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By Monica E. Oss

Last week I took a look at some of the new prevalence and costs numbers for consumers with autism spectrum disorder (ASD) — see Finding The Opportunities In Serving The 1 In 68. If you are a provider organizations serving this population, the perennial question becomes: What have states done recently to either mandate this coverage or to implement programs that can provide greater access to care?

First, the new mandates — in the last few years, we’ve seen these pile up (see Keeping Up With The New Developments In The Autism Market). Currently, 47 states mandate some form of autism coverage (see State Insurance Mandates for Autism Spectrum Disorder). The good news is that they are working. A recent report found that state autism insurance mandates requiring health plans to provide diagnosis and treatment to children with autism have helped 12% more children with autism obtain treatment (see State Insurance Mandates For Autism Treatment Helped 12% More Children Obtain Treatment).

Most recently we’ve seen the Ohio legislature passed a bill requiring commercial individual and group health plans to cover autism treatment (see Ohio Legislature Passes Autism Insurance Coverage Mandate); and Oklahoma now requires commercial health plans and the state employee health plan to cover services for children diagnosed with autism, including applied behavior analysis (see Oklahoma To Mandate Commercial Coverage Of Autism Services).

What else are states doing to expand and increase access to treatment? Here are some of the most recent developments:

Kansas – The Kansas Medicaid program is planning to move consultative clinical and therapeutic services from an autism specialist; intensive individual supports for individuals with autism; and interpersonal communication therapy, from its Autism Waiver to the state plan under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit. The goal: to increase access to services, remove the wait list, and remove the three-year limit to services (see Kansas Medicaid To Move Three Autism Waiver Services To State Plan).

Nebraska – The Nebraska state Medicaid program will cover behavioral modification services to support the needs children with autism spectrum disorder and other developmental services and their families. Services will include day treatment, community treatment aide, and outpatient therapy. Treatment models approved for coverage include cognitive behavioral therapy, comprehensive behavioral intervention, and applied behavioral analysis (ABA) for children (see Nebraska Medicaid To Cover Behavioral Modification Services For Children With Autism).

South Carolina – South Carolina’s Early Intervention Program, BabyNet, implemented a two-tiered autism screening process with presumptive eligibility (not linked to a formal diagnosis) to serve children more quickly. Only 2.5% of children identified as eligible were later found to not have ASD following a comprehensive evaluation (see South Carolina’s Tiered Screening Process Improved Early Identification Of Children With Autism).

It’s notable that these three state initiatives are focused on children. This is interesting since the majority of the costs in the U.S. health care systems for ASD are directed at the adult population: $175 to $196 billion for adults compared to $61 to $66 billion for children (see Costs of autism spectrum disorders in the United Kingdom and the United States). I’m assuming these new initiatives were developed to get the human and economic benefits of early intervention — see Early Autism Treatment Estimated To Cut Long-Term Costs By 7% and The Economic Consequences Of Autistic Spectrum Disorder Among Children In A Swedish Municipality.

For more on the implications of these changes, check out:

  1. The Growing Opportunity For Community-Based Services For Autism
  2. The ‘Aging Out’ Problem In Autism
  3. An Update On ABA & State Autism Coverage Mandates
  4. An Update On Medicaid Waivers Serving Individuals With Autism
  5. Aging Out Of Autism Services: How Many? What Are Their Options?
  6. Evidence-Based Autism Treatment Now “the Rule” in California Regional Centers
  7. What States Mandate ABA Benefits For Autism Spectrum Disorder?: An OPEN MINDS Market Intelligence Report
  8. An Autism Reality Check
  9. The Autism Mandate Landslide
  10. Autism Coverage Mandates…31 States & Counting

Also, join OPEN MINDS on September 28 for the session, “Diversifying Your Revenue Streams: How To Successfully Launch A New Service Line,” with OPEN MINDS Senior Associate Joe Naughton-Travers at The 2017 OPEN MINDS Executive Leadership Retreat in Gettysburg, Pennsylvania.


New Market Intelligence From OPEN MINDS: State Medicaid Care Coordination & Value-Based Payment Initiatives: An OPEN MINDS Reference Guide

This new OPEN MINDS Reference Guide catalogues the current and future use of the ten most significant Medicaid care coordination and value-based payment initiatives in every state. These ten initiatives include: alternative payment model (APM) requirements in managed care organizations (MCO) contracts; accountable care organizations (ACOs); specialty consumer health plans; health homes; patient-centered medical homes (PCMH); dual eligible demonstration; delivery system reform incentive payment (DSRIP) program; managed long-term services and supports (MLTSS); State Innovation Model (SIM) grants; and Certified Community Behavioral Health Clinics (CCBHC) demonstrations. Use this important tool to track what’s happening in your market and to compare state Medicaid programs across the country. OPEN MINDS Reference Guides are available to all Elite- and Premium-level OPEN MINDS Circle members.

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