Implementation of Federal Mental Health Parity

2008年10月，美国国会通过了Paul Wellstone和Pete Domenici精神健康平等和成瘾平等（MHPAE）法案。这项法律于2010年1月实施，是几十年来为实现全面联邦平等所作努力的结果。在《MHPAE法案》颁布之前，精神健康福利往往包括财务要求（即，免赔额、费用分摊）和治疗限制（即，住院天数、门诊次数），不适用于医疗/手术福利。美国国会旨在通过MHPAE法案消除保险范围的这些差异。预计将影响1.4亿美国人的保险覆盖范围。在该法案通过之前，关于均等影响的最明确证据来自对联邦雇员健康福利方案中网络内福利的全面均等的评估。这项研究发现，平等并不影响精神卫生保健的总支出，但确实降低了自付费用。一些证据表明，健康计划能够通过更严格地管理心理健康福利来控制平价后的支出。MHPAE法案和FEHBP平等指令之间存在一些关键差异，导致健康计划和雇主担心MHPAE法案的影响可能与根据联邦雇员的经验所预期的不同。我们建议研究联邦均等对以下方面的影响：1）心理健康总支出和自付心理健康支出; 2）心理健康服务使用的概率，以及心理健康治疗的数量和价格; 3）使用，支出和网络外访问的提供者的组合。对于目标1和目标2，我们将使用来自安泰健康计划的索赔数据进行差异分析，以比较根据MHPAE法案新近受到联邦平价的个人与已经受到8个州预先存在的强平价法律的个人之间的支出，利用模式和价格变化。对于目标3，我们将使用国家Marketscan数据进行中断时间序列分析，以确定OON在平价后的变化是否与现有长期趋势的预期不同。这一应用的重要性在于我们能够就这一全面的新政策举措提供新的信息。了解联邦均等对心理健康支出、利用模式和价格以及出于多种原因获得的护理的影响至关重要。首先，从2014年开始，这项政策将通过根据《平价医疗法案》（ACA）建立的州交易所扩展到个人保险。我们的研究结果可能会对实施具有里程碑意义的医疗改革法的这一规定产生影响。其次，重要的是要注意，为小企业工作的4200万人不受《MHPAE法案》和《ACA》的平等要求的约束。这项研究的结果可以提供有关将联邦均等扩大到这一人群的潜在影响的有价值的信息。

DESCRIPTION (provided by applicant): In October 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act was passed by the U.S. Congress. This law, implemented in January 2010, is the culmination of a decades-long effort to achieve comprehensive federal parity. Prior to enactment of the MHPAE Act, mental health benefits often included financial requirements (i.e., deductibles, cost sharing) and treatment limits (i.e., number of inpatient days, outpatient visits) that did not apply to medical/surgical benefits. The U.S. Congress aimed to eliminate these differences in insurance coverage with the passage of the MHPAE Act. It is expected to affect insurance coverage for 140 million Americans. Prior to its passage, the most definitive evidence on the effects of parity came from an evaluation of comprehensive parity for in-network benefits in the Federal Employees Health Benefits Program (FEHBP). This study found that parity did not affect total spending on mental health care, but did lower out-of-pocket costs. Some evidence suggests that health plans were able to control spending after parity by more stringently managing mental health benefits. There are a number of critical differences between the MHPAE Act and the FEHBP parity directive that have led health plans and employers to raise concerns that the effects of MHPAE Act might differ from what might have been expected based on the experience of federal employees. We propose to study the effects of federal parity on: 1) total mental health spending and out-of-pocket mental health spending; 2) the probability of mental health service use, and the quantity and price of mental health treatments; 3) use, spending and the mix of providers accessed out-of-network. For Aims 1 and 2, we will use claims data from Aetna health plans to conduct a difference-in-differences analysis to compare changes in spending, utilization patterns and price among individuals newly subject to federal parity under the MHPAE Act with changes among individuals already subject to pre-existing strong parity laws in 8 states. For Aim 3, we will use interrupted time series analysis using national Marketscan data to determine whether OON changes post parity differ from those expected given existing secular trends. The significance of this application lies in our ability to produce new information on this sweeping new policy initiative. It is critical to understand the effects of federal parity on mental health spending, utilization patterns and price, and care obtained OON for a number of reasons. First, beginning in 2014, this policy will be extended to those with individual insurance through state-based exchanges established under the Affordable Care Act (ACA). Our findings could be influential in informing implementation of this provision of the landmark health care reform law. Second, it is important to note that the 42 million individuals working for small businesses are exempt from the parity requirements of both the MHPAE Act and ACA. Findings from this study could provide valuable information on the potential effects of extending federal parity to this population.