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Michael Petruzzelli

, National Council for Mental Wellbeing

CMS Releases FAQ on Medicaid’s Role in Covering Autism Services

October 2, 2014 | Medicaid | Comments
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Last week, the Centers for Medicare and Medicaid Services (CMS) released a FAQ on Autism Spectrum Disorder (ASD) and the role Medicaid can play in supporting beneficiaries with ASD. The FAQ also reviewed state obligations under the Early and Periodic Screening Diagnostic and Treatment (EPSDT) and how ASD therapies fit into state plan amendments and home and community based services waivers.

ASDs are comprised of a range of five disorders, from autism to Asperger Syndrome. In July, CMS released a bulletin outlining Medicaid coverage categories that are available to cover services to treat these diseases. In response to questions from states and stakeholders regarding the bulletin, last week CMS published the FAQ.

The FAQ clarifies that CMS has not mandated Applied Behavior Analysis (ABA) services for children under 21 with ASD. The agency further clarifies that ABA “is one treatment modality for ASD” and that “State Medicaid Agencies are responsible for determining what services are medically necessary for eligible individuals” pursuant to “longstanding EPSDT obligations for individuals from birth to age 21, including providing medically necessary services available for the treatment of ASD.”

CMS recognizes that states may not have been focusing on the application of these requirements and may need time to review their current plans to determine if changes are needed. CMS explained there is currently no specific deadline for reviewing state compliance with coverage requirements for children with ASD.