The Effects of Federal Parity on Substance Use Disorder Treatment

Overview

Journal Am J Manag Care

Specialty Health Services

Date 2014 Feb 12

PMID 24512166

Citations 26

Authors

Susan H Busch

Andrew J Epstein

Michael O Harhay

David A Fiellin

Hyong Un

Deane Leader Jr

Colleen L Barry

Affiliations

Soon will be listed here.

Abstract

Background: In 2008, the US Congress enacted the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) requiring insurers to equalize private insurance coverage for mental health and substance use disorder services with coverage for general medical services.

Objective: To examine the effects of MHPAEA on substance use disorder treatment.

Study Design: We used a difference-in-differences design to compare changes in outcomes among plan enrollees in the years before and after implementation of federal parity (2009-2010) with changes in outcomes among a comparison group of enrollees previously covered by state substance use disorder parity laws.

Methods: Insurance claims data from Aetna Inc health plans in 10 states with state parity laws were used to compare outcomes for plan enrollees in fully insured and self-insured health plans (N = 298,339).

Results: In the first year of implementation, we found that federal parity did not lead to changes in the proportion of enrollees using substance use disorder treatment. We did find a modest increase in spending on substance use disorder treatment per enrollee ($9.99, 95% confidence interval, 2.54-18.21), but no significant change in identification, treatment initiation, or treatment engagement.

Conclusions: Inclusion of substance use disorder services in the federal parity law did not result in substantial increases in health plan spending. It will be critical to study results for year 2 after regulations affecting the management of care (eg, utilization review, network access) take effect.

Citing Articles

Factors Affecting State-Level Enforcement of the Federal Mental Health Parity and Addiction Equity Act: A Cross-Case Analysis of Four States.

Presskreischer R, Barry C, Lawrence A, McCourt A, Mojtabai R, McGinty E J Health Polit Policy Law. 2022; 48(1):1-34.

PMID: 36112956 PMC: 9938503. DOI: 10.1215/03616878-10171062.

Trends In The Use Of Treatment For Substance Use Disorders, 2010-19.

Saloner B, Li W, Bandara S, McGinty E, Barry C Health Aff (Millwood). 2022; 41(5):696-702.

PMID: 35500189 PMC: 10161241. DOI: 10.1377/hlthaff.2021.01767.

Insurance expansions and adolescent use of substance use disorder treatment.

Hamersma S, Maclean J Health Serv Res. 2020; 56(2):256-267.

PMID: 33210305 PMC: 7969204. DOI: 10.1111/1475-6773.13604.

Private health insurance coverage of drug use disorder treatment: 2005-2018.

Mojtabai R, Mauro C, Wall M, Barry C, Olfson M PLoS One. 2020; 15(10):e0240298.

PMID: 33035265 PMC: 7546457. DOI: 10.1371/journal.pone.0240298.

Implementing parity for mental health and substance use treatment in Medicaid.

Burns M, Dague L, Saloner B, Voskuil K, Kim N, Serna Borrero N Health Serv Res. 2020; 55(4):604-614.

PMID: 32578233 PMC: 7376004. DOI: 10.1111/1475-6773.13309.

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