{"id":11822,"date":"2014-11-26T09:00:29","date_gmt":"2014-11-26T13:00:29","guid":{"rendered":"http:\/\/www.wrightslaw.com\/blog\/?p=11822"},"modified":"2014-11-25T13:55:42","modified_gmt":"2014-11-25T17:55:42","slug":"medicaid-coverage-feds-clarify-obligations-to-kids-with-autism","status":"publish","type":"post","link":"https:\/\/www.wrightslaw.com\/blog\/medicaid-coverage-feds-clarify-obligations-to-kids-with-autism\/","title":{"rendered":"Medicaid Coverage: Feds Clarify Obligations To Kids With Autism"},"content":{"rendered":"<div style=\"padding-bottom:20px; padding-top:10px;\" class=\"hupso-share-buttons\"><!-- Hupso Share Buttons - https:\/\/www.hupso.com\/share\/ --><a class=\"hupso_pop\" href=\"https:\/\/www.hupso.com\/share\/\"><img decoding=\"async\" src=\"https:\/\/static.hupso.com\/share\/buttons\/gallery\/share-button-gray.png\" style=\"border:0px\" alt=\"Share\" \/><\/a><script type=\"text\/javascript\">var hupso_services=new Array(\"Twitter\",\"Facebook\",\"Google Plus\",\"Pinterest\",\"Linkedin\",\"StumbleUpon\",\"Digg\",\"Reddit\",\"Bebo\",\"Delicious\");var hupso_icon_type = \"labels\";var hupso_background=\"#FFFFFF\";var hupso_border=\"#FFFFFF\";var hupso_image_folder_url = \"\";var hupso_twitter_via=\"wrightslaw\";var hupso_url=\"\";var hupso_title=\"Medicaid%20Coverage%3A%20Feds%20Clarify%20Obligations%20To%20Kids%20With%20Autism\";<\/script><script type=\"text\/javascript\" src=\"https:\/\/static.hupso.com\/share\/js\/share.js\"><\/script><!-- Hupso Share Buttons --><\/div><h6 style=\"padding-left: 120px;\"><a href=\"http:\/\/www.disabilityscoop.com\/2014\/07\/17\/feds-clarify-kids-autism\/19519\/\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter\" src=\"https:\/\/www.wrightslaw.com\/blog\/images\/uploads\/ds140717_autism_therapy.jpg\" alt=\"\" width=\"500\" height=\"333\" \/><span style=\"color: #999999;\">Melanie Feazell works with Declan Byrne during an ABA session. Federal officials say states must provide treatment services like ABA for kids with autism on Medicaid. (Francine Orr\/Los Angeles Times\/MCT)<\/span><\/a><\/h6>\n<p>&nbsp;<\/p>\n<p>&#8220;<strong>Medicaid programs nationwide must offer <em>medically necessary diagnostic and treatment services<\/em> to kids\u00a0with autism<\/strong>, the Centers for Medicare and Medicaid Services told states in a bulletin earlier this month. (From <a href=\"http:\/\/www.disabilityscoop.com\/2014\/07\/17\/feds-clarify-kids-autism\/19519\/\"><span style=\"color: #000080;\">Disability Scoop<\/span><\/a>, July 17, 2014). That includes everything from speech and occupational therapy to personal care services and medical equipment, the agency said.&#8221;<\/p>\n<p><a href=\"http:\/\/www.medicaid.gov\/Federal-Policy-Guidance\/Downloads\/CIB-07-07-14.pdf\"><span style=\"color: #000080;\">Clarification of Medicaid Coverage of Services to Children with Autism<\/span><\/a>, Informational Bulletin (July 7, 2014)\u00a0 from the Department of Health and Human Services, Centers for Medicare &amp; Medicaid Services, (CMS).<!--more--><\/p>\n<p>&#8220;The services must be included in what\u2019s known as the Early and Periodic Screening, Diagnosis and Treatment program, or EPSDT, a package of offerings that every state is required to provide children under age 21 who qualify for Medicaid.<\/p>\n<p>The move comes in response to an increasing number of inquiries in recent years from states facing legal action for denying services to Medicaid beneficiaries with autism, Melissa Harris, director of the Division of Benefits and Coverage at CMS, told members of the Interagency Autism Coordinating Committee recently.<\/p>\n<p>Many of the court cases focused on coverage of ABA therapy, though Harris said that CMS was careful not to single out ABA or any other specific treatment in its directive to states.&#8221;<\/p>\n<p>Full article published July 17, 2014 at <a href=\"http:\/\/www.disabilityscoop.com\/2014\/07\/17\/feds-clarify-kids-autism\/19519\/\"><span style=\"color: #000080;\">Disability Scoop<\/span><\/a><\/p>\n<p><strong>EPSDT Benefit &#8211; Early and Periodic Screening, Diagnosis and Treatment<br \/>\n<\/strong><\/p>\n<p>Michelle Andrews\u00a0(NPR, August 26, 2014) explained, &#8220;The EPSDT benefit, as it&#8217;s called, covers any services that are medically necessary to correct or ameliorate physical or behavioral conditions in children and young people up to age 21.&#8221;<\/p>\n<p>In <a href=\"http:\/\/www.npr.org\/blogs\/health\/2014\/08\/26\/343206636\/federal-officials-order-medicaid-to-cover-autism-services\"><span style=\"color: #000080;\">Federal Officials Order Medicaid To Cover Autism Services<\/span><\/a>\u00a0 she reported that:<\/p>\n<p>&#8220;&#8230;comprehensive autism services must be covered for children under all state Medicaid and Children&#8217;s Health Insurance Program plans, another federal-state partnership that provides health coverage to lower-income children.&#8221;<\/p>\n<p>&#8220;The new coverage guidelines apply to children with autism spectrum disorder, a group of developmental conditions including autistic disorder and Asperger&#8217;s syndrome.&#8221;<\/p>\n<p>&#8220;Although coverage of applied behavioral analysis, which uses positive reinforcement and other techniques to encourage behavior change, isn&#8217;t explicitly required, advocates expect it will be covered.&#8221;<\/p>\n<p>&#8220;But the new policy is important because it requires mandatory coverage for everybody under 21, says Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage, a Burlingame, Calif.-based advocacy group.&#8221;<\/p>\n<p><a href=\"http:\/\/mchb.hrsa.gov\/epsdt\/\"><span style=\"color: #000080;\">EPSDT<\/span><\/a> from DHHS, Maternal and Child Health<\/p>\n<p>Links<\/p>\n<p><a href=\"http:\/\/www.disabilityscoop.com\/2014\/07\/17\/feds-clarify-kids-autism\/19519\/\"><span style=\"color: #000080;\">http:\/\/www.disabilityscoop.com\/2014\/07\/17\/feds-clarify-kids-autism\/19519\/<\/span><\/a><\/p>\n<p><a href=\"http:\/\/www.npr.org\/blogs\/health\/2014\/08\/26\/343206636\/federal-officials-order-medicaid-to-cover-autism-services\"><span style=\"color: #000080;\">http:\/\/www.npr.org\/blogs\/health\/2014\/08\/26\/343206636\/federal-officials-order-medicaid-to-cover-autism-services<\/span><\/a><\/p>\n<p><a href=\"http:\/\/www.medicaid.gov\/Federal-Policy-Guidance\/Downloads\/CIB-07-07-14.pdf\"><span style=\"color: #000080;\">http:\/\/www.medicaid.gov\/Federal-Policy-Guidance\/Downloads\/CIB-07-07-14.pdf<\/span><\/a><\/p>\n<p><a href=\"http:\/\/mchb.hrsa.gov\/epsdt\/\"><span style=\"color: #000080;\">http:\/\/mchb.hrsa.gov\/epsdt\/<\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Melanie Feazell works with Declan Byrne during an ABA session. Federal officials say states must provide treatment services like ABA for kids with autism on Medicaid. (Francine Orr\/Los Angeles Times\/MCT) <a class=\"more-link\" href=\"https:\/\/www.wrightslaw.com\/blog\/medicaid-coverage-feds-clarify-obligations-to-kids-with-autism\/\">Continue Reading \u2192<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[1271],"tags":[42,1209,1203,376],"class_list":["post-11822","post","type-post","status-publish","format-standard","hentry","category-autism","tag-autism","tag-epsdt","tag-federal-policy-guidance","tag-medicaid"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/posts\/11822","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/comments?post=11822"}],"version-history":[{"count":23,"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/posts\/11822\/revisions"}],"predecessor-version":[{"id":12050,"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/posts\/11822\/revisions\/12050"}],"wp:attachment":[{"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/media?parent=11822"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/categories?post=11822"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.wrightslaw.com\/blog\/wp-json\/wp\/v2\/tags?post=11822"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}