Evaluating the Effects of Autism Insurance Mandates

描述（由申请人提供）：三十个州已颁布法律，要求私人保险公司承保诊断和治疗自闭症谱系障碍 (ASD) 的服务。从历史上看，私人保险公司排除了 ASD 保险或只提供最低限度的保险。关于这些法律存在很多争论。拥护者们宣传他们的通过是为了扩大获得专门治疗的机会。随着保险范围的扩大，家庭将有更多的机会和动力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。州政府要求私人保险公司承保必要的医疗服务~然而，由于对自闭症谱系障碍儿童的必要医疗治疗的构成混乱，保险公司可能选择不承保某些服务。同样，提供者网络可能无法增长以满足对自闭症谱系障碍服务不断增长的需求，特别是如果报销率设定在阻碍临床医生进入市场的水平的话。为了提供有关这些强制规定的影响的实证证据，我们与 United Health Group 的子公司 OptumHealth 合作，这是一家大型健康保险计划，在 2009 年至 2012 年期间在 25 个实施自闭症强制规定的州和 23 个在此期间没有实施自闭症强制规定的州运营。我们建议：1）检查州自闭症指令对自闭症儿童治疗患病率的影响〜2）检查州自闭症指令对服务利用模式和自闭症儿童使用治疗的提供者报销率的影响〜3）检查州自闭症指令对私人保险承保的自闭症儿童使用的服务支出的影响〜4）探索不同州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进行双重差分分析，通过比较以下结果来检验州强制措施的影响：1) 强制州中参加完全保险健康计划的儿童，受这些强制规定的约束 ~ 2) 强制州中参加自我保险健康计划的儿童，不受这些强制规定的约束 ~ 3) 在非强制州同时参加完全保险和自我保险健康计划的儿童。通过这种严格的准实验设计，我们将确定这一重大的国家级新政策举措的效果。对于目标 4，我们将采访保险管理者、提供者组织和消费者权益组织，以探讨使用索赔数据不易研究的强制规定的潜在影响，包括州一级强制实施的差异以及对医疗计划内外提供和支付的护理的影响。在没有任何证据证明自闭症强制令的影响的情况下，其他州正在努力制定类似的立法，这使得这项提议显得特别及时。早期发现也将与各州设计《平价医疗法案》基本健康福利要求相关。研究结果将有助于为有关使用保险设计作为实现卫生政策目标的机制的更广泛的辩论提供信息。

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.