title: 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.
authors.affiliation: Emma E. McGinty (bmcginty@jhu.edu) is an assistant professor of health policy and management and of mental health at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland.
authors.forename: Emma E
authors.initials: EE
authors.lastname: McGinty
authors.affiliation: Susan H. Busch is a professor of health policy at Yale School of Public Health, in New Haven, Connecticut.
authors.forename: Susan H
authors.initials: SH
authors.lastname: Busch
authors.affiliation: Elizabeth A. Stuart is a professor of mental health, biostatistics, and health policy and management at the Johns Hopkins Bloomberg School of Public Health.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stuart
authors.affiliation: Haiden A. Huskamp is a professor of health care policy at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.affiliation: Teresa B. Gibson is a faculty research associate of health care policy at Harvard Medical School and a senior research scientist at the Arbor Research Collaborative for Health, in Ann Arbor, Michigan.
authors.forename: Teresa B
authors.initials: TB
authors.lastname: Gibson
authors.affiliation: Howard H. Goldman is a professor of psychiatry at the University of Maryland School of Medicine, in Baltimore.
authors.forename: Howard H
authors.initials: HH
authors.lastname: Goldman
authors.affiliation: Colleen L. Barry is an associate professor of health policy and management and of mental health at the Johns Hopkins Bloomberg School of Public Health.
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
mesh_terms: D006291:Health Policy; D054625:Healthcare Disparities / Q000331:legislation & jurisprudence*; D006801:Humans; D007342:Insurance Benefits / Q000331:legislation & jurisprudence*; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007348:Insurance, Health / Q000331:legislation & jurisprudence*; D008605:Mental Health Services / Q000331:legislation & jurisprudence; D017063:Outcome Assessment, Health Care; D019966:Substance-Related Disorders / Q000517:prevention & control; D014481:United States
keywords: Mental Health/Substance Abuse