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Autism Advocates Burn Over State Plan

State officials last week released a draft of criteria for Medi-Cal beneficiaries to get autism therapy and children’s advocates called the proposed requirements onerous and a barrier to accessing care.

The Department of Health Care Services released for public review on Nov. 12 a letter to managed care health plans that serve Medi-Cal beneficiaries.

The letter outlines the process for autism diagnosis and rules that need to be met in treating it. According to Julie Kornack, senior public policy analyst at the Center for Autism and Related Disorders, based in Woodland Hills, those requirements are excessive and will impede access to care for many of the estimated 75,000 Medi-Cal kids in California with autism.

“These are the most onerous [conditions] I’ve seen in the country because of the multi-disciplinary requirements,” Kornack said. “For them to create administrative and diagnostic barriers, that’s just putting up barriers to people who need services.”

In response to questions, DHCS spokesperson Anthony Cava provided a written statement that said, in part:

“DHCS continues to work closely with the Department of Developmental Services, managed care plans, regional centers and stakeholders to cover behavioral health treatment for children with autism spectrum disorder under the Early and Periodic Screening, Diagnostic, and Treatment benefit,” the statement said.

“Nearly 3,000 managed care members are currently receiving BHT services and thousands more have been referred for a comprehensive diagnostic evaluation or behavioral assessment.” 

Cava’s statement also referred to the DHCS decision to delay till Feb. 1 the transition of services from regional centers to DHCS and its managed care plans.

“This delay will provide additional time for DHCS and DDS to prepare for the transition,” the statement said. “DHCS is committed to a thoughtful and deliberate transition for this population.  We have worked extensively with parents, advocates, and providers over the last several months.  Once we have secured federal approval of our State Plan Amendment, we will resume discussions about the final stages required by the addition of this new benefit.”

Advocates criticized several specific parts of the guideline, including:

  • A lengthy diagnostic assessment needs to be completed for every Medi-Cal beneficiary of autism therapy, even if a child has already been diagnosed;
  • The state wants an assessment by a speech pathologist and occupational therapist before treatment can begin;
  • Therapy cannot be conducted in a school setting;
  • A cap of 40 hours has been proposed for autism services, and any hours spent in school count against those hours; and
  • Participating providers need to file a status update every month to managed care plans.

“That’s ridiculous,” Kornack said, adding that she doesn’t know of any other mental health therapy that requires monthly evaluations. “The plans can ask for that information anytime they want,” she said. “For them to require monthly reporting, it’s just onerous and limiting and it’s going to make providers not participate.”

Comments on the guidelines are due to DHCS by Friday this week.

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