The Fiscal Impact of Autism Insurance Reform

Recognizing the significance of early intervention for Autism Spectrum Disorders (ASD), 29 states have enacted laws for autism insurance reform. These laws mandate that health insurance providers cover medically necessary treatments for ASD, including behavioral health treatments like Applied Behavior Analysis (ABA).

To assess the financial impact of autism insurance reform, Autism Speaks has been collecting claims data from states where these laws apply to state employee health plan members with at least one year of implementation.

Interpretive Summary:

1. Autism insurance reform laws have been in effect for at least one year in 15 states. Out of these, 12 states require coverage for members of their state employee health plan, and the specific coverage details are outlined in Appendix 1.
2. Requests for claims data have been made to all 12 states. Data has been received from 6 states, presented in Appendix 2.
3. Claims data is available for the first year of implementation in 5 states (SC, IL, FL, AZ, and KY). The coverage costs in the first year range from $0.09 per member per month (PMPM) to $0.30 PMPM, with an average of $0.15 PMPM (Table 1).
4. Claims data is available for the second year of implementation in 5 states (SC, IL, LA, FL, and AZ). The coverage costs in the second year range from $0.10 PMPM to $0.43 PMPM, with an average of $0.31 PMPM (Table 2).
5. Although Minnesota hasn’t implemented autism insurance reform, due to a settlement of litigation against Blue Cross and Blue Shield of Minnesota, they have been providing unlimited coverage for ASD treatment since 2001. After six years, the premium impact on the commercial market resulting from unlimited coverage for ASD was $0.83 PMPM (BCBS Minnesota).
6. Fiscal notes were prepared for legislatures in 5 states where claims data was obtained. These cost projections, corresponding to fiscal or calendar years, overestimated the actual cost of autism insurance reform by 293% to 1,261% (Table 3).

It is vital to acknowledge that autism insurance reform has increased access to necessary treatments and services for individuals and families affected by ASD. The collected data and cost analyses provide a deeper understanding of the financial implications of these laws, which can inform future policies and decision-making related to autism.

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Recognizing the Significance of Early Intervention

If you found the information on autism insurance reform and its financial impact interesting, you may want to explore other pages on the site that provide relevant and valuable content on Autism Spectrum Disorders and early intervention. Here are some suggestions:

1. Understanding Autism
   • This page will provide a comprehensive overview of Autism Spectrum Disorders, including common characteristics, diagnosis, and treatment options.
2. Early Intervention for Autism
   • Learn about the importance of early intervention in supporting individuals with Autism Spectrum Disorders. This page covers evidence-based intervention strategies and the benefits of starting interventions young.
3. Applied Behavior Analysis (ABA) Therapy
   • Gain insights into Applied Behavior Analysis, a widely recognized treatment approach for individuals with autism. Discover how ABA therapy focuses on modifying behavior and developing essential skills.
4. Legislation and Advocacy
   • Explore the legislative efforts and advocacy initiatives aimed at improving the lives of individuals with Autism Spectrum Disorders. Stay informed about the latest developments in autism insurance reform and other policy changes.
5. Family Resources
   • Find a compilation of resources and support networks for individuals and families affected by Autism Spectrum Disorders. The page includes information on support groups, educational materials, and practical tips for caregivers.

Feel free to explore these pages to broaden your understanding of autism-related topics and gather further insights into the crucial aspects of early intervention and support for individuals with Autism Spectrum Disorders.