The federal parity law: Improving access to behavioral health?
In 2008, the US federal government passed the Mental Health Parity and Addiction Equity Act (MHPAEA), intended to improve patients’ access to behavioral health care and financial protection. The act is now fully implemented in private health plans, after several years of regulatory refinement. This panel will examine the extent to which MHPAEA’s goals are being met, using claims data from one insurer and responses from two national surveys. The first paper examines changes in behavioral health benefits, utilization management and provider payment prior to and following full implementation of MHPAEA, using nationally representative surveys of private health plans. Results are provided on the private plans’ use of prior authorization for outpatient behavioral health treatment, and changes in their behavioral health provider networks and provider payment arrangements due to parity. The second paper uses 2008-13 data for 3,822 “carve-in” plans from one of the largest managed behavioral health organizations in the country to document the associations of MHPAEA and subsequent regulations with benefit design changes relevant to substance use disorder (SUD) services. The paper reports on post-parity changes in cost-sharing, hospital day and outpatient visit limits and other benefits features. The third paper investigates how SUD treatment rates and financial protection have changed in association with implementation of MHPAEA. Difference-in-differences models are tested using nationally representative survey data from ten years of the National Survey on Drug Use and Health (2004-2013), to compare treatment rates among individuals with different types of insurance, or none.