Evaluating the Effects of Autism Insurance Mandates

描述（由申请人提供）：30个州颁布了法律，要求私人保险公司承担诊断和治疗自闭症谱系障碍（ASD）的服务。从历史上看，私人保险公司不包括或只提供最低限度的ASD保险。关于这些法律有很多争论。提倡者认为，法案的通过将扩大专业治疗的可及性。随着覆盖面的扩大，家庭将有更多的机会和动力使用私人保险来支付孩子的护理费用。然而，这些法律将如何实施还存在不确定性。州的规定要求私人保险公司承担必要的医疗服务，然而，由于对自闭症儿童的医疗必要治疗的定义存在混淆，保险公司可能会选择不承担某些服务。同样，提供者网络可能无法满足对ASD服务日益增长的需求，特别是如果报销率设定在阻止临床医生进入市场的水平。为了提供有关这些规定的影响的经验证据，我们与OptumHealth合作，OptumHealth是United Health Group的子公司，这是一个大型健康保险计划，在2009年至2012年期间在25个实施自闭症规定的州运营，在此期间在23个没有自闭症规定的州运营。我们建议：1)研究各州自闭症授权对自闭症儿童治疗患病率的影响；2)研究各州自闭症授权对自闭症儿童治疗服务使用模式和提供者报销率的影响；3)研究各州自闭症授权对私人保险覆盖的自闭症儿童使用服务支出的影响；4)探索不同州自闭症授权实施的异质性。对于目标1-3，我们将使用健康保险索赔来进行差异中差异分析，通过比较以下结果来检验州授权的影响：1)在授权州参加完全保险健康计划的儿童，这些健康计划受这些授权的约束；2)在授权州参加自我保险健康计划的儿童，他们不受这些授权的约束；3)在非授权州参加完全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新的国家级政策举措的影响。对于目标4，我们将采访保险管理人员、供应商组织和消费者权益组织，以探索使用索赔数据难以研究的授权的潜在影响，包括各州在授权执行方面的差异，以及对健康计划内外提供和支付的护理的影响。其他州正在努力制定类似的立法，但没有任何证据表明自闭症法令的影响，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》的基本健康福利要求有关。研究结果将有助于为关于使用保险设计作为实现卫生政策目标的机制的更广泛辩论提供信息。

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.