Douglas Megan D, Benevides Teal W, Carretta Henry
1 Morehouse School of Medicine, Atlanta, GA, USA.
2 Augusta University, Augusta, GA, USA.
OTJR (Thorofare N J). 2017 Oct;37(4):218-226. doi: 10.1177/1539449217730355. Epub 2017 Sep 5.
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.
由于自闭症谱系障碍（ASD）的普遍性、严重性以及相关成本，它已成为一个公共卫生问题。作为回应，州政府已通过针对ASD的私人保险授权，要求涵盖ASD筛查、诊断和治疗。尽管这些法律迅速得到采用，但在保险范围的类型和水平上仍存在差异，尤其是对于包括职业治疗在内的联合健康服务。我们试点了一种结构化的法律研究方法，对影响联合健康服务提供的ASD保险授权进行编码。州私人保险授权来自WestlawNext。在14个州试点了一种编码方法，包括年龄和服务限制、涵盖的治疗以及医疗必要性等变量。编码方法在评估者之间是可行且高度可靠的。12个州中有10个州有保险覆盖授权，许多州对联合健康提供者有具体规定。有必要对所有50个州进行全面分析，以确定影响为患有ASD的个人提供服务的联合健康提供者的规定。
