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Saturday, November 11, 2017

Insurance Mandates Mean Autistic Kids Get More Services

The Politics of Autism includes an extensive discussion of insurance and the regulation of autism service providers.

Brendan Saloner and Colleen L Barry have an article at Autism titled "Changes in Spending and Service Use after a State Autism Insurance Mandate." The abstract:
Almost all states have insurance coverage mandates for childhood autism spectrum disorder treatment, yet little is known about how mandates affect spending and service use. We evaluated a 2011 Kansas law mandating comprehensive coverage of autism spectrum disorder treatments in the State Employee Health Plan. Data were extracted from the Kansas All-Payer Claims Database from 2009 to 2013 for enrollees of State Employee Health Plan and private health plans. The sample included children aged 0–18 years with >2 claims with an autism spectrum disorder diagnosis insured through State Employee Health Plan or a comparison group enrolled through private health plans. We estimated differences-in-differences regression models to compare trends among State Employee Health Plan to privately insured children. Average annual total spending on autism spectrum disorder services increased by US$912 (95% confidence interval: US$331–US$1492) and average annual out-of-pocket spending on autism spectrum disorder services increased by US$138 (95% confidence interval: US$53–US$223) among diagnosed children in the State Employee Health Plan relative to the comparison group following the mandate, representing 92% and 75% increases over baseline total and out-of-pocket autism spectrum disorder spending, respectively. Average annual quantity of outpatient autism spectrum disorder services increased by 15.0 services (95% confidence interval: 8.4–21.6) among children in the State Employee Health Plan, more than doubling the baseline average. Implementation of a comprehensive autism spectrum disorder mandate in the Kansas State Employee Health Plan was associated with substantial increases in service use and spending for autism spectrum disorder treatment among autism spectrum disorder–diagnosed children.
From the study:
It is unclear what factors drive increased utilization. One likely possibility is that increasing the spending cap led families with children who were previously constrained
to use more services. Another possibility is that some of the increase in spending and service use with an ASD diagnosis code may be related to reclassification of services
that were already being provided to children prior to the mandate. For example, a child previously receiving counseling with an intellectual disability diagnosis may be classified with an ASD diagnosis after the mandate in order to take advantage of better coverage. We found large, but not statistically significant, reductions in non-ASD spending and prescription drug spending after the mandate. Finally, better access to services for ASD-diagnosed youth may reduce spending in other areas due to improved medical management (e.g. reduced visits to the emergency department). Identifying the contribution of these factors is important for further research.
The Kansas SEHP experience demonstrates that coverage mandates can be effective in increasing receipt of services among youth with diagnosed ASD. With a growing number
of states implementing these mandates, experiences may differ depending upon factors such as the scope and enforcement of the mandate, the response of insurance companies to new requirements, and the level of awareness among physicians, patients, and parents of children with ASD. As was found in Kansas, new mandates may create opportunities for children to take advantage of a broader array of services. Whether these policies lead to better quality of care and improved outcomes among these children will be an important benchmark for future evaluation.