Association for Public Policy Analysis & Management

Behavioral health services for children with autism spectrum disorders (ASD) have often not been covered under private health insurance.  There was hope that the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 would improve access to services under private insurance.  The law required insurers to cover mental health conditions at the same level (e.g., same deductibles and cost sharing, removal of special treatment limits) as other medical conditions.  However, it is unclear whether children with ASD will benefit from the law, which did not specify which mental health conditions must be covered at parity. This is particularly a concern given health insurers’ history of excluding ASD as a covered diagnosis and parental report of difficulty accessing and paying for the extensive services, such as behavioral therapies (e.g., applied behavioral analysis), speech/language services, and physical/occupational therapy, required to treat their child.  No previous work has examined whether the federal parity law has improved receipt of behavioral health care services covered by private insurance and whether there were spillovers in receipt of functional therapies for the growing population of children with ASD. This study used an interrupted time series design to compare changes in use of mental health services and functional services (i.e., speech/language therapy, occupational/physical therapy) among children with ASD, compared with what would have been expected given previous secular trends.  Specific outcomes at the month level included the probability of using services, the quantity of different services used, and spending (including out-of-pocket and total) on each type of service.  Autocorrelation of measures across time was accounted for using Yule-Walker regression models.  The study sample included children ages 0-18 with an ASD diagnosis from the Truven Health MarketScan Commercial Claims and Encounters Database, years 2007-2012 (N=48,568).  This database included all mental and physical health care claims.  Findings indicate that the federal parity law was associated with an increased probability and quantity of receiving mental health, speech/language, and occupational/physical therapy services.   Over a one year period post-parity, this translated into an increase of 1.5 mental health visits, 1.7 speech/language visits, and 0.7 occupational/physical therapy visits for each child receiving such services.  Federal parity was also associated with a small increase in the trend in total health care spending for children with ASD, corresponding to an increase of $80 per year, representing 1% of their total costs.  Despite increases in the number of visits, however, there was no impact of the federal parity law on out-of-pocket spending for mental health or speech therapy care (and only a small increase for OT/PT).  In summary, we found that the federal parity law improved access to care and increased the number of outpatient services received by children with ASD paid for by private insurance without increasing family out-of-pocket costs.