Parity Law Boosted Access to Mental Health Services for Kids With Autism

After the passage of the 2008 Mental Health Parity and Addiction Equity Act, children with autism spectrum disorder (ASD) used more mental health services and functional therapies while out-of-pocket spending remained level, according to a recent study.

The law, which required that commercial insurers cover mental health and substance abuse treatment as fully as they would cover medical services, was the subject of a federal task force report last October which called for stricter enforcement. Still, the results of a new Health Affairs study indicated that families of children with ASD may already be benefiting from the parity law.

The wide range of services recommended to help ease the effects of ASD, including behavioral, speech, occupational, and physical therapies as well as pharmacology and psychotherapy, can cause families to incur significant costs, even with insurance. Since the parity law includes a provision that allows insurers to exclude certain diagnoses, it was possible that many could have dropped ASD coverage and left families to struggle with the bills.

A prior study found no association between mental health parity laws and access to care and spending among children with ASD, but it examined earlier state versions of such laws and used insufficiently specific data from 2005 and 2006. In the current Health Affairs study, researched examined the impact of the federal law among children with ASD covered under private, commercial insurance to determine whether they used more mental health services, spent more on these services, used more functional therapies, and spent more on healthcare overall.

Using a large claims database, the study authors assessed those variables before and after the parity law’s implementation in 2010. They found that the parity law’s passage was followed by an increased rate of change in the use of mental health services, speech and language therapies, and occupational and physical therapies. Among children who had already used certain services, the number of visits also increased after the parity law. For instance, in the year after the law’s implementation, there were 1.6 additional mental health visits per user of mental health services.

There were small increases in the trends of total healthcare spending, with an average increase of $73 per patient, but it appears that these costs were not passed on to families. There were no significant associations between the parity law and out-of-pocket spending, although the trend of families’ spending on occupational and physical therapy services increased slightly. According to the study authors, this finding indicates that the parity law achieved its goal of providing financial protection to affected patients and their families.

Interestingly, the researchers found that the increases in utilization were mainly concentrated among children 12 years or younger, as opposed to those aged 13 to 18. They hypothesized that this was because the adolescent children would receive more care in school settings as opposed to medical practices, that they would seek treatment less frequently as they became older and busier, and that they had fewer treatment choices as many providers only work with younger children.

While the finding of increased service use without concurrent out-of-pocket spending increases was encouraging, the authors cautioned that the utilization rates are still lower than expected considering the rapidly growing population of children diagnosed with ASD. Ultimately, they came to a conclusion similar to that of the White House task force on the parity law’s implementation.

“Our findings suggest that more stringent parity enforcement, additional policy approaches, or both, might be needed to ensure that children with ASD are connected to evidence-based services and supports,” they wrote.