The Effects of State and Federal Insurance Policies on Quality of Care for Autism

州和联邦保险政策对自闭症护理质量的影响

• 批准号: 8438010
• 负责人: DOUGLAS L. LESLIE
• 金额: $ 45.05万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-20 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8438010
• 关键词: Address; Affect; Age-Months; Autistic Disorder; Behavior; Behavioral; Caregivers; Caring; Characteristics; Child; Child health care; Cognitive; Communities; Complex; Consensus; Data; Disadvantaged; Disease; Early treatment; Eligibility Determination; Employment; Enrollment; Ethnic Origin; Family; Health Care Reform; Health Insurance; Health Services Accessibility; Healthcare; Home environment; Improve Access; Income; Individual; Insurance; Insurance Carriers; Insurance Coverage; Life; Link; Medicaid; Mental Health; Minority Groups; Outcome; Parents; Physical therapy; Policies; Population; Provider; Qualifying; Quality of Care; Race; Research; Services; Social Interaction; Social Security; Speech Therapy; Statutes and Laws; Surveys; Symptoms; System; Time; Variant; addiction; autism spectrum disorder; community based service; developmental disease; effective therapy; improved; medical specialties; parity; programs; racial and ethnic; racial and ethnic disparities; residence; satisfaction; social communication; tool; waiver

DESCRIPTION (provided by applicant): Autism and other autism spectrum disorders (ASD) are complex developmental disorders characterized by repetitive behavior and delayed social interaction and communication. Autism affects approximately 1 in 110 children, with symptoms occurring as early as 18 months of age and continuing throughout the individual's life. Although there is no consensus about the most effective treatments for ASD, studies have shown early intervention to enhance cognitive and adaptive functioning and early educational attainment. Who pays for ASD services, however, is often unclear. There are considerable differences in states' approaches to financing ASD services and supporting programs for children with ASD. Many states have implemented Home and Community Based Services (HCBS) waivers under their Medicaid programs, which expand coverage to children with ASD who might not otherwise qualify for Medicaid or have access to specialized services. There is considerable variation across states, however, in the number of children included and the services offered. In addition, some states have passed legislation requiring private insurers, who traditionally have limited or excluded coverage for individuals with ASD, to cover specific ASD services or to provide coverage at a level on par with other disorders. The challenges in identifying, accessing, navigating and paying for ASD services available in a given community, given the complexity of a child's needs, available services, and these financing arrangements, can place a substantial burden on parents and caregivers of children with ASD. Although previous studies have examined satisfaction with care and the impact of having a child with ASD on parental income and employment, little is known about the effects of state policies regarding coverage and financing of services for children with ASD on these outcomes, or whether these effects differ by race/ethnicity. This study would explore these effects using data from multiple waves of two national surveys of children's health: the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health. Data from these surveys span the period 2001 through 2011, a time when many states implemented Medicaid waiver programs and passed insurance coverage mandates for ASD. We will examine the effects of these policies on access to care, satisfaction and family burden among children with ASD and their families in both publicly and privately insured populations. We will also explore whether characteristics of the waivers (e.g., eligibility criteria, benefit limits, etc.) or of the mandates (e.g., coverage lmits, whether specific services [such as physical therapy, speech therapy or applied behavioral analysis] must be covered, etc.) are associated with changes in access to care, family burden and satisfaction, and whether these effects differ by race/ethnicity. In addition to informing futue Medicaid HCBS waivers and insurance coverage mandates, the results of the study will be instrumental in implementing the Federal Mental Health Parity and Addiction Equity Act and health care reform. PUBLIC HEALTH RELEVANCE: The challenges in identifying, accessing, navigating and paying for ASD services available in a given community, given the complexity of a child's needs, available services, and financing arrangements, can place a substantial burden on parents and caregivers of children with ASD. Although previous studies have examined satisfaction with care and the impact of having a child with ASD on parental income and employment, little is known about the effects of state policies regarding coverage and financing of services for children with ASD on these outcomes, or whether these effects differ by race/ethnicity. This study would explore these effects using data from multiple waves of two national surveys of children's health: the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health.

描述（由申请人提供）：自闭症和其他自闭症谱系障碍（ASD）是复杂的发育障碍，其特征是重复行为，社交互动和沟通延迟。自闭症会影响110名儿童中的大约1个，症状早在18个月大时就会发生，并在整个人的生活中持续。尽管对ASD的最有效治疗尚无共识，但研究表明，早期干预以增强认知和适应性功能以及早期的教育程度。但是，谁支付ASD服务的费用通常不清楚。各州为ASD服务的融资方法和为ASD儿童提供支持计划的方法存在很大差异。许多州在其医疗补助计划下实施了家庭和社区服务（HCBS）豁免，这些服务扩大了ASD的儿童的覆盖范围，而ASD可能没有资格获得医疗补助或获得专业服务。但是，各州的儿童人数和提供的服务都有很大的差异。此外，一些州已经通过了立法，要求私人保险公司传统上对ASD患者的承保范围有限或排除在外，以涵盖特定的ASD服务或以其他疾病的级别提供覆盖范围。鉴于儿童的需求，可用服务和这些融资安排的复杂性，可以识别，访问，导航和支付给定社区中可用的ASD服务的挑战，这可能会给ASD的父母和护理人员带来重大负担。尽管以前的研究已经检查了对护理的满意度以及让ASD对父母收入和就业的影响的影响，但对国家政策在覆盖和ASD的服务对这些结果的服务的影响和融资的影响知之甚少，或这些影响对这些结果的影响，或者这些影响是否因种族/种族而有所不同。这项研究将使用来自两次国家儿童健康调查的多个浪潮中的数据来探索这些效果：针对特殊医疗保健需求的儿童的全国调查以及全国儿童健康调查。 这些调查的数据跨越了2001年至2011年，许多州都实施了医疗补助计划并通过了ASD的保险范围授权。我们将研究这些政策对公共和私人保险人群中ASD及其家人获得护理，满意度和家庭负担的影响。我们还将探讨豁免（例如，资格标准，收益限制等）的特征还是授权（例如，覆盖范围LMIT，例如特定服务（例如物理治疗，语音治疗或应用行为分析）等）是否与对护理，家庭负担和满意度的访问变化以及种族相差有关。除了告知Futue Medicaid HCBS豁免和保险范围授权外，该研究的结果还将有助于实施《联邦心理健康均等和成瘾权益法》和医疗保健改革。 公共卫生相关性：鉴于儿童需求，可用服务和融资安排的复杂性，识别，访问，导航和支付ASD服务的挑战可能会给ASD的父母和儿童的照顾者带来重大负担。尽管以前的研究已经检查了对护理的满意度以及让ASD对父母收入和就业的影响的影响，但对国家政策在覆盖和ASD的服务对这些结果的服务的影响和融资的影响知之甚少，或这些影响对这些结果的影响，或者这些影响是否因种族/种族而有所不同。这项研究将使用来自两次国家儿童健康调查的多个浪潮中的数据来探索这些效果：针对特殊医疗保健需求的儿童的全国调查以及全国儿童健康调查。