Evaluating the Effects of Autism Insurance Mandates

描述(由申请人提供)：30个州已颁布法律，要求私营保险公司涵盖诊断和治疗自闭症谱系障碍(ASD)的服务。从历史上看，私营保险公司一直将自闭症排除在外或提供最低限度的保险。关于这些法律已经有了很多争论。倡导者将其宣传为扩大获得专门疗法的机会。随着保险覆盖面的扩大，家庭将有更多机会和动机使用私人保险来支付子女的护理费用。然而，这些法律将如何实施还存在不确定性。国家规定要求私营保险公司承保医疗必要的服务~然而，由于不清楚什么是自闭症儿童的医疗必要治疗，保险公司可能会选择不承保某些服务。同样，提供商网络可能无法满足日益增长的ASD服务需求，特别是如果报销率设定在阻止临床医生进入市场的水平。为了提供关于这些强制令效果的经验证据，我们与联合健康集团(United Health Group)的子公司OpumHealth合作，后者是一项大型医疗保险计划，在2009年至2012年期间实施了自闭症强制令的25个州和在此期间没有强制实施自闭症强制令的23个州运营。我们建议：1)检查州自闭症指令对自闭症儿童的治疗流行率的影响~2)检查州自闭症指令对自闭症儿童使用的治疗的服务利用模式和提供者报销率的影响~3)检查州自闭症指令对私人保险覆盖的自闭症儿童使用的服务支出的影响~4)探索不同国家执行自闭症指令的异质性。对于目标1-3，我们将使用健康保险索赔来进行差异差异分析，通过比较以下几方面的结果来检查州强制令的效果：1)参加全保健康计划的强制州的儿童，这些儿童受这些强制要求的约束；2)参加自我保险健康计划的强制州的儿童，他们不受这些强制要求的约束；以及3)在非强制州同时参加全面保险和自我保险健康计划的儿童。使用这种严格的准实验设计，我们将确定这一重大的国家级政策举措的效果。对于目标4，我们将采访保险管理人、服务提供者组织和消费者权益倡导组织，以探索使用索赔数据不易研究的任务的潜在影响，包括任务执行中的州一级差异，以及对医疗计划内外提供和支付的护理的影响。在没有任何关于自闭症影响的证据的情况下，其他州正在努力制定类似的立法，这使得这项提议特别及时。早期的调查结果也将与各州设计《平价医疗法案》的基本医疗福利要求有关。这些结果将有助于为更广泛的关于使用保险设计作为实现卫生政策目标的机制的辩论提供信息。

DESCRIPTION (provided by applicant): Thirty states have enacted laws mandating private insurers to cover services to diagnose and treat autism spectrum disorders (ASD). Historically, private insurers have excluded or provided minimal coverage for ASD. There has been much debate about these laws. Advocates promote their passage as expanding access to specialized therapies. With enhanced coverage, families will have more opportunity and incentive to use private insurance to pay for their children's care. There is uncertainty, however, about how these laws will be implemented. State mandates require private insurers to cover medically necessary services~ however, because of confusion over what constitutes medically necessary treatment for children with ASD, insurers may opt not to cover certain services. Likewise, provider networks may not grow to meet the increased demand for ASD services, especially if reimbursement rates are set at levels that discourage clinicians from entering the market. To provide empirical evidence about the effects of these mandates, we have partnered with OptumHealth, a subsidiary of United Health Group, a large health insurance plan operating in 25 states with autism mandates implemented from 2009 to 2012 and 23 states without autism mandates during this period. We propose to: 1) examine the effects of state autism mandates on the treated prevalence of children with ASD~ 2) examine the effects of state autism mandates on service utilization patterns and provider reimbursement rates for treatments used by children with ASD~ 3) examine the effects of state autism mandates on spending on services used by children with ASD covered under private insurance~ and 4) explore heterogeneity in the implementation of autism mandates in different tates. For Aims 1-3, we will use health insurance claims to conduct difference-in-difference-in-differences analyses to examine the effects of state mandates by comparing outcomes among: 1) children in mandate states enrolled in fully-insured health plans, which are subject to these mandates~ 2) children in mandate states enrolled in self-insured health plans, who are not subject to these mandates~ and 3) children enrolled in both fully- and self-insured health plans in non- mandate states. Using this rigorous quasi-experimental design, we will identify the effects of this major new state-level policy initiative. For Aim 4, we will interview insurance administrators, provider organizations and consumer advocacy organizations to explore potential effects of mandates not easily studied using claims data, including state-level variation in mandate implementation and effects on care provided and paid for both in and outside health plans. Efforts underway in other states to enact similar legislation in the absence of any evidence on the effects of autism mandates make this proposal particularly timely. Early findings also will be relevant to states' design of the essential health benefits requirements of the Affordable Care Act. The results will help inform the broader debate over the use of insurance design as a mechanism for achieving health policy objectives.