Dataset Information

Carve-out plan financial requirements associated with national behavioral health parity.

ABSTRACT:

Objectives

To examine changes in carve-out financial requirements (copayments, coinsurance, use of deductibles, and out-of-pocket maxima) following the Mental Health Parity and Addiction Equity Act (MHPAEA).

Data source/study setting

Specialty mental health benefit design information for employer-sponsored carve-out plans from a national managed behavioral health organization's claims processing engine (2008-2013).

Study design

This pre-post study reports linear and logistic regression as the main analysis.

Data collection/extraction methods

NA.

Principal findings

Copayments for in-network emergency room (-$44.9, 95% CI: -78.3, -11.5; preparity mean: $56.2), outpatient services (eg, individual psychotherapy: -$7.4, 95% CI: -10.5, -4.2; preparity mean: $17.8), and out-of-network coinsurance for emergency room (-11 percentage points, 95% CI: -16.7, -5.4; preparity mean: 38.8 percent) and outpatient (eg, individual psychotherapy: -5.8 percentage points, 95% CI: -10.0, -1.6; preparity mean 41.0 percent) decreased. Probability of family OOP maxima use (29 percentage points, 95% CI: 19.3, 38.6; preparity mean: 36 percent) increased. In-network outpatient coinsurance increased (eg, individual psychotherapy: 4.5 percentage points, 95% CI: 1.1, 7.9; preparity mean: 2.7 percent), as did probability of use of family deductibles (15 percentage points, 95% CI: 6.1, 23.3; preparity mean: 38 percent).

Conclusions

MHPAEA was associated with increased generosity in most financial requirements observed here. However, increased use of deductibles may have reduced generosity for some patients.

SUBMITTER: Friedman S

PROVIDER: S-EPMC7704471 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Carve-out plan financial requirements associated with national behavioral health parity.

Friedman Sarah S Xu Haiyong H Azocar Francisca F Ettner Susan L SL

Health services research 20200902 6

<h4>Objectives</h4>To examine changes in carve-out financial requirements (copayments, coinsurance, use of deductibles, and out-of-pocket maxima) following the Mental Health Parity and Addiction Equity Act (MHPAEA).<h4>Data source/study setting</h4>Specialty mental health benefit design information for employer-sponsored carve-out plans from a national managed behavioral health organization's claims processing engine (2008-2013).<h4>Study design</h4>This pre-post study reports linear and logisti ...[more]

PMID: 32880927

Similar Datasets

Project description:ObjectiveTo evaluate differences in access to behavioral health services for Medicaid enrollees covered by a Medicaid entity that integrated the financing of behavioral and physical health care ("carve-in group") versus a Medicaid entity that separated this financing ("carve-out group").Data sources/study settingMedicaid claims data from two Medicaid entities in the Portland, Oregon tri-county area in 2016.Study designIn this cross-sectional study, we compared differences across enrollees in the carve-in versus carve-out group, using a machine learning approach to incorporate a large set of covariates and minimize potential selection bias. Our primary outcomes included behavioral health visits for a variety of different provider types. Secondary outcomes included inpatient, emergency department, and primary care visits.Data collectionWe used Medicaid claims, including adults with at least 9 months of enrollment.Principal findingsThe study population included 45,786 adults with mental health conditions. Relative to the carve-out group, individuals in the carve-in group were more likely to access outpatient behavioral health (2.39 percentage points, p < 0.0001, with a baseline rate of approximately 73%). The carve-in group was also more likely to access primary care physicians, psychologists, and social workers and less likely to access psychiatrists and behavioral health specialists. Access to outpatient behavioral health visits was more likely in the carve-in arrangement among individuals with mild or moderate mental health conditions (compared to individuals with severe mental illness) and among black enrollees (compared to white enrollees).ConclusionsFinancial integration of physical and behavioral health in Medicaid managed care was associated with greater access to behavioral health services, particularly for individuals with mild or moderate mental health conditions and for black enrollees. Recent changes to incentivize financial integration should be monitored to assess differential impacts by illness severity, race and ethnicity, provider types, and other factors.

Project description:ImportanceIn 2020, Michigan Medicaid implemented a new work requirement policy for enrollees in the Healthy Michigan Plan (HMP), the state's expanded Medicaid program. Under the policy, enrollees would be required to report 80 hours of work or other qualifying activities each month or obtain an exemption to maintain health insurance coverage.ObjectiveTo assess the experiences of health navigators (and beneficiaries by proxy) with the implementation of Michigan's Medicaid work requirement.Design setting and participantsThis qualitative study included health navigators who participated in 11 focus groups from September to December 2020. Focus group questions addressed topics related to implementation and communication of the HMP work requirement policy. A survey was administered to capture background information, assess readiness to assist with navigation, and assess the quality of the state's communication about the policy.Main outcomes and measuresThe main outcomes were general understanding of policy components, communications about the policy, navigation of the exemption process, navigation of the reporting process, and beneficiaries' ability to comply with the policy.ResultsOf 50 health navigators who participated in the focus groups, 44 (88.0%) responded to the survey and 43 provided demographic information (mean [SD] age, 44.0 [10.5] years). All 43 had at least some college or vocational education, with 27 (62.8%) reporting a 4-year degree or higher, and they resided in geographic regions across Michigan. Navigators indicated that they felt prepared to assist HMP enrollees navigate work requirements. Communication to beneficiaries regarding the new policy was viewed as an improvement compared with traditional Medicaid communications. However, the complex policy was potentially difficult for beneficiaries to understand. Limited language options besides English created barriers for some enrollees. Exemptions were confusing for beneficiaries owing to the numerous categories and sometimes vague guidelines. Those who used the online reporting system generally found the platform to be user-friendly. Navigators expressed concern regarding HMP enrollees' ability to report compliance with work requirements owing to barriers with internet access, telephone access, language challenges, and computer literacy.Conclusions and relevanceIn this qualitative analysis of health navigators in Michigan, respondents reported overall positive feedback about many of the implementation and communication strategies, including human-centered design, automatic exemptions, and use of state administrative data to assess whether beneficiaries were in compliance with the policy; however, barriers to reporting remained for enrollees. The findings suggest that state agencies should seek to reduce administrative barriers and apply a human-centered design approach to alleviate risk of unnecessary loss of Medicaid benefits.

Project description:Background and objectiveIn Iran, Health Sector Evolution Plan, the most significant reform in the healthcare system in recent decades, has been launched since 2014 with the objective of achieving universal health coverage, decreasing out-of-pocket health expenditures and improving access to health services in hospitals and clinics affiliated to the Ministry of Health and Medical Education (MOHME). This study aimed to estimate the hospitalization costs of lung cancer and the impact of HSEP on hospitalization costs of lung cancer and patients' contribution in Iran between 2010 and 2017.MethodsThis was a prevalence-based cost of illness study with a bottom-up costing approach. The sample size included 1778 lung cancer patients hospitalized in the Imam Reza hospital in Tabriz, Iran, between May 5, 2010, to May 5, 2014, and four years after the implementation of Health Sector Evolution Plan: from May 5, 2014, to May 5, 2017. The analysis was conducted from a societal perspective. Data were extracted from the electronic medical records of patients and were analyzed using SPSS V22.0, STATA V13.0 and Microsoft Excel 2016. The Interrupted Time-Series design was applied to estimate the impact of the implementation of HSEP on hospitalization costs and patient contribution rate for reimbursement of costs.ResultsThe mean hospitalization costs of lung cancer before and after the implementation of Health Sector Evolution Plan was estimated at 2860 ± 4575 and 5300 ± 8880 PPP (Current International $), respectively. Moreover, the amount of out-of-pocket payments reduced from 705 PPP (Current International$) (22.16%) before the implementation of Health Sector Evolution Plan to 480 PPP (Current International $) (10.5%) after its implementation. the hospitalization costs went up moderately before the HSEP (increased from 2320 $ in 2010 to 3025 $ in 2013). After the HSEP, it continued to rise, but with a more significant increase until 2016. Then, in 2016, it reached a peak (6395 $) before dropping in 2017 (5005 $). Regarding patient contribution, before the HSEP, the percentage of patient contributions increased from 19.45 in 2010 to 24.28 in 2013. With HSEP's implementation, this fell dramatically to 14.47 and continued to decline, reaching 7.99% in 2016. In 2017, patient contribution increased again and reached 9.58%.ConclusionOverall, hospitalization costs experienced an upward trend over the course of study, but this trend considerably intensified further after the HSEP. The patient contribution demonstrated an upward trend before HSEP, followed by a significant decline post-HESP, and the percentage of out-of-pocket payments reduced after implementation of HSEP. Therefor this plan has been successful in achieving the goal of financial protection of patients.

Dataset Information

Carve-out plan financial requirements associated with national behavioral health parity.

Objectives

Data source/study setting

Study design

Data collection/extraction methods

Principal findings

Conclusions

Publications

Carve-out plan financial requirements associated with national behavioral health parity.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets