UCLA School of Nursing, 700 Tiverton Ave, Factor Bldg Room 3-238, Los Angeles, CA, 90095, USA.
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101-2453, USA.
Matern Child Health J. 2020 Jul;24(7):894-900. doi: 10.1007/s10995-020-02950-2.
Autism mandates are laws that require commercial insurers to cover certain evidence-based treatments for Autism Spectrum Disorder (ASD). The purpose of this study was to review state variability in autism insurance mandates and the benefits they cover and to discuss recommendations for research and policy to improve ASD services across states.
Data were extracted from 2001 to 2020 from all 50 states plus the District of Columbia (N = 51) from policy text. News articles and websites of ASD advocacy organizations were also reviewed to ensure inclusion of the most recent policy changes. Descriptive statistics and heatmaps were used to characterize the autism mandate landscape and visualize variability in benefit parameters across states.
Autism mandates vary greatly in benefit parameters across US states, but there is a common set of benefits that most states have adopted. These include coverage of provider-recommended ASD services except for medical equipment, coverage up to an age limit of 18 to 21, an annual dollar limit of $36,000 with no restriction on the number of hours or visits, no lifetime cap on benefits, and requirement of BCBA® certification or its equivalent for providers of ABA.
There is a need for continued research evaluating the impact of autism mandates and benefit parameters on access to care, service utilization, and clinical outcomes for the ASD population. Stakeholder engagement and understanding the impact of autism mandates on clinical and patient-centered outcomes may provide direction for policy advocacy and public health initiatives.
自闭症保险法案是指要求商业保险公司为自闭症谱系障碍（ASD）的某些循证治疗提供保险的法律。本研究旨在综述各州自闭症保险法案的差异以及涵盖的福利，并讨论改善各州 ASD 服务的研究和政策建议。
本研究从 2001 年至 2020 年，从 50 个州和哥伦比亚特区（N=51）的政策文本中提取数据。此外，还查阅了自闭症倡导组织的新闻文章和网站，以确保纳入最新的政策变化。采用描述性统计和热点图来描述自闭症保险法案的概况，并可视化各州之间福利参数的差异。
美国各州的自闭症保险法案在福利参数方面差异很大，但大多数州都采用了一套共同的福利。这些福利包括涵盖提供者推荐的 ASD 服务，但不包括医疗设备；保障年龄在 18 至 21 岁以下的儿童；每年最高 36000 美元的福利金额限制，没有时间或就诊次数的限制；没有福利终身上限；并且要求提供 ABA 的服务提供商具备 BCBA®认证或同等认证。
需要持续开展研究，评估自闭症保险法案和福利参数对 ASD 患者获得医疗服务、服务利用率和临床结果的影响。利益相关者的参与以及了解自闭症保险法案对临床和以患者为中心的结果的影响，可能为政策倡导和公共卫生举措提供方向。
