title: The Mental Health Parity and Addiction Equity Act (MHPAEA) Evaluation Study: Impact on Quantitative Treatment Limits.
abstract: OBJECTIVE
  The Mental Health Parity and Addiction Equity Act (MHPAEA) significantly changed regulations governing behavioral health benefits for large, commercially insured employers. Pre-MHPAEA, many plans covered only a specific number of behavioral health treatment days or visits; post-MHPAEA, such quantitative treatment limits (QTLs) were allowed only if they were "at parity" with medical-surgical limits. This study assessed MHPAEA's effect on the prevalence of behavioral health QTLs.
  
  
  METHODS
  Analyses used 2008-2013 specialty behavioral health benefit design data for Optum large-group plans, both carve-outs (N=2,257 plan-years, corresponding to 1,527 plans and 40 employers) and carve-ins (N=11,644 plan-years, 3,569 plans, and 340 employers). Descriptive statistics were calculated for limits existing at parity implementation, distinguished by accumulation period (annual or lifetime), level of care (inpatient, intermediate, or outpatient), unit (days, visits, or courses), condition, and network level. Proportions of plans using specific limits during the preparity (2008-2009), transition (2010), and postparity (2011-2013) periods were compared with Fisher's exact tests.
  
  
  RESULTS
  Preparity, the most common QTLs were annual visit or day limits. Accounting for overlap in limit types, 89% of regular carve-out plans, 90% of in-network-only carve-outs, and 77% of carve-in plans limited outpatient visits; 66% of regular carve-out plans, 74% of in-network-only carve-outs, and 73% of carve-ins limited inpatient or intermediate days. Postparity, QTLs almost entirely disappeared (p<.001).
  
  
  CONCLUSIONS
  Before MHPAEA, QTLs were common. Postimplementation, virtually all plans dropped such limits, suggesting that MHPAEA was effective at eliminating QTLs. However, increasing access to behavioral health care will mean going beyond such QTL changes and looking at other areas of benefit management.
authors.affiliation: When this work was done, Dr. Thalmayer was with Optum, United Health Group, Eden Prairie, Minnesota, where Dr. Azocar is affiliated. Dr. Thalmayer is now with the Institute of Psychology, University of Lausanne, Lausanne, Switzerland (e-mail: ambergayle@gmail.com ). Ms. Friedman and Dr. Ettner are with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA). Ms. Harwood is with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA.
authors.forename: Amber Gayle
authors.initials: AG
authors.lastname: Thalmayer
authors.affiliation: When this work was done, Dr. Thalmayer was with Optum, United Health Group, Eden Prairie, Minnesota, where Dr. Azocar is affiliated. Dr. Thalmayer is now with the Institute of Psychology, University of Lausanne, Lausanne, Switzerland (e-mail: ambergayle@gmail.com ). Ms. Friedman and Dr. Ettner are with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA). Ms. Harwood is with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Friedman
authors.affiliation: When this work was done, Dr. Thalmayer was with Optum, United Health Group, Eden Prairie, Minnesota, where Dr. Azocar is affiliated. Dr. Thalmayer is now with the Institute of Psychology, University of Lausanne, Lausanne, Switzerland (e-mail: ambergayle@gmail.com ). Ms. Friedman and Dr. Ettner are with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA). Ms. Harwood is with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA.
authors.forename: Francisca
authors.initials: F
authors.lastname: Azocar
authors.affiliation: When this work was done, Dr. Thalmayer was with Optum, United Health Group, Eden Prairie, Minnesota, where Dr. Azocar is affiliated. Dr. Thalmayer is now with the Institute of Psychology, University of Lausanne, Lausanne, Switzerland (e-mail: ambergayle@gmail.com ). Ms. Friedman and Dr. Ettner are with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA). Ms. Harwood is with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Harwood
authors.affiliation: When this work was done, Dr. Thalmayer was with Optum, United Health Group, Eden Prairie, Minnesota, where Dr. Azocar is affiliated. Dr. Thalmayer is now with the Institute of Psychology, University of Lausanne, Lausanne, Switzerland (e-mail: ambergayle@gmail.com ). Ms. Friedman and Dr. Ettner are with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, and with the Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA). Ms. Harwood is with the Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
mesh_terms: D006264:Health Benefit Plans, Employee / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000191:economics / Q000628:therapy; D014481:United States
keywords: Behavioral health care policy; Insurance benefit design; Insurance benefit mandates; Insurance parity laws; Managed care; Mental illness & alcohol/drug abuse