Medi-Cal Update on ABA Coverage

October 9, 2014

Update on ABA Coverage through Medi-Cal Funding

Insurance specialists at Trumpet Behavioral Health are working closely with Medi-Cal representatives to interpret new rules and regulations regarding Behavioral Health Treatment for Autism Spectrum Disorders under Section 1374.73 of the Health and Safety Code. Services under this safety code will be provided through contracted providers. You can call your specific plan administrator to learn more about service options in your area.

Trumpet’s leaders will continue to research and disseminate important information regarding this ruling as it becomes clear. Identified as a stakeholder in the state’s new regulations, Trumpet Behavioral Health is analyzing the appropriate course of action for involvement with exclusive or nonexclusive contracts both statewide and within limited geographic areas, pursuant to DHCS guidance.

DHCS Overview of BHT Interim Policy

Effective August 29th, 2014, Medi-Cal managed care health plans (MCPs) are directed under interim policy guidance for providing Behavioral Health Treatment (BHT) services to Medi-Cal children and adolescent beneficiaries 0 to 21 years of age diagnosed with Autism Spectrum Disorder (ASD).

The Department of Health Care Services (DHCS) intends to provide BHT services as a covered Medi-Cal benefit for individuals 0 to 21 years of age with ASD to the extent required by the federal government.

DHCS will seek federal approval to provide BHT as it is defined by Section 1374.73 of the Health and Safety Code. The DHCS is beginning the process to obtain all necessary federal approvals to secure federal funds for the provision of BHT in Medi-Cal, to seek statutory authority to implement this benefit in Medi-Cal, to seek an appropriation that would provide the necessary state funding, and to consult with stakeholders. The department will further develop and define eligibility criteria, provider participation criteria, utilization controls, and the delivery system for ABA services, subject to the limitations allowed under federal law and provide final policy guidance to Plans as soon as possible.

Read more about interim policy, health plan readiness, recipient criteria for ABA-based therapy services and more here.

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