Many Steps To Go Before Authorizing Autism Therapy As Benefit, State Says

Paradigm Note: For school districts participating in California’s LEA Medi-Cal Billing Option Program (LEA Program) it’s important to note that these developments, while important, do not impact the list of services that are billable under the LEA program. Behavioral health services are not a covered service under the LEA program and would therefore require a state plan amendment (SPA) to be considered eligible for billing. For the past few years, California’s Department of Health Care Service (DHCS) has been working with the LEA Ad-Hoc Committee to investigate adding behavioral health services as eligible under the program and we will continue to track their progress. 


State officials on Friday said they have not determined whether or not to offer applied behavior analysis (ABA therapy) as a Medi-Cal benefit to children with autism.

Federal officials earlier this month issued guidance on the subject, saying it is covered for Medicaid beneficiaries under age 21 as part of the Early and Periodic Screening, Diagnosis and Treatment program.

“Under the Medicaid state plan, services to address [autism spectrum disorder] may be covered under several different … benefit categories,” the CMS guidance said. For children, it said, “states must cover services that could otherwise be covered at state option under these categories consistent with the provisions … for Early and Periodic Screening, Diagnostic and Treatment services (EPSDT).

According to René Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, there are many steps before determination of coverage can be made.

“We are not changing course on this issue,” Mollow said in an email. “Now that we have federal guidance, we are beginning the process of planning and implementing policy based upon that federal guidance and state statutory requirements.  It is a complex process involving the department and control agencies, stakeholders, Legislature, administration and federal government.”

Read full California Healthline article here…