Parity Law Research Articles

Oral Oncology Parity Laws, Medication Use, and Out-of-Pocket Spending for Patients With Blood Cancers.

In this study, we sought to estimate the association between oral oncology parity law adoption and anticancer medication use for patients with chronic myeloid leukemia or multiple myeloma. This was an observational study of administrative claims from 2008 to 2017. Among individuals initiating tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia or immunomodulatory drugs for multiple myeloma, we compared out-of-pocket spending, adherence, and discontinuation before and after parity among individuals in fully insured plans (subject to parity) vs self-funded plans (exempt from parity) using propensity-score weighted difference-in-differences regression models. Among patients initiating TKIs (N = 2082) or immunomodulatory drugs (N = 3326) there were no statistically significant differences in adherence or discontinuation associated with parity. The proportion of patients with initial out-of-pocket payments of $0 increased in fully insured plans after parity from 5.7% to 46.1% for TKIs and from 10.9% to 48.8% for immunomodulatory drugs. Relative to changes in self-funded plans, those in fully insured plans were 4.27 (95% CI = 2.20 to 8.27) times as likely to pay nothing for TKIs and 1.96 (95% CI = 1.40 to 2.73) times as likely to pay nothing for immunomodulatory drugs after parity. Similarly, the proportion paying more than $100 decreased from 30.3% to 24.7% for TKIs and 30.6% to 27.5% for immunomodulatory drugs in fully insured plans after parity. Relative to changes in self-funded plans, those in fully insured plans were 0.74 (95% CI = 0.54 to 1.01) times as likely to pay more than $100 for TKIs and 0.85 (95% CI = 0.68 to 1.06) times as likely to pay more than $100 for immunomodulatory drugs after parity. Among patients initiating TKIs or immunomodulatory drugs, parity was not associated with better adherence or less discontinuation of therapy but yielded decreased patient out-of-pocket payments for some patients.

After parity. A mixed methods study on gender bias in the volume of media coverage of electoral campaigns

The absence of gender bias in the media coverage of political campaigns is one of the elements of the much sought after political participation of women. In this respect, Mexico is an interesting case as its legal framework has transitioned in a few years to include a mandated parity principle. In this study, we examine the relationship between the volume of coverage and gender to determine if there were gender differences in the radio coverage of local elections in Mexico (2012-2015). Findings show lower average shares of coverage for women after the increase in female candidates mandated by the parity principle. Semi-structured interviews conducted with journalists and former candidates suggest that the gender bias may reflect adverse attitudes towards female newcomers benefitted by the parity law, and gender differences in campaign resources, candidate placement criteria, and candidates’ political experience.

Holding Insurers Accountable for Parity in Coverage of Mental Health Treatment.

Despite a series of federal laws aimed at ensuring parity in insurance coverage of treatment for mental health and general health conditions, patients with mental disorders continue to face discrimination by insurers. This inequity is often due to overly restrictive utilization review criteria that fail to conform to accepted professional standards. A recent class action challenge to the practices of the largest U.S. health insurer may represent an important step forward in judicial enforcement of parity laws. Rejecting the insurer's guidelines for coverage determinations as inconsistent with usual practices, the court enunciated eight principles that defined accepted standards of care.

State Legislators' Support for Behavioral Health Parity Laws: The Influence of Mutable and Fixed Factors at Multiple Levels.

We conducted a multimodal (post mail, email, telephone) survey of US state legislators in 2017 (N = 475). The dependent variable was strong support for C-SBHPL, and the independent variables included legislators' fixed and mutable characteristics and state-level contextual factors. We conducted multivariable, multilevel (legislator, state) logistic regression. Thirty-nine percent of the legislators strongly supported C-SBHPL. After adjustment, the strongest predictors of C-SBHPL support were beliefs that C-SBHPL increases access to behavioral health treatments (aOR = 5.85; 95% CI = 2.41, 14.20) and does not increase insurance premiums (aOR = 2.70; 95% CI = 1.24, 5.90). Stigma toward people with mental illness was inversely associated with support (aOR = 0.86; 95% CI = 0.78, 0.95). After adjustment, ideology was the only fixed characteristic significantly associated with support for C-SBHPL. State-level contextual factors did not moderate associations between mutable characteristics and support for C-SBHPL. Legislators' mutable characteristics are stronger predictors of C-SBHPL support than are most of their fixed characteristics and all state-level contextual factors, and thus should be targeted by dissemination efforts.

Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity.

Adequate access for mental illness and substance use disorder (SUD) treatment, particularly for Medicaid enrollees, is challenging. Policy efforts, including the Mental Health Parity and Addiction Equity Act (MHPAEA), have targeted expanded access to care. With MHPAEA, more Medicaid plans were required to increase their coverage of SUD treatment, which may impact provider acceptance of Medicaid. To identify changes in Medicaid acceptance by SUD treatment facilities after the implementation of MHPAEA (parity). Observational study using an interrupted time series design. 2002-2013 data from the National Survey of Substance Abuse Treatment Services (N-SSATS) for all SUD treatment facilities was combined with state-level characteristics. Primary outcome is whether a SUD treatment facility reported accepting Medicaid insurance. Implementation of MHPAEA was associated with a 4.6 percentage point increase in the probability of an SUD treatment facility accepting Medicaid (P<0.001), independent of facility and state characteristics, time trends, and key characteristics of state Medicaid programs. After parity, more SUD treatment facilities accepted Medicaid payments, which may ultimately increase access to care for individuals with SUD. The findings underscore how parity laws are critical policy tools for creating contexts that enable historically vulnerable and underserved populations with SUD to access needed health care.

Resource Management: Parity and Access to Care

The current structure of our mental health parity laws are a combination of multiple bills at the national and state levels which have been passed since the original Mental Health Parity and Addiction Act of 2008 (MHPAEA). With the MHPAEA only employer-provided insurance programs that covered 50 or more employees and covered mental health services were required to have parity between mental health and physical health coverage. With the passage of the Affordable Care Act in 2010 and its essential benefit mandate (which required the coverage of mental health services) the MHPAEA broadened its reach to include smaller health plans and some Medicaid plans. Reforms in Medicare, CHIP and Tricare also have included parity between mental health and physical health coverage. Despite these changes there is still work needed in regards to state parity laws and better access to care. This review contains 5 figures, and 25 references. Key Words: Parity, Mental Health, Access, Coverage, MHPA, MHPAEA, NQTL, Essential Health Benefits

AMA Identifies Six State Strategies for Ending Opioid Epidemic

Back to table of contents Previous article Next article ProfessionalFull AccessAMA Identifies Six State Strategies for Ending Opioid EpidemicMark MoranMark MoranSearch for more papers by this authorPublished Online:30 Sep 2019https://doi.org/10.1176/appi.pn.2019.10a20AbstractThe report highlights tools and strategies devised by states that have already achieved success in reducing opioid deaths and turning the tide of the epidemic.Network adequacy—whether health plans have enough health care professionals in their network to meet demand—and enforcement of parity laws are among the keys to addressing the opioid epidemic, according to an analysis by the AMA and Manatt Health, a health care consulting firm.The “National Roadmap on State-Level Efforts to End the Opioid Epidemic: Leading Edge Practices and Next Steps” analyzes the response to the epidemic in four states—Colorado, Mississippi, North Carolina, and Pennsylvania—and highlights six strategies that appear to be critical to success. The two already noted—enforcement of parity laws and network adequacy—are also among APA’s top legislative priorities.“States have to be willing to use their oversight to enforce parity laws,” psychiatrist and AMA President Patrice Harris, M.D., M.A., told Psychiatric News. “The work APA has been doing in this area to develop tools that physicians can use to evaluate whether states are complying with parity has been invaluable.” Harris is also chair of the AMA Task Force to Reduce Opioid Abuse.Complementary to parity enforcement is ensuring that health plans have adequate numbers of mental health professionals in their networks. This is likely to require payment reforms, collaborative care models, and other efforts to bolster and support the nation’s treatment workforce for opioid use disorder (OUD), according to the report.Four other effective strategies identified in the roadmap are the following:Improving access to evidence-based treatment for opioid use disorder. Remove prior authorization requirements and other barriers to medication for addiction treatment (MAT) for OUD—and ensure MAT is affordable.Expanding pain management options. Enhance access to comprehensive pain care, including nonopioid and nonpharmacologic options.Improving access to naloxone. Reduce harm by expanding access to the overdose-reversing drug and coordinating care for patients in crisis.Evaluating policy success and barriers. Evaluate policies and outcomes to identify what is working and build on successful efforts, and identify policies and programs that might need to be revised or rescinded.“We are at a crossroads in our nation’s efforts to end the opioid epidemic, and states are being creative on how they respond,” Harris said in a statement. “It is time to end delays and barriers to treatment; time for payers, pharmacy benefit managers, and pharmacy chains to revise policies that restrict opioid therapy to patients based on arbitrary thresholds; and time to help all patients access evidence-based care for pain and substance use disorders. Physicians must continue to demonstrate leadership, but unless and until these actions occur, the progress we are making will not stop patients from dying.”Joel Ario, managing partner at Manatt Health Strategies and former insurance commissioner in Oregon and Pennsylvania, added: “These recommendations are already proving effective in leading states. If state policymakers want to have a tangible impact on improving patient care, these are the policies that are showing real promise. This is not hypothetical—this is what is needed to end the epidemic.”The recommendations by the AMA and Manatt emerged from four key themes identified in an earlier analysis of strategies in the four states. The broad themes include the following:Vigorous state oversight and enforcement. State regulators can have a significant impact on reducing barriers and improving patient care, and some have used these tools to increase access to evidence-based treatment. Regulators have successfully held payers and others accountable for restricting access by using prior authorization for MAT. Additionally, states have found success by enforcing state and federal insurance parity laws, benefitting patients needing treatment for mental or substance use disorders.Medicaid expansion. Medicaid often provides more comprehensive care for substance use disorders than the commercial insurance market, often by removing barriers to MAT and providing greater access to nonopioid pain care. Expanding Medicaid in states that have not yet done so would establish a strong foundation to help even more patients.Long-term funding. Grants are being used to advance many best practices, but to continue saving lives, states need long-term, sustainable funding. Without reliable funding streams, programs that are showing promise to reduce overdose and death—and to connect patients to treatment—might simply disappear.Measuring success. Some states are evaluating policies and programs to determine what works. Most of these evaluations are just beginning. Comprehensive analysis is essential to focus resources on successful interventions and to revise or drop policies that are having unintended consequences. ■The AMA report is posted here. ISSUES NewArchived

289EMF Are State Telemedicine Parity Laws Associated With Greater Uptake of Telemedicine in the Emergency Department?

Telemedicine may improve access to specialists and clinical outcomes. In an effort to increase use of telemedicine, almost half of all states have passed telemedicine parity laws which require insurers to reimburse for telemedicine visits. Our objective was to determine if there is an association between such laws and use of telemedicine in the emergency department (ED). Building on prior research, we determined each states’ telemedicine policy environment as of January 2016. States were divided into those with any form of telemedicine parity law (conditional mandate, non-conditional mandate, or requirement for full parity in payment by private payers) and those without. As part of the 2016 National ED Inventory (NEDI)-USA survey, we surveyed the directors of all 5,381 EDs on the use of telemedicine with the question, “Does your ED receive telemedicine services for patient evaluation? Yes/No.” We assessed the association between a telemedicine parity law and use of telemedicine with a hierarchical logistic regression model controlling for a number of ED characteristics (annual total and pediatric visit volumes, academic status, freestanding ED, U.S. region, and rural/urban location); state was included as a random intercept. In 2016, among the 50 states and the District of Columbia (DC), 21 (41%) had a telemedicine parity law while 30 (59%) did not. Among the 4,419 respondents to the telemedicine question, (82% response rate), 2,125 (48%) used telemedicine. The proportion of EDs using telemedicine varied widely across the states and DC ranging from 13% in DC to 89% in Maine. In unadjusted analyses, there was no difference between the use of telemedicine in EDs in states with and without telemedicine parity laws (55% vs. 53%, p=0.17). After accounting for baseline ED characteristics, there was also no association between state policy environment and ED use of telemedicine, though telemedicine use did vary significantly by state (Table). Many states have adopted parity laws to encourage use of telemedicine. Surprisingly, we found no association between the presence of these laws and use of telemedicine in the ED. These results suggest that other factors are driving the wide variation in ED adoption of telemedicine across states.TableEmergency Department (ED) Characteristics Associated with Receipt of TelemedicineOdds Ratio95% Confidence IntervalAnnual ED volume(per 10,000patient increase)0.980.95-1.02Annual pediatric volume(reference: <3,000)Annual pediatric volume>3,0001.661.40-1.98Annual pediatric volume unknown1.461.18-1.81Academic0.360.25-0.53Freestanding ED0.480.38-0.61Region (Reference: Northeast)Region Midwest0.690.36-1.35Region South0.610.32-1.16Region West0.810.41-1.58Rural1.200.99-1.44Telemedicine parity law1.040.67-1.62Random intercept: state0.690.55-0.88 Open table in a new tab

Gender parity and the symbolic representation of women in Senegal

AbstractFollowing the adoption of the Senegalese Law on Parity and the subsequent influx of women to the National Assembly, we saw a strong gendered polarisation of attitudes towards women as political leaders among the Senegalese population. This study explores whether similar attitudinal changes are found among political elites in the Senegalese National Assembly. Theory suggests that an increase in the number of women elected to legislatures (‘descriptive representation’) will challenge people's perceptions of politics as a male domain and strengthen belief in women's ability to govern (‘symbolic representation’). Although the effects of gender quotas on women's representation has received considerable scholarly attention, the field of symbolic representation remains under-studied. A case study of the effects of the Senegalese parity law addresses this knowledge gap, contributing with new empirical insights. This study also develops indicators that can help measure potential developments in the symbolic representation of women. Parity appears to have contributed to slightly more acceptance towards women as political leaders within the National Assembly. The findings are discussed in the last section.

U.S. alcohol treatment admissions after the Mental Health Parity and Addiction Equity Act: Do state parity laws and race/ethnicity make a difference?

BackgroundThe U.S. Mental Health Parity and Addiction Equity Act (MHPAEA) was a landmark federal policy aimed at increasing access to substance use treatment, yet studies have found relatively weak impacts on treatment utilization. The present study considers whether there may be moderating effects of pre-existing state parity laws and differential changes in treatment rates across racial/ethnic groups. MethodsWe analyzed data from SAMHSA'S Treatment Episode Data Set (TEDS) from 1999 to 2013, assessing changes in alcohol treatment admission rates across states with heterogeneous, pre-existing parity laws. NIAAA's Alcohol Policy Information System data were used to code states into five groups based on the presence and strength of states' pre-MHPAEA mandates for insurance coverage of alcohol treatment and parity (weak; coverage no parity; partial parity if coverage offered; coverage and partial parity; strong). Regression models included state fixed effects and a cubic time trend adjusting for state- and year-level covariates, and assessed MHPAEA main effects and interactions with state parity laws in the overall sample and racial/ethnic subgroups. ResultsWhile we found no significant main effects of federal parity on alcohol treatment rates, there was a significantly greater increase in treatment rates in states requiring health plans to cover alcohol treatment and having some pre-existing parity. This was seen overall and in all three racial/ethnic groups (increasing by 25% in whites, 26% in blacks, and 42% in Hispanics above the expected treatment rate for these groups). Post-MHPAEA, the alcohol treatment admissions rate in these states rose to the level of states with the strongest pre-existing parity laws. ConclusionThe MHPAEA was associated with increased alcohol treatment rates for diverse racial/ethnic groups in states with both alcohol treatment coverage mandates and some prior parity protections. This suggests the importance of the local policy context in understanding early effects of the MHPAEA.

Summer in Washington: How Hot Will It Get?

Summer in Washington: How Hot Will It Get?

New parity legislation to require transparency, accountability introduced

More than 10 years following passage of the federal mental health parity law, Senate lawmakers have introduced new legislation to tighten parity enforcement and improve transparency and accountability to help ensure consumers have access to mental health and substance use services in their plans. The bill seeks to eliminate disparities in the way insurance plans cover mental illness and substance use disorders.

N.J. Law to Improve Enforcement, Accountability of Mental Health Parity Law

N.J. Law to Improve Enforcement, Accountability of Mental Health Parity Law

Does Mental Health Parity Encourage Mental Health Utilization Among Children and Adolescents? Evidence from the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA).

This study examines the effects of mental health parity laws on mental health care utilization and mental health outcomes of children and adolescents from middle-income households in the context of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), using data from the 2007 and 2011-2012 waves of the National Survey of Children's Health (N = 57,549). A difference-in-differences method controlling for demographic characteristics, state Medicaid eligibility, and unemployment is used. The analyses show that after the enactment of the MHPAEA, children and adolescents with family income between 150 and 400% of the federal poverty level in states without prior parity laws experience a 2.80 percentage point relative increase (p< 0.01) in mental health care utilization. These children and adolescents also experience an increase in the diagnoses of anxiety, which may suggest that better access to healthcare increases screening for previously under-diagnosed disorders.

New Jersey parity law to improve patient care, hold insurers accountable

Legislation to require insurance companies to treat mental health conditions and substance use disorders (SUDs) the same as they would physical conditions has been signed into law by New Jersey Gov. Phil Murphy. The state parity law holds managed care organizations accountable and expands the definition of mental health conditions that must be covered, including eating disorders and post‐traumatic stress disorder (PTSD).

Connecticut bill seeks to ensure mental health parity

A former Rhode Island congressman is working with Connecticut legislators to pass legislation to ensure health insurers treat mental health illnesses the same as other illnesses, The Associated Press reported March 5. Democrat Patrick Kennedy, a mental health advocate, appeared March 5 with a bipartisan group of state lawmakers to support a bill that requires insurers to submit annual reports concerning parity for mental health and substance use disorder. The bill also requires health insurance coverage for prescription drugs prescribed to treat substance use disorders. Kennedy says the bill is “a modern‐day civil rights bill for those with brain illness.” He pushed for a federal mental health and addiction parity law more than a decade ago. Guilford Rep. Sean Scanlon, a Democrat, says Connecticut has strong parity laws but no mechanism to know they're being enforced.

PUBLIC POLICY Session 4: TEN YEARS SINCE THE FEDERAL PARITY LAW: WHAT NEXT IS NEEDED: Session 315

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Federal Parity Law) requires that insurers treat illnesses of the brain the same way that they treat illnesses of the body. However, ten years later many individuals, including older adults, are needing to pay more out of pocket to obtain treatment for illnesses of the brain. The Carter Center Mental Health Program in collaboration with The Morehouse School of Medicine/ Kennedy-Satcher Center for Mental Health Equity and The Kennedy Forum are taking action aimed at improving regulatory and enforcement activity in order to advance the goals of parity.

The Effects of Federal Parity on Mental Health Services Use and Spending: Evidence From the Medical Expenditure Panel Survey.

This study evaluated the effects of the federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 on the use of outpatient and clinic-based mental health services and spending on those services. Data came from the 2005-2013 Medical Expenditure Panel Survey. The analytic sample included adults ages 26-64 who were continuously enrolled in employer-sponsored insurance for a calendar year (N=66,602 person-year observations). A difference-in-differences study design was used to compare changes in outcomes before and after implementation of the MHPAEA between people whose insurance plan was or was not affected by the law. The federal parity law was not significantly associated with changes in the likelihood of using mental health services, the amount of mental health services used, or total or out of-pocket spending for mental health services. The law was marginally significantly associated with a shift toward more use of mental health specialty services rather than primary care services among individuals who used ambulatory mental health care. Consistent with other research using different study designs and data, this study found that the MHPAEA had at most small effects on patterns of mental health services use and spending through 2013. Understanding whether these effects were small because most employer-sponsored plans were already parity compliant or because plans were noncompliant with the law has major implications for mental health policy and parity enforcement.

MHW looks back at some noteworthy moments involving mental health in 2018

As 2019 begins, it's time to reflect on some key moments in mental health over the past year. Some of the more notable events of 2018 included the 10th anniversary of the federal parity law, new opportunities for states to make important improvements to help Medicaid beneficiaries access quality behavioral health care, legislation to combat the opioid crisis and a ruling that the Affordable Care Act (ACA) is unconstitutional.

The impact of state parity laws on copayments for and adherence to oral endocrine therapy for breast cancer.

Adherence to endocrine therapy for breast cancer is often inadequate, in part because of out-of-pocket costs for medication. Numerous states have enacted parity laws to limit patient cost-sharing for oral anticancer drugs. The objective of this study was to estimate the impact of these laws on patient copayments for and adherence to oral endocrine therapy for breast cancer. Administrative health insurance claims data from 2007 to 2014 derived from a US health care database were used to identify female patients aged 18 to 64 years with invasive cancer or ductal carcinoma in situ of the breast who initiated endocrine therapy and were enrolled in fully insured health plans in states that either enacted parity legislation between 2008 and 2013 or had not yet enacted such legislation by 2015. Differences-in-differences analysis was used to compare copayments for and adherence to endocrine therapy during the 1-year period before and after each year of legislation enactment. In total, 6900 individuals who received 7778 unique drug therapy courses were identified. Parity legislation was associated with significant decreases in the 25th percentile of copayments for anastrozole of $4.39 (95% confidence interval [CI], -$4.52 to -$4.26; P < .001) and for exemestane of $3.08 (95% CI, -$4.80 to -$1.35; P < .001). The median copayment for exemestane decreased by $10.25 (95% CI, -$12.61 to -$7.89; P < .001). A higher median monthly copayment was significantly associated with a greater risk of medication nonadherence (adjusted risk ratio, 1.006 per dollar increase; P < .001). Parity laws had a modest effect on lowering the cost of anastrozole and exemestane, but more focused efforts to limit out-of-pocket costs for endocrine therapy may have a greater impact on medication adherence.