Caring for Patients with ASD and Their Caregivers: Federal and State Autism-Specific Insurance Reform

Kelly, Annemarie M.

doi:10.1001/journalofethics.2015.17.4.hlaw1-1504

Cited by 3 publications

(2 citation statements)

References 2 publications

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“…However, treating ASDs can be expensive, with the estimated annual healthcare expenditures per child being $5979-$22,772, and lifetime direct medical costs of $306,000 (Ganz, 2007; Liptak, Stuart, & Auinger, 2006; Wang & Leslie, 2010). Until recently, ASD services in the US had traditionally been covered by Medicaid and not private insurances (Kelly, 2015; Peele, Lave, & Kelleher, 2002). While Medicaid may provide autism coverage for children with ASD through Home and Community Based Services waiver programs under section 1915(c) of the Social Security Act (Merryman, Miller, Shockley, Eskow, & Chasson, 2015; Velott et al, 2015; Wang & Leslie, 2010), the waiver programs usually have a low quota resulting in many children with ASD being placed on a waitlist, unable to receive the ASD services they need (Eskow, Pineles, & Summers, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Changes in healthcare expenditures after the autism insurance mandate

Wang

Dholakia

et al. 2019

Research in Autism Spectrum Disorders

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Background: In recent years, most U.S. states have passed autism mandates requiring private insurers to cover autism spectrum disorders (ASD). Little is known about the post-mandate changes in healthcare expenditures. Method: This study utilized 2006–2012 de-identified insurance claims data from the largest insurer in Pennsylvania (PA), where the mandate went into effect in 2009. Healthcare expenditures were defined as the amount the insurer paid for healthcare services and were adjusted to 2012 price level. A mixed model approach was used to analyze the expenditures. Results: A total of 9,471 children with ASD were included in the study. Although the pre-mandate total expenditures per child with ASD were similar, the post-mandate expenditures significantly increased for groups subject to the autism mandate (87% increase from $7,754 in 2008 to $14,486 in 2010) compared to the exempt groups (27% increase from $7,238 to $9,171). By insurance type, the change from 2008 to 2010 in ASD-related expenditures per child with ASD was $8,439 for fully insured large employer sponsored plans and $43 for the Children’s Health Insurance Program (CHIP), both subject to the PA mandate; and $2,631 for the self-insured, $980 for small-employers, and $−92 for individual plans, all of which are exempt from the mandate. These increases were due to outpatient services but not inpatient or drug costs. Conclusions: Healthcare expenditures increased significantly following the PA autism mandate. Nonexempt, large employer groups had the largest increase in spending. Some exempt, self-insured companies may have voluntarily covered ASD services, leading to a moderate increase.

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Section: Introductionmentioning

confidence: 99%

“…To improve access to autism care, more and more states have passed autism insurance mandates that require private insurers to provide autism coverage (Autism Speaks, 2018; Kelly, 2015). As of 2017, 46 states plus the District of Columbia have enacted an autism mandate (Autism Speaks, 2018).…”

Section: Introductionmentioning

confidence: 99%

Changes in healthcare expenditures after the autism insurance mandate

Wang

Dholakia

et al. 2019

Research in Autism Spectrum Disorders

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Early Intervention Before Autism Diagnosis in Children Referred to a Regional Autism Clinic

Monteiro

Dempsey

Broton³

et al. 2016

Journal of Developmental &Amp; Behavioral Pediatrics

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Despite concerns that long wait lists for diagnostic ASD evaluations may delay initiation of critical early interventions, our data indicate that most children are receiving early intervention services before their diagnostic ASD evaluations, particularly if an ASD diagnosis is confirmed. This may be attributable to increased awareness among primary care providers and families of the importance of early interventions. Further investigation into access to more intensive interventions (such as applied behavioral analysis) once an ASD diagnosis is established is warranted.

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Implementing early intensive behavioral intervention in community settings

Plavnick

Bak

Avendano

et al. 2020

Autism

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Although research shows early intensive behavioral intervention is efficacious when delivered in university or private intervention centers, little is known about effectiveness or feasibility of disseminating early intensive behavioral intervention to larger communities. The Michigan State University Early Learning Institute was developed to address gaps in distribution of early intensive behavioral intervention to community settings, with an emphasis of serving children and families on Medicaid. This short report describes the Early Learning Institute’s approach and preliminary utilization data among Medicaid families. Results suggest the model has potential for dissemination within community settings and promote utilization among Medicaid children. Lay abstract Although research shows early intensive behavioral intervention can be very beneficial for children with autism spectrum disorder when delivered in university or private intervention centers, little is known about the best way to provide early intensive behavioral intervention within the broader community. The Michigan State University Early Learning Institute was developed to address challenges with providing early intensive behavioral intervention in community settings, with an emphasis on serving children and families on Medicaid. This short report describes the approach taken by the Early Learning Institute and reports data regarding enrollment and utilization among Medicaid families. Results suggest the model has potential to be used within community settings and that children on Medicaid are likely to consistently attend their treatment sessions.

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Caring for Patients with ASD and Their Caregivers: Federal and State Autism-Specific Insurance Reform

Cited by 3 publications

References 2 publications

Changes in healthcare expenditures after the autism insurance mandate

Changes in healthcare expenditures after the autism insurance mandate

Early Intervention Before Autism Diagnosis in Children Referred to a Regional Autism Clinic

Implementing early intensive behavioral intervention in community settings

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