Content by Keyword: Insurance

PDF report
HHS Secretary's Report on: Addressing Surprise

HHS Secretary's Report on: Addressing Surprise Medical Billing

This report responds to a requirement in Executive Order 13877, "Improving Price and Quality Transparency in American Healthcare to Put Patients First." It describes the phenomenon of a "surprise billing," particularly in the commercial insurance market, the underlying federal and state regulatory frameworks, and recent state actions to address th
  • HHS Secretary's Report on: Addressing Surprise Medical Billing
    export-csvPDF
Basic report
Analysis of Pathways to Dual Eligible Status:

Analysis of Pathways to Dual Eligible Status: Final Report

Zhanlian Feng, PhD,Alison Vadnais, MHS, Emily Vreeland, BA, Susan Haber, PhD, Joshua Wiener, PhD, and Bob Baker, BA RTI International Printer Friendly Version in PDF Format (46 PDF pages)
PDF report
Analysis of Pathways to Dual Eligible Status:

Analysis of Pathways to Dual Eligible Status: Final Report

There are multiple pathways to becoming dually eligible for Medicare and Medicaid. The purpose of this study is to identify the frequency with which these pathways are followed and the beneficiary characteristics and patterns of service use by pathway. We used the Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) to identify individ
  • DualStatus.pdf
    export-csvPDF
Basic report
Loss of Medicare-Medicaid Dual Eligible Status:

Loss of Medicare-Medicaid Dual Eligible Status: Frequency, Contributing Factors and Implications

Zhanlian Feng, PhD, Alison Vadnais, MHS, Emily Vreeland, MSPH, MicahSegelman, PhD, Abigail Ferrell, BA, Joshua M. Wiener, PhD, and Bob Baker, BA RTI International Printer Friendly Version in PDF Format (32 PDF pages)
PDF report
Loss of Medicare-Medicaid Dual Eligible Status:

Loss of Medicare-Medicaid Dual Eligible Status: Frequency, Contributing Factors and Implications

This paper seeks to document the frequency of Medicaid coverage loss among full-benefit dual eligible beneficiaries and identify potential causes for coverage loss. For dual eligible beneficiaries, the loss of full-benefit Medicaid coverage is of concern because most of them do not have an alternative source of health insurance for the services co
  • DualLoss.pdf
    export-csvPDF
Basic report
Transitions in Care and Service Use among

Transitions in Care and Service Use among Medicare Beneficiaries in Inpatient Psychiatric Facilities Issue Brief

Randall Blair, Jonathan D. Brown, Xiao Barry, and Angela Schmitt Mathematica Policy Research Printer Friendly Version in PDF Format (22 PDF pages)
PDF report
Transitions in Care and Service Use among

Transitions in Care and Service Use among Medicare Beneficiaries in Inpatient Psychiatric Facilities Issue Brief

Medicare beneficiaries in inpatient psychiatric facilities (IPFs) have complex conditions that require sustained engagement with physical and mental health care providers. People who receive care from IPFs are at risk for a range of negative health outcomes, but surprisingly little is known about their patterns of care.
  • IPFTransIB.pdf
    export-csvPDF
PDF report
Work-Focused Interventions for Depression: Final

Work-Focused Interventions for Depression: Final Report

Among employed adults, major depression is a leading cause of work absences (absenteeism) and impaired work performance (presenteeism) as well as short-term and long-term work disability. Depression is one of the largest and fastest growing categories of work disability claims filings in the public and private disability insurance sectors. Despite
  • DeprInterv.pdf
    export-csvPDF
Report page
APPENDIX F: National Drug Codes Used to Identify

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. APPENDIX F: National Drug Codes Used to Identify Prescription Drug Fills for Substance Use Disorders in Preliminary Analysis

National Drug Code Product Name Use Dosage in MG 00456-3330-01 CAMPRAL AUD 333
Report page
APPENDIX E: Supplemental Regression Analyses

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. APPENDIX E: Supplemental Regression Analyses Results

Annual Descriptive Trends and Simple Regression Analysis We produced annual outcome trends for the average and 95thpercentile for all service categories, comparing non-BH, MH, and SUD diagnosis groups as well as OUD and non-OUD SUD trends. We then produced plotted graphs to visually assess whether there were distinct patterns in results or disco
Report page
APPENDIX D: Prescription Drug National Drug Codes

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. APPENDIX D: Prescription Drug National Drug Codes Used to Identify Opioid Use Disorder Subpopulation

NDC Prod_Name Route of Admin Master Form Code Strength in MG Generic Name
Report page
APPENDIX C: Mental Health and Substance Use

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. APPENDIX C: Mental Health and Substance Use Disorder Diagnosis Codes

ICD-9-CM Diagnosis Code Description of ICD-9-CM Diagnosis Code MH or SUD Diagnosis Group Related CCS Category 3090 Adjustment disorder with depressed mood
Report page
APPENDIX B: Methods

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. APPENDIX B: Methods

Introduction The purpose of this appendix is to provide additional details on the methodology and analytic approach used in the study to obtain the results presented in the main section of the report. This includes details on specific codes used in data from the MarketScan CCAE Database, such as International Classification of Diseases, Ninth Re
Report page
APPENDIX A: Definitions of Acronyms and

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. APPENDIX A: Definitions of Acronyms and Abbreviations

Acronym Definition ASAM American Society of Addiction Medicine ASPE HHS Office of the Assistant Secretary for Planning and Evaluation AUD Alcohol Use Disorder
Report page
NOTES

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. NOTES

Stuart EA, McGinty EE, Kalb L, et al. Increased service use among children with autism spectrum disorder associated with Mental Health Parity Law. Health Affairs. 2017; 36(2): 337-345. For more information on the federal rulemaking process refer to: https://www.federalregister.gov/uploads/2011/01/the_rulemaking_process.pdf .
Report page
5. CONCLUSIONS

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. 5. CONCLUSIONS

MHPAEA Had a Positive Impact on Utilization of Outpatient Behavioral Health Services at the Mean
Report page
4. RESULTS

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. 4. RESULTS

We divide our results into several sections: Utilization Outcomes . Average Insurer and Enrollee Spending Outcomes . Insurer Reimbursement and Enrollee Out-of-Pocket Outcomes . Out-of-Network Outcomes . Outcomes for Service Utilizers at the 95th Percentile and Subpopulations .
Report page
3. METHODS

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. 3. METHODS

Study Period Our period of study was from January 2005 through September 2015. We selected these years to have an adequate number of pre-parity and post-parity months for analysis.[ 28 ] Within the full study period, we defined three separate time periods to assess the impact of MHPAEA based on the timeline of MHPAEA's implementation:
Report page
2. BACKGROUND

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. 2. BACKGROUND

Efforts to ensure that individuals with BH conditions receive insurance benefits that are comparable to those with medical conditions have been unfolding over the course of the past two decades. Two federal parity laws have been passed that directly apply to large group health plans.
Report page
1. INTRODUCTION

Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market: Final Report. 1. INTRODUCTION

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) ensures that large group health plans and health insurance issuers offer comparable benefits for mental health (MH) and substance use disorder (SUD) services and medical/surgical services. This legislation builds on prior federal parity legislation

Pages