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Autism Insurance Mandates in the US: Comparison of Mandated Commercial Insurance Benefits Across States

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Abstract

Introduction

Autism mandates are laws that require commercial insurers to cover certain evidence-based treatments for Autism Spectrum Disorder (ASD). The purpose of this study was to review state variability in autism insurance mandates and the benefits they cover and to discuss recommendations for research and policy to improve ASD services across states.

Methods

Data were extracted from 2001 to 2020 from all 50 states plus the District of Columbia (N = 51) from policy text. News articles and websites of ASD advocacy organizations were also reviewed to ensure inclusion of the most recent policy changes. Descriptive statistics and heatmaps were used to characterize the autism mandate landscape and visualize variability in benefit parameters across states.

Results

Autism mandates vary greatly in benefit parameters across US states, but there is a common set of benefits that most states have adopted. These include coverage of provider-recommended ASD services except for medical equipment, coverage up to an age limit of 18 to 21, an annual dollar limit of $36,000 with no restriction on the number of hours or visits, no lifetime cap on benefits, and requirement of BCBA® certification or its equivalent for providers of ABA.

Discussion

There is a need for continued research evaluating the impact of autism mandates and benefit parameters on access to care, service utilization, and clinical outcomes for the ASD population. Stakeholder engagement and understanding the impact of autism mandates on clinical and patient-centered outcomes may provide direction for policy advocacy and public health initiatives.

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Author information

Authors and Affiliations

  1. UCLA School of Nursing, 700 Tiverton Ave, Factor Bldg Room 3-238, Los Angeles, CA, 90095, USA

    Kristen R. Choi

  2. Utility for Care Data Analysis, Kaiser Foundation Health Plan, Program Office, One Kaiser Plaza – 21 Bayside, Oakland, CA, 94612, USA

    Elizabeth A. Knight

  3. RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA

    Bradley D. Stein

  4. Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101-2453, USA

    Kristen R. Choi & Karen J. Coleman

Authors
  1. Kristen R. Choi
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  2. Elizabeth A. Knight
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Correspondence to Kristen R. Choi.

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Choi, K.R., Knight, E.A., Stein, B.D. et al. Autism Insurance Mandates in the US: Comparison of Mandated Commercial Insurance Benefits Across States. Matern Child Health J 24, 894–900 (2020). https://doi.org/10.1007/s10995-020-02950-2

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  • DOI: https://doi.org/10.1007/s10995-020-02950-2

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