Mental health parity: a review of research and a bibliography (original) (raw)

A Test of Mental Health Parity

Journal of Behavioral Health Services & Research, 2004

The Mental Health Parity Act of 1996 had as its goal the equity of coverage of mental health care and physical health care. The purpose of this study was to examine the outcomes of hospital concurrent utilization review as a measure of the progress toward the equity goal. The study examined 4 years of denials of certification for reimbursement by payers of inpatient care (1998-2001). Psychiatry was frst compared to clinical services with a like number of annual admissions and then compared to clinical services with a like number of concurrent reviews. For each year, psychiatry had the highest numbers of cases denied and patient days denied. The most frequent reason for a psychiatric denial was that the inpatient benefit level had been exceeded. There was only one instance, in 4 years, when this reason (benefit limit exceeded) was given for a patient with a physical illness. This stud), provides evidence of the current inequity of reimbursement for treatment of mental illness. The equity of coverage of mental health care and physical health care is the goal of both federal and state mental health parity legislation. The federal Mental Health Parity Act (MHPA) of 1996, implemented in 1998, was an attempt to treat the insurance coverage of mental illness care on the same basis as the coverage of care for physical illness. The act prohibited the use of lifetime and annual limits that were different for mental and physical illnesses. 1 The MHPA does not require employers to offer mental health benefits, and small employers (less than 50 employees) are exempt from the law as are other benefit plans if the cost increase as result of parity exceeds 1% of total medical costs. The law does not require equity of deductibles, copayments, days, or visits. When the Act expired in 2001, conferees in the US House subsequently approved a l-year extension of the bill for 2002. In November 2002, H.R. 5716 was submitted to President Bush. This bill again extended the requirement that annual and lifetime dollar limits on mental health care not exceed those limits on care for other illnesses through 2003. 2 A bill to require full parity, the Paul Wellstone Mental Health Equitable Treatment Act, was introduced in the 108th Congress. 3 As of 2003, 34 states had passed some form of parity legislation. 4 At the state level, legislation varies greatly, ranging from comprehensive parity to full parity to limited parity. Comprehensive parity legislation, passed in 4 states, applies to all mental health and substance abuse disorders under

Mental health parity: National and state perspectives: A report

1997

Nationally, as well as in Florida, the current system for financing the comprehensive care for individuals with severe mental disorders is inadequate for the individual and expensive for the citizens of Florida. As a result of the various limitations and restrictions placed upon private insurance coverage, serious mental disorders not only are costly to individuals but often place undue burden upon emergency and inpatient hospital settings. Nevertheless, studies (as summarized by Keisler and Silbukin 1) have shown the use of alternative, ambulatory care to be more effective treatment. Recent attempts at modifying health care delivery in America have focused on fundamental characteristics of a system of care, emphasizing prevention, access to primary care, standardized treatment guidelines, and treatment effectiveness. In addition, health and mental health care delivery systems in the United States have increasingly become "managed" in an effort to reduce precipitous increases in health care costs, increase professional accountability, reorganize services, and redesign health benefits to meet the specific needs of specified populations. Meanwhile, mental health and substance abuse services have not been accorded equal insurance coverage compared to other physical illnesses. In addition, they have generally been poorly integrated into primary health care services delivery. Parity initiatives, at both the national and state levels, have emerged as one set of strategies to provide equal coverage for the diagnosis and treatment of mental disorders (and often including substance abuse services) visa -vis other physical (somatic) disorders. This report contains a summary of the available information on the key issues involved in parity initiatives: the experiences at the national level (see "National Parity Initiatives") as well as the experiences of other states that have developed and/or implemented parity legislation (see "State Parity Initiatives"); the cost experiences resulting in implementing parity for mental disorders (see Costs"); and implications and suggestions for proceeding with the development of mental health parity in Florida (see Evaluating Benefits from Mental Health Parity" and "Conclusions"). A comprehensive, flexible approach has many advantages for both mental health consumers and the public sector. As shown in the following report, adopting a flexible, integrated benefit for mental health care can provide delivery of appropriate mental health services to those most in need. The passage of a mental illness parity law would also benefit the state of Florida by shifting the costs of providing treatment for severe mental illness from the state (and Federal) government to the private sector, specifically to the private business sector. One estimate of the benefits to the state of Florida from a mental illness parity law can be acquired by reviewing the relevant data from Florida. In 1995 the population of the Florida was 14.16 million persons, 3.37 million persons under the age of 18 and 10.79 million adults. 2 If the standard prevalence rate is used (2.8% for adults and 3.2% for children), then 302,000 adults (2.8 percent times 10.79 million) and 108,000 (3.2 percent times 3.37 million) persons under the age of 18 currently suffer from severe mental illness, a total of 410,000 persons in Florida. It was estimated by Milliman & Robertson, Inc. that 35.7 percent of Florida's population would be affected by the proposed parity law. 3 (Certain groups are exempted from the proposed legislation, most importantly the self-insured and those covered by Medicare and Medicaid.) Applying this percentage to the number of persons in Florida with severe mental illness results in an estimate of 146,300 persons who will fall under the parity law: approximately 107,800 adults and 38,500 persons under the age of 18. Consider the following: If treatment utilization rates in Florida are roughly comparable to rates for the rest of the country, then 60 percent of these adults (64,700) and 29 percent of the persons under age 18 (11,200) are currently receiving treatment for severe mental illness (annual average). If the parity law, via its reduced price of treatment, increases the number of persons with severe mental illness who seek treatment by 120 percent, then approximately 13,000 additional adults and 2,200 additional persons under the age of 18 will seek treatment, a total of approximately 156,000 persons. If treatment efficacy rates average around 70 percent, then approximately 10,500 of these persons will show substantial improvement in their severe mental illness. An estimated annual social benefit for the state of Florida is approximately 70.5million,(usingthestandard70.5 million, (using the standard 70.5million,(usingthestandard6,700 4 as social cost per person multiplying this figure by the estimated 10,500 persons). This is a rough estimate, relying on several relationships that should be verified and refined by additional research. It is likely that it also represents a conservative estimate. In 1990, 5.2 percent of the nation's population lived in Florida. As noted above, it was estimated that in 1990 a nationwide parity law would yield 7.5billioninbenefitsasaresultofreducedsocialcosts(plusanadditional7.5 billion in benefits as a result of reduced social costs (plus an additional 7.5billioninbenefitsasaresultofreducedsocialcosts(plusanadditional1.2 billion in reduced health care costs for physical illness). If these benefits were allocated on a population basis, Florida's share of the benefits would equal 390million(plusanadditional390 million (plus an additional 390million(plusanadditional62 million in reduced health care costs), more than five times the level of benefits estimate above. Furthermore, the estimate omits several factors that should be accounted for in a more complete analysis: 1) the increased treatment utilization of those who are currently receiving treatment; 2) the improved cost effectiveness in treatment that should occur as a result of the law; 3) the reduction in costs for physical health care; and 4) the financial benefit to the state of the transfer of treatment costs to the private sector. Parity legislation for individuals with severe mental illness will bring Florida's mental health system into the mainstream of health care and help dispel the prejudice that surrounds treatment of persons with severe mental illness. It will also be necessary to more closely examine the impact of managed care managed care upon the costs associated with parity legislation as more states implement and evaluate public programs under the auspices of managed care frameworks.

Mental health parity: National and state perspectives 1999

Mental health parity legislation could substantially reduce the degree to which financial responsibility for the treatment of mental illness is shifted to government, especially state and local government. There is substantial evidence that both mental health and addictions treatment is effective in reducing the utilization and costs of medical services. There appears to be a lack of substantial evidence to discourage Florida from pursuing mental health and substance abuse parity legislation. Suggested Citation Bruce Lubotsky Levin, Ardis Hanson, and Richard Coe. "Mental Health Parity: National and State Perspectives 1999" Tampa, FL: The Louis de la Parte Florida Mental Health Institute Jan. 1999. Available at: http://works.bepress.com/ardis\_hanson/79

Mental health parity: 1998 national and state perspectives

1998

The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. To date, twenty states across the nation have enacted parity laws for mental health and/or substance abuse benefits. This report summarizes the essential issues facing the state of Florida in the development of state mental health parity legislation, including an examination of the experiences of other states, a look at potential benefits, and a discussion of the impact of managed care and insurance benefit design on the costs of parity for mental health benefits.

Mental health parity: National and state perspectives 2001: A report to the Florida Legislature

The federal Mental Health Parity Act of 1996 requires insurers to offer the same benefits for mental disorders and substance abuse as they would for physical disorders, including any annual or lifetime limitations and restrictions placed upon such coverage. This report examines actuarial studies, the current state of parity legislation across the nation, cost of treatment issues, and the impact on Florida should parity legislation be passed. Suggested Citation Bruce Lubotsky Levin, Ardis Hanson, and Richard Coe. "Mental health parity: National and state perspectives 2001: A report to the Florida Legislature" Tampa, FL: The Louis de la Parte Florida Mental Health Institute Jul. 2001. Available at: http://works.bepress.com/ardis\_hanson/77

The Effects of State Parity Laws on the Use of Mental Health Care

Medical Care, 2006

We used a quasiexperimental research design to measure the effect of state parity laws on the use of mental health care in the past year. Methods: We pooled cross-sectional data from the 2001, 2002, and 2003 National Surveys on Drug Use and Health. Our sample included 83,531 adults 18 years of age or over with private health insurance stratified by the level of mental and emotional distress experienced in the worst month of the past year. We used a state and year-fixed effects approach to measure the effect of parity. Similar to a difference-in-difference analysis, the effect of parity was measured by comparing pre-/postchanges in mental health service use within states that switched active parity status to changes in service use within states that did not change parity status in the same calendar year. For each subgroup, we report predictions of the percentage point change in any mental health care use, prescription drug use, and outpatient care use resulting from parity laws. Results: Depending on the time window used to define active parity status, we found that parity increased the probability of using any mental health care in the past year by as much as 1.2 percentage points (P Ͻ 0.01) for the lower distress group and by as much as 1.8 percentage points (P Ͻ 0.05) in the middle distress group. We found no statistically significant changes in service use for the upper distress group. Whether measured differences were attributable to changes in the use of prescription drug or outpatient care also depended on the definition of active parity status. Conclusions: Overall, the results of this study suggest that state parity laws succeeded in expanding access to mental health care for those with relatively mild mental health problems.