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）：Paul Wellstone和Pete Domenici心理健康均等和2008年的成瘾资产法（MHPAEA）（MHPAEA），该法案从2010年7月开始续签计划生效，显着改变了律法和法规，管理了精神健康和药物滥用的设计和管理（MH/SA）的私人保险产品的益处（MH/SA），以销售给50名员工或更多员工或更多员工或更多员工或更多员工。 MHPAEA代表了法律的变化，因为其规定远远超出了以前的联邦和州均等立法。 MHPAEA是一项联邦法律，因此适用于免于州授权的自保计划，但与以前的联邦均等法不同，MHPAEA包括药物使用障碍，而不仅仅是MH。 MHPAEA还影响了非量化治疗限制（NQTL），影响了利用管理（例如，医疗必要性审查），除了受益的设计功能（例如成本分布要求和定量治疗限制）（例如，涵盖的访问次数）。这项具有里程碑意义的立法的含义尚不清楚，并且可能大大比早期法律的影响大。我们的研究将通过分析来自该国最大的托管行为健康组织的独特行政数据库，OptumHealth行为解决方案（OHBS）来记录MHPAEA对MHPAEA对MH/SA福利设计，管理，利用，成本和成果的影响。该研究设计将使用前，过渡和MHPAEA数据来比较计划，计划，雇主群体和期望会对立法产生不同影响的计划的研究结果的变化。根据雇主群体必须遵守MHPAEA的续签时间，将提供六个月的差异，以提供额外的比较。 AIMS 1-3是计划级别的分析，将研究MHPAEA的关联与MH/SA福利的要约率的变化，以及在继续提供此类福利的计划中，收益设计和NQTL的变化。这些目标将使用有关福利设计和OHB收集的NQTL的详细信息。 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），雇主特征（公司规模，无论是自保险）以及先前存在的国家均等法（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告知政策制定者，考虑将来对MHPAEA或州立法进行修改以补充其规定（例如，旨在防止雇主团体完全放弃承保范围的授权）；为雇主团体提供证据基础，以决定是否继续MH/SA覆盖范围以及涵盖哪些条件；并指示未来研究的有希望的途径。