Wanchek Tanya, Wehby George
Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA.
Department of Health Management and Policy, College of Public Health, University of Iowa, IA, USA.
Cleft Palate Craniofac J. 2020 Jun;57(6):773-777. doi: 10.1177/1055665620910529. Epub 2020 Mar 16.
We conducted a comprehensive review of state laws and regulations that require private health insurance plans to cover the services needed by children born with cleft lip and/or cleft palate (CL/P). The goal is to better understand how states are reducing the barriers children with CL/P face when seeking recommended health care services.
We identified all state laws and regulations mandating insurance coverage of services for children with CL/P by private insurance carriers from 1999 through 2017 using Westlaw legal database. We categorized laws and regulations into ten services: facial surgery (facial, corrective, reconstructive), oral surgery, orthodontics, dental care, habilitation/rehabilitation/speech therapy, prosthetic treatment, audiology, nutrition counseling, genetic testing, and psychological counseling. We also captured broad mandates indicating coverage for all necessary treatments.
There was a trend toward increased coverage of services for CL/P over time. In 1999, 27 states and Washington, DC did not have relevant laws or regulations. By 2017, there were 19 states without laws or regulations mandating services. The most common mandated service was facial surgery followed by habilitation/rehabilitation/speech therapy, orthodontics, dental care, and oral surgery. Nutrition, audiology, genetic testing and psychological counseling were rarely included in mandated services.
States vary widely in their requirements for coverage of services needed by children with CL/P in private health insurance plans. There has been an increase in mandates over the past two decades to cover services, although significant variation continues to exist across states.
我们对州法律法规进行了全面审查，这些法规要求私人健康保险计划涵盖唇腭裂（CL/P）患儿所需的服务。目标是更好地了解各州如何减少CL/P患儿在寻求推荐的医疗服务时所面临的障碍。
我们使用Westlaw法律数据库，确定了1999年至2017年期间所有要求私人保险公司为CL/P患儿提供保险服务的州法律法规。我们将法律法规分为十项服务：面部手术（面部、矫正、重建）、口腔手术、正畸、牙科护理、 habilitation/康复/言语治疗、假体治疗、听力学、营养咨询、基因检测和心理咨询。我们还记录了表明涵盖所有必要治疗的广泛授权。
随着时间的推移，CL/P服务的覆盖范围有增加的趋势。1999年，27个州和华盛顿特区没有相关法律法规。到2017年，有19个州没有要求提供服务的法律法规。最常见的授权服务是面部手术，其次是habilitation/康复/言语治疗、正畸、牙科护理和口腔手术。营养、听力学、基因检测和心理咨询很少被纳入授权服务。
各州对私人健康保险计划中CL/P患儿所需服务覆盖范围的要求差异很大。在过去二十年中，要求提供服务的授权有所增加，尽管各州之间仍然存在显著差异。
