• Susan H Busch, Andrew J Epstein, Michael O Harhay, David A Fiellin, Hyong Un, Deane Leader, and Colleen L Barry.
• Yale School of Public Health, 60 College St, New Haven CT 06520-8034.
• Am J Manag Care. 2014 Jan 1; 20 (1): 76-82.

BackgroundIn 2008, the US Congress enacted the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) requiring insurers to equalize private insurance coverage for mental health and substance use disorder services with coverage for general medical services.ObjectiveTo examine the effects of MHPAEA on substance use disorder treatment.Study DesignWe used a difference-in-differences design to compare changes in outcomes among plan enrollees in the years before and after implementation of federal parity (2009-2010) with changes in outcomes among a comparison group of enrollees previously covered by state substance use disorder parity laws.MethodsInsurance claims data from Aetna Inc health plans in 10 states with state parity laws were used to compare outcomes for plan enrollees in fully insured and self-insured health plans (N = 298,339).ResultsIn the first year of implementation, we found that federal parity did not lead to changes in the proportion of enrollees using substance use disorder treatment. We did find a modest increase in spending on substance use disorder treatment per enrollee ($9.99, 95% confidence interval, 2.54-18.21), but no significant change in identification, treatment initiation, or treatment engagement.ConclusionsInclusion of substance use disorder services in the federal parity law did not result in substantial increases in health plan spending. It will be critical to study results for year 2 after regulations affecting the management of care (eg, utilization review, network access) take effect.

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