State Files Autism Benefit Plan to CMS

Last week, California health officials submitted a state plan amendment to federal officials, outlining some of the rules dealing with autism therapy as a Medi-Cal benefit.

The submission by the Department of Health Care Services allows the state to get federal matching funds retroactive to July 7 — the day federal guidance clearly established the benefit — for beneficiaries, plans and providers who could be reimbursed for autism therapy care retroactive to that date.

The state’s submission of a coverage plan included a change to recent policy that had worried advocates. In the original draft of the amendment, an eligibility requirement only allowed coverage to beneficiaries who “… exhibit excesses or deficits of behaviors that significantly interfere with home and community services.”

Advocates asked DHCS to change that provision and it was deleted from the state plan amendment.

In addition, said Kristin Jacobson, president of Autism Deserves Equal Coverage, a statewide advocacy group based in Burlingame, the state also agreed to broaden the benefit language to include other behavioral health treatments beyond applied behavior analysis.

“The fact that the state made two significant changes to this document — those are both signs the state is listening, considering and making changes based on stakeholder input, which is very encouraging,” Jacobson said.

DHCS is holding a stakeholder meeting on autism issues Oct. 16 that may include participation by health plans, Jacobson said.

“The quality of the networks that are being built, and the accessibility of services to families, that’s still the big question,” Jacobson said. “We are encouraged with the process, but are families going to be able to access a meaningful benefit in a timely fashion? That’s what still needs to happen.”

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Capitol Desk Medi-Cal