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Medi-Cal Autism Coverage To Start Soon

In a draft plan for providing autism therapy to Medi-Cal beneficiaries, state officials tentatively set a date of Sept. 15 for the services to begin. Medi-Cal is California’s Medicaid program.

That is big news for low-income families of roughly 4,000 to 6,000 children in California who have need of the medically necessary, standard-of-care treatment known as applied behavior analysis — or ABA therapy, said Kristin Jacobson, president of Autism Deserves Equal Coverage, a statewide advocacy group based in Burlingame.

Some of the details still need to be talked out tomorrow at a stakeholder meeting hosted by the Department of Health Care Services. But with release of a final draft letter last week to managed care health insurers, the state has moved quickly in its implementation plans by setting a tentative start date of Sept. 15 for ABA therapy services, Jacobson said.

“It appears … that life will change on Sept. 15th for families in Medi-Cal who can’t get treatment at the regional centers,” Jacobson said. “That could be very significant for families.”

It’s not just going to benefit families excluded from 21 regional centers across the state — the private not-for-profit companies that operate under contract with the state, to provide or coordinate services for Medicaid beneficiaries with developmental disabilities, including autism.

“Life should also change for those individuals already in regional centers who are not getting ABA therapy, or are getting it in insufficient quantities,” she said. “Those children will also significantly benefit.”

The state wanted to move carefully but quickly to implement federal guidance it received last month from CMS, according to Norman Williams, deputy director of public affairs for DHCS.

“The all plan letter includes interim policy guidance and a proposed effective date of Sept. 15 for medically necessary behavioral health treatment for children and adolescents ages 0 to 21 years with a diagnosis of autism spectrum disorder,” Williams said. 

“DHCS staff will meet with health plans and stakeholders over the next few weeks to answer questions and discuss, finalize and implement the interim policy guidance,” he said.

Payment for ABA therapy will be retroactive to July 7, Williams said, the day DHCS received federal guidance that autism therapy was a Medicaid benefit under Early and Periodic Screening, Diagnosis and Treatment provisions.

“The draft document describes reimbursement processes for services provided to Medi-Cal members prior to Sept. 15, retroactive to July 7,” Williams said.

“It’s clear they’re taking this CMS direction very seriously, and putting steps in place to provide these kids services,” Jacobson said. “I’m optimistic and hopeful that they’re going to take meaningful stakeholder input, and put together a good plan, including a quick timeframe for implementation.”

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