Table 1.

Overview of Data and Methods Used to Calculate Baseline and Postmandate Utilization, Cost, and Coverage Impacts

Utilization, Cost, and Coverage Components (Varies by Mandate)	Data Sources
Baseline (Premandate)
1. Current utilization levels, and costs of the mandated benefit	Milliman Health Cost Guidelines (HCGs); prevalence of disease estimates for utilization
	Public health or population data estimates of prevalence
2. Current coverage of the mandated benefit, including out of pocket charges, referral requirements, visit or dollar limits	Five largest health plans are mailed a survey of their coverage policies
	Evidence of Coverage; health plan and insurer documents
	Laws or regulations, for public programs
3. Current costs borne by payers (both public and private entities) in the absence of the mandated benefit	HCGs to estimate current out-of-pocket spending
Postmandate
1. Utilization changes	HCGs
	Population surveys and prevalence
	Research on utilization changes for the service or similar services following coverage
	Utilization in plans with full coverage
	Behavioral assumptions based on standard economic theory relating to consumer price and demand
2. Unit cost of the affected services	HCGs
3. Impact on administrative and other expenses	HCGs
4. Impact of the mandate on total health care costs in percentage change and dollars	Total change in costs = change in premiums+change in out-of-pocket expenditures
5. Costs or savings by market segment	Percent and dollar changes in premiums for each market segment, including public sector