, A. J. O'Malley, et. al. 

This National Association of State Alcohol and Drug Abuse Directors (NASADAD) report examines state-level health care reform efforts in Maine, Massachusetts, and Vermont and their effects on substance abuse treatment and prevention.  Though all three states passed mandates and parity for substance abuse services within private insurance plans, NASADAD found that the Single State Agency (SSA) continued to play a prominent role in substance abuse treatment and prevention both during and after health care reform.  The SSAs played a valuable implementation role, including acting as liaisons with the criminal justice and welfare systems.  Furthermore, NASADAD notes the continued importance of SAMHSA's Substance Abuse Prevention and Treatment (SAPT) Block Grant during and after health care reform.  The report notes that all three states experienced increased numbers of uninsured clients seeking services after reform and further notes that reform does not fund recovery support services traditionally delivered by SAT providers.  Finally, NASADAD notes that even under reform, the SAPT Block Grant remained the primary funder of prevention services in all three states. The authors conclude that there is a vital role for the SSA and the SAPT Block Grant both during and after health care reform. 

Full report: http://www.nasadad.org/resource.php?base_id=2104 

National Association of State Alcohol and Drug Abuse Directors. (2010). The effects of health care reform on access to, and funding of, substance abuse services in Maine, Massachusetts, and Vermont.

On May 19, Milliman Inc. released a brief examining the regulatory process establishing the Mental Health Parity and Addiction Equity Act of 2008.  The brief explains the U.S. Treasury Department's interim final rule (IFR) requiring group health plans to have no more restrictions on mental health and substance abuse disorders than they do on medical/surgical benefits.  The author outlines how the IFR will affect the business of behavioral health.

From the report: In the absence of formal guidance until the publication of the IFR and with the MHPAEA requiring compliance for plan years starting on or after October 3, 2009, many group health plans have been operating under a good-faith compliance standard.  The IFR from the federal agencies provides significant guidance in some areas, and several of the requirements will necessitate additional steps to ensure compliance.  The IFR, published in February 2010, generall applies to plan years beginning on or after July 1, 2010 (with a delayed effective date available for collectively bargained plans).  Understanding how the IFR may affect the business of behavioral healthcare and the decisions that follow will be of great importance to all interested parties, including health insurance companies, health plans, employers, providers, and consumers of behavioral healthcare.

Full report: Implementing Parity: Investing in Behavioral Health (PDF | 94.95 KB) 

Milliman Inc.  (2010).  Implementing parity: investing in behavioral health.  Melek, S.