Analyzing State Autism Private Insurance Mandates for Allied Health Services: A Pilot Study.
Megan D Douglas, Teal W Benevides, Henry Carretta
PMID 28874097WHAT IT FOUND
State autism insurance laws vary widely in age caps and service limits, often restricting coverage for occupational therapy and other allied health services.
Therapists must check specific state mandates for treatment caps and provider licensure requirements to understand what services private insurance will actually pay for.
Key findings
01The pilot study analyzed private insurance laws in 14 states to test a method for coding complex legal provisions regarding autism services.
02Most states imposed age limits on autism-related treatment coverage, with the mean age cap occurring at 13.8 years.
03While most states required coverage of allied health services like OT and speech therapy, specific limits on hours or dollar amounts varied significantly.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This was a pilot study of only 14 states, so the findings do not represent all US states. The analysis only looked at private insurance laws, excluding Medicaid and other public programs. The laws were coded as they existed in 2014, so current laws may have changed. The study tested the feasibility of a coding method, not the actual impact of these laws on patient access or outcomes.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by non-U.S. government, NIH, and U.S. government grants.
The easy way to misread this
Do not assume that a state having an autism insurance mandate means unlimited coverage for allied health services. This study found that most states imposed age caps (mean 13.8 years) and specific dollar or hour limits on services, which can prevent adults and adolescents from receiving necessary therapy.