title: The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Mental Health Financial Requirements among Commercial "Carve-In" Plans.
abstract: Did mental health cost-sharing decrease following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA)?
  
  
  
  Specialty mental health copayments, coinsurance, and deductibles, 2008-2013, were obtained from benefits databases for "carve-in" plans from a national commercial managed behavioral health organization.
  
  
  
  Bivariate and regression-adjusted analyses compare the probability of use and (conditional) level of cost-sharing pre- and postparity. An interaction term is added to compare differential levels of pre- and postparity cost-sharing changes for plans that were and were not already at parity pre-MHPAEA.
  
  
  
  Controlling for employer/plan characteristics, MHPAEA is associated with higher intermediate care copayments ($15.9) but lower outpatient ($2.6) copayments among in-network-only plans. Among plans with in- and out-of-network benefits, MHPAEA is associated with lower inpatient ($23.2) and outpatient ($2.5) copayments, but increases in inpatient and intermediate in-network and out-of-network coinsurance (about 1 percentage point). Among the few plans not at parity pre-MHPAEA, changes in use and level of cost-sharing associated with MHPAEA were more dramatic.
  
  
  
  Mixed evidence that MHPAEA led to more generous mental health benefits may stem from the finding that many plans were already at parity pre-MHPAEA. Future policy focus in mental health may shift to slowing growth in cost-sharing for all health services.
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA.|Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Friedman
authors.affiliation: Optum, United Health Group, Minneapolis, MN.
authors.forename: Amber G
authors.initials: AG
authors.lastname: Thalmayer
authors.affiliation: Optum, United Health Group, San Francisco, CA.
authors.forename: Francisca
authors.initials: F
authors.lastname: Azocar
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Haiyong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Harwood
authors.affiliation: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA.|Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Ong
authors.affiliation: Optum, United Health Group, Minneapolis, MN.
authors.forename: Laura Lambert
authors.initials: LL
authors.lastname: Johnson
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA.|Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
mesh_terms: D003669:Deductibles and Coinsurance / Q000706:statistics & numerical data*; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000331:legislation & jurisprudence; D005102:Health Expenditures; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D007358:Insurance, Psychiatric / Q000191:economics*; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States
keywords: Mental health; commercial insurance; parity