Evaluation Topic: Federal Mental Health Parity and Addiction Equity Act (MHPAEA)
Brief Description: The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that requires insurance coverage for mental health and substance use disorders to be comparable to coverage for medical and surgical care. The evaluation will focus on assessing the effectiveness of MHPAEA in achieving its goals of reducing disparities in mental health coverage and ensuring equal access to mental health services. Implementation of federal parity appears to have been accompanied by continuing improvement in behavioral health coverage (Hodgkin et. al., 2018).
Criteria for Evaluation:
Evaluate the extent to which MHPAEA has improved access to mental health services for individuals, including the removal of barriers such as higher co-pays or stricter limitations on the number of covered visits for mental health compared to medical care. MHPAEA is associated with improved access to and utilization of behavioral health outpatient services, and subsequent increases in spending were driven primarily by overall increases in utilization. This study demonstrates the influence that broad policy changes can have on the delivery of behavioral health services at the population level (Mulvaney-Day et. al., 2019).
Assess the adequacy of mental health provider networks within insurance plans, ensuring that individuals have a sufficient number of mental health professionals to choose from, thereby promoting timely and accessible care.
Examine the impact of MHPAEA on cost-sharing requirements for mental health services, ensuring that financial barriers do not disproportionately affect individuals seeking mental health treatment. Commercially-insured populations tend to be moderate- to high-income, suggesting that modest improvements in cost-sharing would have less impact than among more socioeconomically vulnerable populations (Ettner et. al., 2016).
Analyze data to identify and address any disparities in the type and quality of mental health treatments covered compared to medical treatments, aiming for equity in coverage.
Social Determinants Impact: The effectiveness of MHPAEA is influenced by various social determinants of mental health, including socioeconomic status, race, and geographic location. Individuals from marginalized communities may still face barriers to accessing mental health services, such as limited availability of providers in certain areas or persistent stigmas surrounding mental health. Future research should evaluate effects produced by the Affordable Care Act’s inclusion of behavioral health care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets (Harwood et. al., 2017). Economic factors can also impact an individual’s ability to afford even parity-compliant mental health services.
In conclusion, while MHPAEA represents a significant step toward achieving mental health parity, the evaluation should consider ongoing challenges related to social determinants that may impede its full effectiveness. Advocacy groups and coalitions identify multiple reasons for ongoing barriers to MH/SUD treatment, including nationwide provider shortages, lack of provider acceptance of insurance, and stigmatizing attitudes. They have also pointed to a lack of sufficient compliance by insurers and enforcement by government agencies as potential causes of the underwhelming effects of MHPAEA (Presskreischer et. al., 2023). Addressing these challenges requires a comprehensive approach that considers the intersectionality of various factors influencing mental health access and outcomes. The continuous monitoring and adaptation of policies are essential to ensure that mental health services are equitable and accessible for all individuals, irrespective of their background or socioeconomic status.
References:
Ettner, S. L., M Harwood, J., Thalmayer, A., Ong, M. K., Xu, H., Bresolin, M. J., Wells, K. B., Tseng, C. H., & Azocar, F. (2016). The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral health utilization and expenditures among “carve-out” enrollees. Journal of health economics, 50, 131–143. https://doi.org/10.1016/j.jhealeco.2016.09.009Links to an external site.
Harwood, J. M., Azocar, F., Thalmayer, A., Xu, H., Ong, M. K., Tseng, C. H., Wells, K. B., Friedman, S., & Ettner, S. L. (2017). The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees. Medical care, 55(2), 164–172. https://doi.org/10.1097/MLR.0000000000000635
Hodgkin, D., Horgan, C. M., Stewart, M. T., Quinn, A. E., Creedon, T. B., Reif, S., & Garnick, D. W. (2018). Federal Parity and Access to Behavioral Health Care in Private Health Plans. Psychiatric services (Washington, D.C.), 69(4), 396–402. https://doi.org/10.1176/appi.ps.201700203Links to an external site.
Mulvaney-Day, N., Gibbons, B. J., Alikhan, S., & Karakus, M. (2019). Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. American journal of public health, 109(S3), S190–S196. https://doi.org/10.2105/AJPH.2019.305023Links to an external site.
Presskreischer, R., Barry, C. L., Lawrence, A. K., McCourt, A., Mojtabai, R., & McGinty, E. E. (2023). Factors Affecting State-Level Enforcement of the Federal Mental Health Parity and Addiction Equity Act: A Cross-Case Analysis of Four States. Journal of health politics, policy and law, 48(1), 1–34. https://doi.org/10.1215/03616878-10171062
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