NETWORK ADEQUACY

The resources below relate to network adequacy, i.e., ensuring access to in-network MH/SU providers:

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RESEARCH AND ANALYSES OF CLAIMS DATA 

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• 2024 RTI Disparity Report: Behavioral Health Parity – Pervasive Disparities in Access to In-Network Care Continue

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Press Release – New Study Finds Continuing Pervasive Disparities in Access to In-Network Mental Health and Substance Use Disorder Treatment

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List of Supporting Organizations and Quotes

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RTI International Website

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• 2019 Updated and Expanded Milliman Disparities Research Report, entitled: Addiction and mental health vs. physical health: Widening disparities in network use and reimbursement; A deeper analytical dive and updated results through 2017 for 37 million employees and dependents

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• 2018 Differential Reimbursement of Psychiatric Services by Psychiatrists and Other Medical Providers by authors at RTI, Truven, and SAMHSA

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• 2020 Milliman High-Cost Report – Impact of behavioral health conditions on physical and total healthcare spending

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TOOLS FOR QUANTITATIVE CLAIMS DATA ANALYSIS

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• 2024 Model Data Request Form (MDRF) - All 5 Sections (Updated) – Quantitative data templates used by employers, employer coalitions, regulators and other stakeholders in requesting targeted, quantitative data from third party administrators and insurers for assessment of access to in-network behavioral health services. The MDRF has been used as a source and template by multiple regulators. Note: Clicking the link above or the links below will download a Word document to your computer, which contains embedded Excel files.

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• MDRF Section 1 Only - Out-of-Network Use

• MDRF Section 2 Only - Reimbursement

• MDRF Section 3 Only - Provider Participation

• MDRF Section 4 Only - Denial Rates

• MDRF Section 5 Only - UR Frequency/Proportion​

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INDEPENDENT SURVEYS ON ACCESS TO MH/SU CARE

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• Surveys of Patients and Providers: 

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• 2023 Survey conducted by NORC – Equitable Access to Mental Health and Substance Use Care: An Urgent Need: Patient-experience survey conducted by NORC shows stark access barriers for mental health versus physical health and reviews several related studies by others

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Press Release – New Patient Survey Shows Pervasive Disparities in Access Between Mental Health and Substance Use Versus Physical Health Care: Leading mental health and employer groups come together around health system solutions for the nation's "staggering public health challenge" in mental health

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• Network Access and Adequacy – Summary of Published and Unpublished Research 2018-2023 of Susan H. Busch and Kelly A. Kyanko 

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• 2022 Template Survey of Employees to Evaluate Access to In-Network MH/SU Care – A survey employers can use to learn about their employees' experiences seeking MH/SU care  ​

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• Surveys of Employers:

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• 2023 Voice of the Purchaser – Survey of 220 employers by the National Alliance of Healthcare Purchaser Coalitions and  the HR Policy Association

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• 2022 Kaiser Family Foundation – Survey of 2,188 employers