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Treated prevalence of ASD increases following insurance mandates

The prevalence of treated children with autism spectrum disorders increased following implementation of state insurance mandates; however, treated prevalence was much lower than community prevalence estimates 3 years following mandate implementation.

“Until recently, commercial health insurance plans typically did not cover treatments for children with ASD, usually on the grounds that they were unproven or experimental. Even when treatments for ASD were covered under behavioral health benefits, their recommended intensity far outpaced the typically covered number of visits. Other policy mechanisms, such as mental health parity laws, have met with mixed success in addressing the needs of children with ASD,” David S. Mandell, ScD, of University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues wrote. “In response, 42 states have passed ASD insurance mandates. These laws require commercial, fully insured plans to cover ASD-specific behavioral therapies, with annual caps ranging from $12,000 to $50,000 depending on the state and age of the child. Despite some differences, the laws’ intent was to make behavioral treatments for ASD a mandatory part of commercial health insurance benefits.”

To determine if state ASD insurance mandates have increased treated prevalence, researchers conducted a difference-in-difference study using inpatient and outpatient health insurance claims for children aged 21 years and younger covered by United HealthCare, Aetna, and Humana from 2008 through 2012 (n = 1,046,850).

The adjusted treated prevalence in states with ASD insurance mandates was 1.8 per 1,000, compared with 1.6 per 1,000 in states without mandates (P = .006).

The mean increase in treated prevalence due to mandates was 0.21 per 1,000 children during the study period (95% CI, 0.11-0.3; P < .001).

Mandates that had been in place longer had a greater effect on treated prevalence, according to researchers.

The mean increase in treated prevalence due to mandates was 0.17 per 1,000 children (95% CI, 0.09-0.24; P < .001) in the first year following implementation, compared with 0.27 per 1,000 in the second year (95% CI, 0.13-0.42; P < .001), and 0.29 per 1,000 (95% CI, 0.15-0.42; P < .001) 3 years or more following implementation.

“Mandates have had a promising effect on increasing the number of commercially insured children diagnosed with ASD and the effect increases 2 years after implementation; however, that number is still well below the community prevalence of ASD,” the researchers wrote. “On the one hand, this finding should allay insurers’ concerns regarding potential sizable increases in cost. On the other hand, the mandates have not had the full effect that advocates desired. The results suggest the need for additional strategies to enforce the mandates and address barriers, such as regulatory issues or clinician capacity, that inhibit the timely and appropriate identification of children with ASD.” – by Amanda Oldt

Disclosure: Mandell reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.