Increase in Treatment of Children with Autism Remains Modest Following Insurance Mandates

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The longer autism spectrum disorder insurance mandates remained in place, the more that mandate-associated treated prevalence increased.

More children were diagnosed with autism spectrum disorder (ASD) after implementation of insurance mandates requiring commercial companies to cover ASD-related services, but the increases were modest with minimal cost increases, found new research in JAMA Pediatrics.

“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,” the authors wrote.

David S. Mandell, ScD, of the University of Pennsylvania in Philadelphia, and his colleagues analyzed inpatient and outpatient insurance claims for 1,046,850 youth, age 21 and younger, covered by United HealthCare, Aetna and Humana from 2008-2012. The population included 154,089 children with an ASD diagnosis.

In states lacking an ASD insurance mandate, 1.6 children per 1,000 received treatment for diagnosed ASD, with treatment defined as at least one ASD-related health care service in a given month. In states with an ASD insurance mandate, 1.8 children per 1,000 received ASD-related treatment. But the increase resulting from the mandates was just 0.21 more children per 1,000.

Of the 29 states with an ASD insurance mandate before or during the study, Indiana passed the first in 2001, followed by Illinois, South Carolina, and Texas in 2008. During the study period, Arizona, Florida, Louisiana, New Mexico, Pennsylvania and Wisconsin implemented a mandate in 2009; Colorado, Connecticut, Montana and New Jersey in 2010; Arkansas, Kentucky, Massachusetts, Maine, Missouri, New Hampshire, Nevada and Vermont in 2011; and California, Delaware, Michigan, New York, Rhode Island, Virginia and West Virginia in 2012.

The longer ASD insurance mandates remained in place, the more that mandate-associated treated prevalence increased: 0.17 per 1,000 children the first year after a mandate took effect, then 0.27 per 1,000 the subsequent year, and 0.29 per 1,000 at least 3 years after implementation. Percentage increases related to mandates were 10.4% the first year, 17.1% the second year, and 18% the third and later years.

While coverage increased 12.7% for children’s ASD services following implementation of mandates, the prevalence of children receiving treatment remained lower than estimates of community ASD prevalence, suggesting under-diagnosis or children with ASD only receiving publicly funded treatment.

Based on the Centers for Disease Control and Prevention estimates of 15 children with ASD per 1,000 children, “our results suggest that children receiving that intensity of service [monthly or weekly visits] are obtaining it through schools and public insurance, not private insurance,” the authors wrote.

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Mandell DS, Barry CL, Marcus SC, et al. Effects of autism spectrum disorder insurance mandates on the treated prevalence of autism spectrum disorder. JAMA Pediatr. 2016. doi: 10.1001/jamapediatrics.2016.1049.