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Event Date: 

Monday, April 15, 2019 - 12:00pmResearch Economist, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention

Event Location: 

1335 Health Sciences Learning Center

Contact Info: 

Rosalind Bendix-Lewis Rosalind.bendixlewis@wisc.edu, (608) 265-0516

PHS Monday Seminar- Scott Grosse, PhD: "Autism Insurance Mandates and Healthcare Expenditures for Children with Autism Spectrum Disorder in Employer-Sponsored Plans, 2007-2014"

Background:
Many states have adopted insurance mandates that require health plans to cover autism-specific services, such as behavioral therapies. We assessed the associations of autism insurance mandates with expenditures for children with continuous enrollment in employer-sponsored plans that were subject to state insurance regulation.

Methods:
We analyzed IBM MarketScan® employer-sponsored health insurance claims data for children with ≥2 autism spectrum disorder (ASD) claims between 2007 and 2014 in 5 states that adopted mandates in 2010 and 16 states with no mandates during the study period. Expenditures included both health plan reimbursements to providers and the amounts payable by patients and families. We calculated pre-mandate and post-mandate mean expenditures per continuously-enrolled (≥330 days) child-year for years when children were aged 3-17 years at the beginning of the year and were enrolled in plans that contributed data for both outpatient pharmacy and behavioral and mental health service claims (i.e., excluding plans with carve-outs). A difference-in-difference analysis computed absolute and relative changes in expenditures between pre-mandate (2007-2009) and post-mandate (2010-2014) periods separately for mandate and non-mandate states stratified by plan type for all children and separately by age groups 3-7, 8-12, and 13-17 years.

Results:
The analysis included expenditure data for 23,819 unique individuals with ASD who met the inclusion criteria. Mean per-person annual expenditures increased overall in state-regulated plans in mandate states by $2,033 (rate ratio [RR]=1.29, p=0.0002) relative to non-mandate states but did not differ for those enrolled in federally-regulated employer-sponsored health plans. The increase in overall expenditures in state plans was primarily driven by a $1,419 (RR=1.93, p

Conclusions:
These data confirm previous findings that autism insurance mandates are associated with large increases in outpatient covered expenditures for children with ASD who are enrolled in health plans that are subject to state mandates. However, the increases in annual spending per child are small relative to the annual cost of behavioral therapy, which can exceed $50,000. Also, we cannot determine to what extent mandates led to increased use of behavioral therapies versus shifting of costs for behavioral therapies previously paid for by families, Medicaid programs, or school systems. Autism mandates were not associated with reduced utilization and spending on hospital care. The increased outpatient ED spending associated with mandates could potentially reflect pediatric ED patients with ASD being more likely to be treated and discharged home rather than admitted as inpatients.

See Dr. Grosse's CDC introductory video Here

Supplemental Materials: 
PDF icon scottcv_2018.pdf