We’re removing age limits for autism spectrum disorder services

We’re removing age limits for autism spectrum disorder services, including applied behavior analysis, or ABA. This change is retroactive to Jan. 1, 2022, to ensure continued access to treatment for Blue Cross Blue Shield of Michigan commercial and Blue Care Network commercial members whose plan benefits include ABA treatment, other autism services or both.

For dates of service on or after Jan. 1, 2022, we’ll reprocess claims for ASD services that were rejected due to age limits. You don’t need to resubmit the claims. 

Members who aged out of eligibility for ASD services in 2022 will remain eligible to continue receiving ASD services that are medically necessary.

Background

Previously, following state of Michigan legal guidelines, children aged out of eligibility for certain ASD services when they turned 19. We’re updating our benefits to allow members over the age of 19 to receive these ASD services when medically necessary.

We’re making this change because recent medical evidence indicates that age limits are no longer an appropriate method for determining whether ABA treatment is medically necessary.

This change is consistent with recent guidance from the Michigan Department of Insurance and Financial Services, and the federal government.

Additional information

We’re updating our Autism Spectrum Disorder Services medical policy and provider communications — including provider manuals — to reflect this change.

We’ll update our certificate and benefit documents to reflect this change by Jan. 1, 2023.