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Scientists Say Parity Law Did This to U.S. Addiction Treatment Costs

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A key federal health law seems to have pumped up U.S. spending on outpatient treatment of substance abuse without doing much to increase spending on outpatient mental health care.

A team of scientists led by Norah Mulvaney-Day has published data supporting that conclusion in an analysis of the effects of the the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

(Related: Think the Trump Administration Is Mr. Benefits Softie? Maybe Not)

A policy office at the U.S. Department of Health and Human Services (HHS) hired the team to assess the impact of the MHPAEA on outpatient care spending in the large-group insurance market.

The law does not require any plan to offer mental health or addiction treatment benefits.

If, however, a plan does offer such benefits, it must provide behavioral services coverage that’s comparable to the coverage for other types of health problems, such as heart disease, or liver disease. The plan cannot impose tighter quantitative coverage limits, such as higher deductibles. The plan also cannot impose tougher non-quantitative treatment limits, such as tougher utilization review programs.

The regulations needed to implement the MHPAEA parity requirements took effect in 2011.

(Related: New Mental Parity Rules Sweep In)

The Mulvaney-Day team found that the MHPAEA had little or no effect on the percentage of enrollees who sought outpatient mental health or addiction treatment services.

The parity law had only a small effect on the amount of services used by enrollees who sought mental health average. For those enrollee, the team says, the average number of outpatient services per month increased to about 2.8 in 2015, from about 2.1 in 2005.

The MHPAEA had a much bigger effect on use of outpatient care by people with problems with substance abuse.

For those enrollees, the average number of outpatient services per month increased to about 6.5 in 2015, from about 4.1 in 2005.

Average monthly spending per enrollee who sought addiction treatment increased to about $1,000 in 2015, from an average of about $600 from 2005 through 2011.

The increase in addiction treatment spending seemed to be due mainly to the increase in the average number of outpatient services used per affected patient, not because of an increase in use of addiction treatments, and not because of an increase in the average cost of an outpatient addiction treatment service, according to the Mulvaney-Day team.

The team notes, however, that addiction treatment spending accounts for only a small fraction of overall behavioral health spending.

“Because the effects of spending for [mental health] outpatient services were very moderate, the effects of an increase of [substance use disorder] insurer spending on overall insurer spending should not be a significant policy concern,” the team concludes.

But the team says it found that the percentage of addiction treatment services that came from out-of-network providers increased sharply during the study period.

“Future research should investigate the reasons for this shift and the implication that [substance user disorder] provider networks are inadequate,” the team says. “Patients may find it increasingly difficult to find in-network providers. Important questions include whether these patterns suggest provider shortages or use of more narrow provider networks by insurers following parity.”

Researchers should also look at what plans are paying the in-network addiction treatment providers, the Mulvaney-Day team says.

“It will be important to consider whether the rates that insurers pay are insufficient to attract providers to accept insurance,” the team says.


A copy of the report is available here.

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