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Law improves trends in service use, spending among children with autism
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The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, a federal law requiring equal insurance benefits for health care, has modestly increased the use of services by children with autism spectrum disorder without raising out-of-pocket costs to their families, according to findings published in Health Affairs.
“We found that kids with autism spectrum disorder are getting more services, but their families don’t have to pay more to get them, which is the basic point of having health insurance and why the parity law was passed by Congress,” Elizabeth A. Stuart, PhD, from the department of mental health, biostatistics and health policy and management at Johns Hopkins University Bloomberg School of Public Health, said in the press release. “In the past, these families likely would have had to pay more out of their own pockets to get more care and they are already paying an average of $1,250 to $1,500 a year out of pocket to cover treatments and therapies for their children.”
Because the mental health parity law, designed to eliminate discrimination in insurance coverage offered for people seeking treatment for mental illness and addiction, does not explicitly list autism spectrum disorder (ASD) as a covered condition, researchers sought to see whether children with autism benefit. Investigators analyzed the Truven Health MarketScan Research Database from 2007 to 2012, including all children diagnosed with autism aged up to 18 years with at least two insurance claims in a calendar year. They examined multiple health care services, such as mental health visits, speech and language therapy and occupational therapy.
The results showed that outcomes after the implementation of parity law have modestly increased in the use of health care services among children with ASD compared with those during the period before. In the first year following the parity law, researchers saw increases of 1.6 additional mental health visits annually, 0.4 additional speech and language therapy visits annually and 0.7 additional occupational and physical therapy visits annually among children using those health care services. They observed that those most likely to experience increases in the use of services were children aged younger than 12 years.
Although the research shows that the federal parity law led to greater use of services paid for through insurance without increasing the out-of-pocket spending of families with autistic children, Stuart and colleagues believe they are still not meeting expectations.
“Monitoring and enforcement of the federal parity law has been a persistent concern,” Stuart and colleagues wrote in the full article. “Our findings suggest that more stringent parity enforcement, additional policy approaches, or both, might be needed to ensure that children with ASD are connected to evidence-based services and supports.” – by Savannah Demko
Disclosure: The work was supported by the National Institute of Mental Health.
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