Volume 53 | Number 6 | December 2018

Abstract List

Amber Gayle Thalmayer Ph.D., Jessica M. Harwood M.S., Sarah Friedman Ph.D., Francisca Azocar Ph.D., L. Amy Watson, Haiyong Xu Ph.D., Susan L. Ettner Ph.D.


To assess frequency, type, and extent of behavioral health () nonquantitative treatment limits (s) before and after implementation of the Mental Health Parity and Addiction Equity Act of 2008 ().

Data Sources

Secondary administrative data for Optum carve‐out and carve‐in plans.

Study Design

Cross‐tabulations and “two‐part” regression models were estimated to assess associations of parity period with s.

Data Collection/Extraction Methods

Optum provided four proprietary databases, including 2008–2013 data for 40 carve‐out and 385 carve‐in employers from Optum's claims processing databases and 2010 data from interviews conducted by Optum's parity compliance team with 49 carve‐out employers.

Principal Findings

Preparity, carve‐out plans required preauthorization for in‐network inpatient/intermediate care; otherwise coverage was denied. Postparity, 73 percent would review later by request and half charged no penalty for late authorization. Outpatient visit authorization requirements virtually disappeared. For carve‐out out‐of‐network inpatient/intermediate care, and for carve‐ins, plans changed penalties to match medical service policies, but this did not necessarily lead to fewer requirements or lower penalties.


After 2011, was associated with the transformation of care management, including much less restrictive preauthorization requirements, especially for in‐network care provided by carve‐out plans.