Analyzing State Autism Private Insurance Mandates for Allied Health Services: A Pilot Study

OTJR (Thorofare N J). 2017 Oct;37(4):218-226. doi: 10.1177/1539449217730355. Epub 2017 Sep 5.

Abstract

Due to the prevalence, severity, and costs associated with autism spectrum disorders (ASDs), it has become a public health issue. In response, state governments have adopted ASD-specific private insurance mandates requiring coverage of ASD screening, diagnosis, and treatment. Despite rapid uptake of these laws, differences exist in the type and levels of coverage, especially for allied health services including occupational therapy. We piloted a structured legal research methodology to code ASD insurance mandates that impact allied health service provisions. State private insurance mandates were obtained from WestlawNext. A coding methodology was piloted on 14 states and included variables for age and service limits, treatments covered, and medical necessity. Coding methods were feasible and highly reliable among raters. Ten of 12 states had a coverage mandate, many with specific provisions for allied health providers. A full analysis of all 50 states is warranted to identify provisions affecting allied health providers serving individuals with ASD.

Keywords: access; autism; insurance; occupational therapy; policy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Allied Health Occupations
  • Allied Health Personnel
  • Autism Spectrum Disorder / economics*
  • Autism Spectrum Disorder / therapy
  • Autistic Disorder / economics
  • Autistic Disorder / therapy
  • Child
  • Child Development Disorders, Pervasive
  • Clinical Coding
  • Health Services / economics*
  • Health Services Accessibility / economics*
  • Humans
  • Insurance Coverage / legislation & jurisprudence*
  • Insurance, Health / legislation & jurisprudence*
  • Mandatory Programs*
  • Pilot Projects
  • State Government*
  • United States
  • Young Adult