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Insurance Mandates Improve Care of Autism, but Many Still Uncovered

Insurance Mandates Improved Care of Autism, but Many Still Uncovered

New research suggests state mandates that require commercial health plans to cover the cost of services for children with autism spectrum disorder (ASD) have led to more children being diagnosed and treated for ASD.

Investigators from the Perelman School of Medicine at the University of Pennsylvania say that although detection and treatment has improved, many children with ASD remain underserved.

ASD is characterized by impairments in social communication and repetitive behaviors. Its incidence has risen from one in 150 children in 2004 to one in 68 children in 2010.

Care for ASD is intense and often prolonged. Treatment can require up to 25 hours per week of educational and behavioral interventions for several years.

Until recently, most insurance companies did not cover care for ASD because of high costs.

In 2001, Indiana became the first state to mandate that behavioral treatments for ASD be covered through commercial health insurance benefits; many other states followed suit starting in 2008.

Currently, 44 states have implemented an autism mandate with the idea that it would remove the financial barrier to families that had prevented many children from being diagnosed and treated for ASD.

The new research study, to be published JAMA Pediatrics, sought to determine if the new legislation improves care for individuals with ASD.

A team from Pennsylvania’s department of Psychiatry, led by David Mandell, ScD, a professor and director of the Center for Mental Health Policy and Services Research, examined inpatient and outpatient health insurance claims for children 21 years and younger.

Importantly, claims analyzed were from three of the largest insurers in the U.S. — United HealthCare, Aetna, and Humana – from January 2008 through December 2012.

During the study period, 154,089 of the 1,046,850 children in the sample were diagnosed with ASD. In states with ASD insurance mandates, the adjusted prevalence of children diagnosed with ASD was 1.8 per 1,000, compared with 1.6 per 1,000 children in states without a mandate.

Overall, the mandates resulted in a 12.7 percent adjusted increase in prevalence of children diagnosed with ASD.

In addition, the researchers noted that the effects of the mandates increased the longer they remained in effect. In the first year of implementation, mandates were associated with a 10.4 percent increase in the proportion of children diagnosed with ASD; in the second year of implementation, this percentage rose to 17.1 and then to 18 percent in later years.

“These are encouraging findings,” Mandell said.

“We now know that more children are being served, but we are also acutely aware that these numbers are well below the prevalence of ASD in our society, indicating that the mandates have not had the full effect that advocates desired,” he explained.

“This is merely a step in the right direction. These mandates represent a patch, not a panacea.”

Source: University of Pennsylvania

Insurance Mandates Improved Care of Autism, but Many Still Uncovered

Rick Nauert PhD

Rick Nauert, PhDDr. Rick Nauert has over 25 years experience in clinical, administrative and academic healthcare. He is currently an associate professor for Rocky Mountain University of Health Professionals doctoral program in health promotion and wellness. Dr. Nauert began his career as a clinical physical therapist and served as a regional manager for a publicly traded multidisciplinary rehabilitation agency for 12 years. He has masters degrees in health-fitness management and healthcare administration and a doctoral degree from The University of Texas at Austin focused on health care informatics, health administration, health education and health policy. His research efforts included the area of telehealth with a specialty in disease management.

APA Reference
Nauert PhD, R. (2016). Insurance Mandates Improved Care of Autism, but Many Still Uncovered. Psych Central. Retrieved on August 20, 2018, from https://psychcentral.com/news/2016/07/12/insurance-mandates-improve-care-of-autism-but-many-still-uncovered/107045.html

 

Scientifically Reviewed
Last updated: 12 Jul 2016
Last reviewed: By John M. Grohol, Psy.D. on 12 Jul 2016
Published on PsychCentral.com. All rights reserved.