Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services

Abstract

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. Unlike previous parity policies instituted for federal employees and in individual states, the law extends parity to out-of-network services. We conducted an interrupted time-series analysis using insurance claims from large self-insured employers to evaluate whether federal parity was associated with changes in out-of-network treatment for 525,620 users of substance use disorder services. Federal parity was associated with an increased probability of using out-of-network services, an increased average number of out-of-network outpatient visits, and increased average total spending on out-of-network services among users of those services. Our findings were broadly consistent with the contention of federal parity proponents that extending parity to out-of-network services would broaden access to substance use disorder care obtained outside of plan networks.

Keywords: Mental Health/Substance Abuse.

Exhibit 3. Difference In Total Out-Of-Network Inpatient Spending On Substance Use Disorder Services Per User Of The Services, With And Without Federal Parity, 2007–12

SOURCE Authors’ analysis of data for 2007–12 from the Truven Health MarketScan Commercial Claims and Encounters Database. NOTES During the study period, 49,071 people in the sample used inpatient substance use disorder services. “Expected spending” is a continuation of the trends in use and spending observed in 2007–09, which represents spending that would have happened in the absence of federal parity.

Exhibit 4. Difference In Total Out-Of-Network Outpatient Spending On Substance Use Disorder Services Per User Of The Services, With And Without Federal Parity, 2007–12

SOURCE Authors’ analysis of data for 2007–12 from the Truven Health MarketScan Commercial Claims and Encounters Database. NOTES During the study period, 516,983 people in the sample used outpatient substance use disorder services. “Expected spending” is a continuation of the trends in use and spending observed in 2007–09, which represents spending that would have happened in the absence of federal parity.