Citation

Thalmayer AG, Friedman SA, Azocar F, Harwood JM, Ettner SL. Psychiatr. Serv. 2016; 68(5): 435-442.

Affiliation

When this work was done, Dr. Thalmayer was with Optum, United Health Group, Eden Prairie, Minnesota, where Dr. Azocar is affiliated. Dr. Thalmayer is now with the Institute of Psychology, University of Lausanne, Lausanne, Switzerland (e-mail: ambergayle@gmail.com ). Ms. Friedman and Dr. Ettner are with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA). Ms. Harwood is with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA.

Copyright

(Copyright © 2016, American Psychiatric Association)

DOI

10.1176/appi.ps.201600110

PMID

27974003

Abstract

OBJECTIVE: The Mental Health Parity and Addiction Equity Act (MHPAEA) significantly changed regulations governing behavioral health benefits for large, commercially insured employers. Pre-MHPAEA, many plans covered only a specific number of behavioral health treatment days or visits; post-MHPAEA, such quantitative treatment limits (QTLs) were allowed only if they were "at parity" with medical-surgical limits. This study assessed MHPAEA's effect on the prevalence of behavioral health QTLs.

METHODS: Analyses used 2008-2013 specialty behavioral health benefit design data for Optum large-group plans, both carve-outs (N=2,257 plan-years, corresponding to 1,527 plans and 40 employers) and carve-ins (N=11,644 plan-years, 3,569 plans, and 340 employers). Descriptive statistics were calculated for limits existing at parity implementation, distinguished by accumulation period (annual or lifetime), level of care (inpatient, intermediate, or outpatient), unit (days, visits, or courses), condition, and network level. Proportions of plans using specific limits during the preparity (2008-2009), transition (2010), and postparity (2011-2013) periods were compared with Fisher's exact tests.

RESULTS: Preparity, the most common QTLs were annual visit or day limits. Accounting for overlap in limit types, 89% of regular carve-out plans, 90% of in-network-only carve-outs, and 77% of carve-in plans limited outpatient visits; 66% of regular carve-out plans, 74% of in-network-only carve-outs, and 73% of carve-ins limited inpatient or intermediate days. Postparity, QTLs almost entirely disappeared (p<.001).

CONCLUSIONS: Before MHPAEA, QTLs were common. Postimplementation, virtually all plans dropped such limits, suggesting that MHPAEA was effective at eliminating QTLs. However, increasing access to behavioral health care will mean going beyond such QTL changes and looking at other areas of benefit management.

Language: en