Re-evaluation of applied behavior analysis autism treatment only required in certain instances

After careful consideration, Blue Cross Blue Shield of Michigan and Blue Care Network have determined that a re-evaluation of applied behavior analysis autism treatment every three years will only be required when:

• A member has shown only minimal progress in autism treatment.
• There is a significant question about the continued accuracy of a member’s diagnosis or treatment plan.

Note: State of Michigan employees, URMBT members, Denso Corporation employees and other group accounts not managed by New Directions, our behavioral health care manager, aren’t affected by this change.

Background
As part of the state’s autism mandate, insurance companies may require a re-evaluation of ABA autism treatment for members at three-year intervals. Because the mandate went into effect three years ago, many of our members are now approaching the time that re-evaluation would be required.

Blue Cross and BCN have decided that a mandatory review isn’t needed for many of our members who are receiving ABA autism treatment. We expect that those needing re-evaluation and redirection of their ABA treatment will be identified through the continual monitoring and evaluation providers are doing in conjunction with New Directions’ behavioral health care managers.

We also rely on providers to identify a member’s additional needs during the utilization review process, which may include various evaluations (psychiatric, pediatric, neurological, speech therapy, occupational therapy, physical therapy, etc.) and services. These needs should be discussed by the providers and the behavioral health care managers as part of the ongoing utilization management process for a member in ABA treatment. We may also require annual developmental testing to measure treatment progress.

Collaboration is key
Blue Cross and BCN appreciate the collaborative relationship we have with our autism treatment providers and their treatment teams. We also know how crucial this collaboration is to our members’ achieving enhanced functioning within their family and social networks.

For more information
You can find more information on autism on web-DENIS.

• Click on BCBSM Provider Publications and Resources.
• Click on Newsletters & Resources.
• Click on Clinical Criteria & Resources.
• Under Resources, click on Autism.