Parity and Addiction Act: Impact on Benefits, Use and Costs

《平等与成瘾法案》：对福利、使用和成本的影响

• 批准号: 8783070
• 负责人: SUSAN Louise ETTNER
• 金额: $ 12.32万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-15 至 2016-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8783070
• 关键词: Address; Affect; Alaska; Alcohol abuse; Alcohols; Amendment; Behavioral; Caring; Characteristics; Collaborations; Congresses; Contracts; Cost Sharing; Country; Data; Diagnosis; Disease; Drops; Drug abuse; Drug usage; Economics; Eligibility Determination; Employee; Evaluation; Expenditure; Future; Gender; Hawaii; Health Planning; Health Services Accessibility; Healthcare; Insurance; Insurance Coverage; Laws; Lead; Link; Marketing; Medical; Mental Health; Mental Health Associations; Mental disorders; Modification; Operative Surgical Procedures; Outcome; Outcome Study; Patients; Pharmaceutical Preparations; Psychotropic Drugs; Public Sector; Regulation; Research; Research Design; Research Personnel; Sea; Services; Shapes; Solutions; Statutes and Laws; Substance Use Disorder; Substance abuse problem; Testing; Time; Treatment Cost; United States Virgin Islands; Variant; Visit; addiction; administrative database; age group; base; behavioral health; comparison group; cost; design; evidence base; experience; health organization; improved; interest; multidisciplinary; parity; patient population; prevent; prevention service; substance abuse treatment

DESCRIPTION (provided by applicant): The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which took effect for plans renewing from July 2010 on, significantly changed the law and regulations governing the design and management of mental health and substance abuse (MH/SA) benefits for private insurance products sold to employers with 50 or more employees. MHPAEA represents a sea change in the law, as its provisions go well beyond prior federal and state parity legislation. MHPAEA is a federal law, so it applies to self-insured plans that are exempt from state mandates, but unlike the previous federal parity law, MHPAEA includes substance use disorders, not just MH. MHPAEA also affects non-quantitative treatment limits (NQTLs) affecting utilization management (e.g., medical necessity review) in addition to benefit design features such as cost-sharing requirements and quantitative treatment limits (e.g., number of visits covered). The implications of this landmark piece of legislation are not yet known and are likely to be substantially greater than the effects of earlier laws. Our study would document the impact of the MHPAEA on MH/SA benefit design, management, utilization, costs and outcomes by analyzing unique administrative databases from the largest managed behavioral health organization in the country, OptumHealth Behavioral Solutions (OHBS). The study design will use pre-, transition and post-MHPAEA data to compare changes in study outcomes over time among plans, employer groups and patients expected to experience differential impact of the legislation. An additional comparison will be provided by a six-month difference in the timing of when employer groups had to comply with MHPAEA, based on their renewal periods. Aims 1-3, which are plan-level analyses, will examine the association of MHPAEA with changes in offer rates for MH/SA benefits, as well as changes in benefit designs and NQTLs among plans that continue to offer such benefits. These Aims will use detailed information on benefit design and NQTLs collected by OHBS on each health plan one year before and the first two years after parity. Aims 4-5, which are patient-level analyses, will examine the association of MHPAEA with changes in access, utilization and cost of MH/SA services and psychotropic drugs, using linked insurance claims and eligibility data from 2008 to 2013. All five Aims will examine how the changes in these endpoints vary by type of disorder (MH vs. SA), plan characteristics (e.g., small vs. large-group market, carve- in vs. carve-out), employer characteristics (firm size, whether self-insured), and pre-existing state parity laws (strong, weak or none). Aims 4 and 5 will also include patient characteristics. Findings from our evaluation will help to inform policymakers considering future modification to the MHPAEA or state legislation to supplement its provisions (e.g., mandates aimed at preventing employer groups from dropping coverage altogether); provide an evidence base for employer groups deciding whether to continue MH/SA coverage and which conditions to cover; and indicate promising avenues for future research.

描述（由申请人提供）：《2008 年保罗·威尔斯通 (Paul Wellstone) 和皮特·多梅尼奇 (Pete Domenici) 精神健康平等和成瘾公平法案 (MHPAEA)》自 2010 年 7 月起对计划更新生效，显着改变了管理心理健康设计和管理的法律和法规。向拥有 50 名或以上员工的雇主出售的私人保险产品的健康和​​药物滥用 (MH/SA) 福利。 MHPAEA 代表了法律的巨大变化，因为其规定远远超出了之前的联邦和州平等立法。 MHPAEA 是一部联邦法律，因此它适用于不受州强制规定约束的自我保险计划，但与之前的联邦平价法不同，MHPAEA 包括物质使用障碍，而不仅仅是 MH。除了费用分摊要求和定量治疗限制（例如涵盖的就诊次数）等福利设计特征之外，MHPAEA 还影响影响利用管理（例如医疗必要性审查）的非定量治疗限制（NQTL）。这项具有里程碑意义的立法的影响尚不清楚，但可能比早期法律的影响要大得多。我们的研究将通过分析来自该国最大的行为健康管理组织 OptumHealth 行为解决方案 (OHBS) 的独特管理数据库，记录 MHPAEA 对 MH/SA 福利设计、管理、利用、成本和结果的影响。研究设计将使用 MHPAEA 之前、过渡和之后的数据来比较预计将受到立法不同影响的计划、雇主团体和患者之间研究结果随时间的变化。根据雇主团体的续签期限，雇主团体必须遵守 MHPAEA 的时间有六个月的差异，将提供额外的比较。目标 1-3 是计划层面的分析，将检查 MHPAEA 与 MH/SA 福利提供率变化的关联，以及继续提供此类福利的计划中福利设计和 NQTL 的变化。这些目标将使用 OHBS 在均等前一年和后前两年收集的每个健康计划的福利设计和 NQTL 的详细信息。目标 4-5 是患者层面的分析，将使用 2008 年至 2013 年相关的保险索赔和资格数据，检查 MHPAEA 与 MH/SA 服务和精神药物的获取、利用和成本变化之间的关系。所有五个目标将检查这些终点的变化如何随疾病类型（MH 与 SA）、计划特征（例如，小市场与大群体市场、分割市场与大群体市场）而变化。剥离）、雇主特征（公司规模，是否有自我保险）以及预先存在的州平等法律（强、弱或无）。目标 4 和 5 还将包括患者特征。我们的评估结果将有助于决策者考虑未来修改 MHPAEA 或州立法以补充其条款（例如，旨在防止雇主团体完全放弃保险的规定）；为雇主团体决定是否继续 MH/SA 承保以及承保哪些条件提供证据基础；并指出未来研究的有希望的途径。