Human Resources Department 211 South Williams Street Royal Oak, MI 48067

Size: px
Start display at page:

Download "Human Resources Department 211 South Williams Street Royal Oak, MI 48067"

Transcription

1 Human Resources Department 211 South Williams Street Royal Oak, MI Approval of Autism Benefits Rider to the City s Self-insured Health Care Plan for Active Employees March 16, 2015 The Honorable Mayor Ellison and Members of the City Commission: The Human Resources Department has been contacted by three to five employees requesting that the city add the rider for autism spectrum benefits to our health care plan. Each has dependents diagnosed with autism. This rider is required by law for all fully-insured plans. Self-insured plans like ours can voluntarily elect to add this benefit, but are not required to do so. I contacted the supervisor of employee benefits at Oakland County, which is also self-insured. The county voluntarily added the autism spectrum benefits to its self-insured plans in January She said their claim cost for all of 2013 and as of November 2014 was less than $3,000. Cornerstone Benefits, the city s health care consultant is aware of two other self-insured communities within its book of business that have added this benefit voluntarily. One took the position that it would voluntarily add the same benefits that would have been added, had it been fully-insured. Blue Cross advises that adding this rider will not cause an increase to the illustrative rates for which all active employees pay 20 percent. Blue Cross has assigned a formula of $1.50 per member per month to estimate the annual cost of claims for this benefit. Based on our number of active members (employees and covered dependents), this would be $12,888. Public Act 101 of 2012 established the Autism Coverage Reimbursement Program to assist health insurance carriers offset the costs of offering the autism benefits for the diagnosis and treatment of these disorders. This may be of some assistance, however Oakland County was not able to utilize it due to inconsistency with code numbers, but did not pursue it, since its claims cost was lower than the cost of correcting the data. Historically, the city has added benefits that were mandated. When plans were discontinued by carriers, they were eliminated from our offering. When the city wanted to change plans, implement major changes to plans, benefits and/or employee contribution to reduce the cost of health care, it was negotiated with the bargaining units. In this case, we are being asked to add a rider to our plan for active employees that will benefit some members; perhaps more than we are aware, but not all. It should be noted that not all benefits provided through our current plan are necessarily utilized by all who are covered. Cornerstone advises we can provide the benefit to our active employees only. The autism benefits rider is attached for your review (Attachment 1). We recommend the following resolution for adoption:

2 Be It Resolved, the City Commission hereby approves adding the autism benefits rider to the city s self-insured health care plan for active employees. Respectfully submitted, Mary Jo DiPaolo Human Resources Director Approved, Donald E. Johnson City Manager 1 Attachment

3 IMPORTANT KEEP THIS RIDER WITH YOUR CERTIFICATE RIDER CB.AMB ASC COMMUNITY BLUE AUTISM MANDATED BENEFITS (Avatlable to ASC Accounts onlyf AMENDS COMMUNITY BLUE GROUP BENEFITS CERTIFICATE ASC 457r. Rider cb-amb ASC amends the certificates named above to add benefits for the diagnosis and treatment of autism disorders. This rider is effective when you, your employer or remitting agent is notilied. swffi A nonprollt coiporatlolt and indclt adcnt Uccrrce ofthc Blue Croas.!rd BluG Shlcfti AssocLtton

4 The "Coverage for Other Health Care Services' or'what BCBSM Pays For" section ofyour certiflcate ls amended to add benefits for the diagnosis and treatment of autism disorders as follows: Autlsm Disorders Covered Autism Spectrum Disorders We pay for the diagnosis and outpatient treatment of Autism Spectrum Disorders, including: Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified, as described below. Covered Services Diagaostic services must be provided by a licensed physician or a licensed psychologist and include: assessments, evaluations or tests, including the Autism Diagnostic Observation Schedule..^r- Before applied behavior analysis services will be covered, a BCBSMtot6 approved autism evaluation center must evaluate and diagnose the member as having one ofthe covered autism spectrum disorders. Treatment includes the following evidence-based care if prescribed or ordered by a licensed physician or licensed psychologist for a member who has been diagnosed with one of the covered autism spectrum disorders: r Applled behavior analysis treatment. It must be provided or supervised by a board certified behavior analyst or a licensed psychologist so long as the services performed are commensurate with the psychologist's formal university training and supervised experience. Board certified behavior analysts wiii be paid only for applied {0'{6 behavior analysis services. Any other treatment performed by board certified behavior analysts including, but not limited to, treatment of traumatic brain injuries will not be paid' - Applied behavior analysis treatment is covered subject to the following requlrements: r Treatment Plan - Applied behavior analysis treatment must be included in a treatment plan recommended by a BCBSM-approved autism evaluation center that evaluated and diagnosed the member's condition. If requested by BCBSM, the cost of treatment review will be Paid by BCBSM. z

5 Autism Disorders (continued) Covered Services (continued) o Prior Authorization - Applied behavior analysis treatment must be approved for payment through BCBSM's prior authorization process. If prior authorization is not obtained, rendered services will not be covered and the member will be responsible to pay for those services. Prior authorization is not required for any other covered autism services. o Behavioral health treatment. It includes evidence-based counseling that must be provided or supervised by a licensed psychologist, so long as the services performed are commensurate with the psychologist's formal university training and supervised experience.. Psychlatric care. It includes evidence-based direct or consultative services provided by a psychiatrist licensed in the state where the psychiatrist practices.. Psychological care. It includes evidence-based direct or consultative services provided by a psychologist licensed in the state where he/she practices. t tot Benefits for autism disorders are in addition to any psychiatric, psychoiogical and non-applied behavior analysis benelits that may be available under your certificate or related riders. o Therapeutlc care. It includes evidence-based physical therapy, occupational therapy, speech and language pathologr, or other care performed by a licensed certified speech therapist, occupational therapist, physical therapist or social worker. Therapeutic care also includes nutritional therapy performed by a physician and genetic testing as recommended in the treatment plan. Coverase Requirements A11 autism services and treatment must be: Medically necessary and appropriate Comprehensive and focused on managing and improving the symptoms directly related to a member's Autism Spectrum Disorder.

6 Autlsm Dlsorders (continued) Coveraqe Requirements (continued). Deemed safe and effective by BCBSM. 1 Services or treatments that are deemed experimental or /air ilvesligational by BCBSM, such as applied behavior analysis treatment, are covered only when they are approved by BCBSM and included in a treatment plan recommended by the BCBSM-approved autism evaiuation center that evaluated and diagnosed the member's condition. Limltations and Excluslons In addition to those listed in this certificate and any riders that you may have, the following limitations and exclusions apply: o Benehts for applied behavior analysis treatment are limited to children through the age of 18. This age limitation does not apply to psychiatric, psychoiogical, non-appiied behavior analysis services and services to diagnose autism. o Benefrts for line therapy (one facet of applied behavior analysis treatment) are limited to a maximum of 25 hours per member, per week' o Payment for services to treat autism will not count toward any dollar maximums in your coverage including, but not limited to, dollar maximums on psychiatric and psychological services.. Occupational therapy, physical therapy and speech and language patholory services for treatment of autism are subject to the visit limitations that apply to these services (if your certificate has visit limitations). o All autism benefits including, but not limited to, medical-surgical services and/or behavioral health treatment covered under this certificate are subject to any hospital/medical deductibles and coinsurance imposed under this certificate. r Any treatment that is not a covered benefit by BCBSM, including, but not limited to, sensory integration therapy and chelation therapy wiil not be oaid. +

7 Autism Disorders (continued) Llmitations and Excluslons (continued) Conditions such as Rett's Disorder and Childhood Disintegrative Disorder are not payable under this certilicate. When a member is treated with approved services for covered autism disorders, coverage for the services under this autism benefit overrides certain exclusions in your certificate such as the exclusion of: Experimental treatment Treatment of chronic, developmental or congenital conditions Treatment of learning disabilities or inherited speech abnormalities Treatment solely to improve cognition, concentration and/or attentiveness, organizational or problem-solving skills, academic skills, impulse control or other behaviors for which behavior modification is sought. A11 autism services must be provided by professional providers who are registered with BCBSM as a participating or nonparticipating provider.. Applied behavior analysis services rendered outside of Michiean are not covered. 'The Language of Health care'or (Definitions' aection ofyour certificate is anended to add the following deflnitions: Autism Diagnostic Observation Schedule The protocol available through western psychological services for diagnosing and assessing autism spectrum disorders or any other standardized diagnostic measure for autism spectrum disorders that is approved by the Michigai Department of Insurance and Finaacial services, if this department djtermines that the diagnostic measure is recognized by the health care industry and is an evidence-based diagnostic tool. q

8 'The Language of Health Care" or (Definitions' section ofyout certlficate is amended to add the following deflnitions: (continued) Autism Evaluation Center An academic and/or hospital-based, multidiscipiinary center experienced rn the assessment, work-up, evaluation and diagnosis of the autism spectrum disorders. The autism evaluation center must be approved by BCBSM to: o Evaluate and dlagnose the member as having one of the covered autism spectrum disorders and o Recommend an initial high-levei treatment plan for member's with autism spectrum disorders. Autlsm Spectrum Disorders Autism spectrum disorders include Autism Disorder, Autism Pervasive Developmental Disorder Not Otherwise Specified, or Asperger's Disorder, as defined in the most current American Psychiatric Association Diagnostic and Statistical Manual. Behavioral Health Treatment Evidence-based counseling and treatment programs, including applied behavior analysis, that meet both of the following requirements: o Are necessary to develop, maintain, or restore, to the maximum extent practicable, the functioning of an individual.. Are provided or supervised by a board certified behavior analyst or a licensed psychologist so long as the services performed are commensurate with the psychologist's formal university training and supervised experience. Board Certlfied Behavior AnalYst An analyst certified by the Behavior Analyst Certihcation Board (BACB) at the time services are rendered. { Board certified behavior analysts wili be paid only for applied behavior toft analysis services. Any other treatment performed by board certified behavior analysts inciuding, but not limited to, treatment of traumatic brain iniuries will not be Paid. 6

9 'The Language of Health Careo or (Deflnltlons' section ofyour certlflcate ls amended to add the followlng deflnltlons: (continued) Evaluation An evaluation must include a review of the member's clinical history and examination of the member. Based on the member's needs, as determined by the BCBSM-approved treatment center, an evaluation may also include cognitive assessment, audiologic evaluation, a communication assessment, assessment by an occupational or physical therapist and lead screening. Line Therapy Tutoring or other activities performed one-on-one with a person diagnosed with an Autism Spectrum Disorder. Line therapy must be performed in accordance with a treatment plan that has been designed by a BCBSM-approved autism eva-luation center and a board-certihed behavior analvst. Prior Authorization Process A process occurring before treatment is rendered in which a BCBSM nurse or case manager (or a BCBSM delegate/representative) approves all applied behavior ana-lysis services. A request for continued services will be authorized contingent on the member meeting a mutually agreed upon (between BCBSM and the board certified behavior analyst) demonstration of measurable improvement and therapeutic progress, which can typically occur at three, six, or nine month intervals or at other mutually agreed upon intervals after the onset of treatment. crhe Language of Health care'or cdefinitions' section ofyour cerdficate ls amended to revlse the deftnitions below as follows: Professional Provider One of the following:. Doctor of Medicine (M.D.). Doctor of Osteopathy (D.O.) o Podiatrist o Chiropractor. F\rlly iicensed psychologist o Clinical licensed master's social worker o Oral surgeon. Board certified behavior analyst. Other providers as identified by BCBSM Professional providers may also be referred to as "practitioners.n 7

10 'The Language of Health Care'or "Definitlons" sectlon ofyour certlflcate ls amended to revise the deftnittons below as follows: (continued) Treatment Plan A written plan that describes the goals, expected outcomes, type and limited duration of services to be provided to the member under the case management program. The treatment plan may include medically necessary services that BCBSM determines should be covered because of the member's condition as specified in the plan, even if those services are not covered under the patient's hospital and professional certificates. (Such services are referred to as noncontractual services.) All services described in the treatment plan must be ordered by the member's physician. Because plans that include noncontractual services are a binding contract between the member and BCBSM, they must be signed by the member (or representative) and the BCBSM case manager. Treatment Plan for Autism Disorders A written, comprehensive, and individua)ized intervention plan that incorporates specific treatment goals and objectives and that is developed by a board certified or licensed provider who has the appropriate credentials and who is operating within his or her scope of practice, when the treatment of an autism spectrum disorder is first prescribed or ordered by a licensed physician or licensed psychologist. Measurable improvement in the member's condition must be expected from the recommended treatment plan. Once treatment begins, the plan will be subject to periodic assessment by a BCBSM nurse or case manager at three, six and/or nine months or at mutually agreed upon intervals. There are two levels to the treatment plan:. The approved autism evaluation center will recommend an initial highjevel treatment plan. o The board certifred behavior analyst will develop a detailed treatment plan specific to applied behavior analysis treatment. 8

11 GENERAL Until further notice, all the terms, definitions, limitations, exclusions and conditions of your certificate and related riders remain unchanged and in full force and effect, except as provided in Rider CB-AMB ASC. BLUE CROSS BLUE SHIELD OF MICHIGAN Danlel.I. Loepp President and Chlef Enecutlve Ofllcer G t- E FF state approva, "".^:;;:ljl Form No. 538G!r'F' :E-sEg Effective O]-l][ 9

INDIANA: Frequently Asked Questions About the Autism Insurance Reform Law. What does Indiana s Autism Spectrum Disorder Insurance Mandate do?

INDIANA: Frequently Asked Questions About the Autism Insurance Reform Law. What does Indiana s Autism Spectrum Disorder Insurance Mandate do? INDIANA: Frequently Asked Questions About the Autism Insurance Reform Law What does Indiana s Autism Spectrum Disorder Insurance Mandate do? Broadly speaking, the insurance mandate requires insurance providers

More information

MISSOURI. 2. When did the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect?

MISSOURI. 2. When did the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect? MISSOURI FREQUENTLY ASKED QUESTIONS ABOUT THE AUTISM INSURANCE REFORM LAW 1. Generally speaking, what does the Missouri law do? The law requires all group health plans to cover the diagnosis and treatment

More information

LOUISIANA: Frequently Asked Questions About the Autism Insurance Reform Law

LOUISIANA: Frequently Asked Questions About the Autism Insurance Reform Law LOUISIANA: Frequently Asked Questions About the Autism Insurance Reform Law What does the Autism Insurance Act (Act 648) do? Act 648 does several things: 1. Act 648 requires many health insurance plans

More information

Your Anthem Blue Cross HMO Plan Amendment

Your Anthem Blue Cross HMO Plan Amendment Your Anthem Blue Cross HMO Plan Amendment Anthem Blue Cross ( Anthem ) agrees to modify your Combined Evidence of Coverage and Disclosure (Evidence of Coverage) Form by this amendment. All other provisions

More information

FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law. What does the Florida Autism Legislation (Senate Bill Number 2654) do?

FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law. What does the Florida Autism Legislation (Senate Bill Number 2654) do? FLORIDA: Frequently Asked Questions About the Autism Insurance Reform Law What does the Florida Autism Legislation (Senate Bill Number 2654) do? There are three major components of the Florida Autism Legislation,

More information

PENNSYLVANIA'S AUTISM INSURANCE ACT: A FACT SHEET. Prepared by the Disability Rights Network of Pennsylvania

PENNSYLVANIA'S AUTISM INSURANCE ACT: A FACT SHEET. Prepared by the Disability Rights Network of Pennsylvania PENNSYLVANIA'S AUTISM INSURANCE ACT: A FACT SHEET Prepared by the Disability Rights Network of Pennsylvania Prior to the Pennsylvania Autism Insurance Act (sometimes called "Act 62"), 40 P.S. 764h, almost

More information

Referred to Committee on Commerce and Labor. SUMMARY Revises provisions relating to autism spectrum disorders. (BDR 54-67)

Referred to Committee on Commerce and Labor. SUMMARY Revises provisions relating to autism spectrum disorders. (BDR 54-67) A.B. ASSEMBLY BILL NO. COMMITTEE ON COMMERCE AND LABOR (ON BEHALF OF THE LEGISLATIVE COMMITTEE ON HEALTH CARE) PREFILED DECEMBER, 0 Referred to Committee on Commerce and Labor SUMMARY Revises provisions

More information

Autism Insurance Act Frequently Asked Questions and Answers

Autism Insurance Act Frequently Asked Questions and Answers Autism Insurance Act Frequently Asked Questions and Answers Overview What does Autism Insurance Act (Act 62) do? Broadly speaking, Act 62 does three main things: 1. It requires many private insurers to

More information

House File 1 - Introduced

House File 1 - Introduced House File 1 - Introduced HOUSE FILE BY ZIRKELBACH Passed House, Date Passed Senate, Date Vote: Ayes Nays Vote: Ayes Nays Approved A BILL FOR 1 An Act requiring certain group health insurance policies,

More information

15 HB 429/AP A BILL TO BE ENTITLED AN ACT

15 HB 429/AP A BILL TO BE ENTITLED AN ACT House Bill 429 (AS PASSED HOUSE AND SENATE) By: Representatives Stephens of the 164 th, Wilkinson of the 52 nd, Shaw of the 176 th, Dollar of the 45 th, Rogers of the 29 th, and others A BILL TO BE ENTITLED

More information

Applied Behavior Analysis for Autism Spectrum Disorders

Applied Behavior Analysis for Autism Spectrum Disorders Applied Behavior Analysis for Autism Spectrum Disorders I. Policy University Health Alliance (UHA) will reimburse for Applied Behavioral Analysis (ABA), as required in relevant State of Hawaii mandates,

More information

Subject: Health; health insurance; autism spectrum disorders. Statement of purpose: This bill proposes to require health insurers6

Subject: Health; health insurance; autism spectrum disorders. Statement of purpose: This bill proposes to require health insurers6 2010 Page 1 1 2 3 4 5 S.262 Introduced by Senators Carris and Campbell Referred to Committee on Finance Date: Janaury 5, 2010 Subject: Health; health insurance; autism spectrum disorders Statement of purpose:

More information

Medical Policy Original Effective Date: 07-22-09 Revised Date: 01-27-16 Page 1 of 5

Medical Policy Original Effective Date: 07-22-09 Revised Date: 01-27-16 Page 1 of 5 Disclaimer Medical Policy Page 1 of 5 Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans or the plan may have broader or

More information

Be it enacted by the General Assembly of the State of Colorado:

Be it enacted by the General Assembly of the State of Colorado: NOTE: This bill has been prepared for the signature of the appropriate legislative officers and the Governor. To determine whether the Governor has signed the bill or taken other action on it, please consult

More information

Florida Senate - 2016 SB 144

Florida Senate - 2016 SB 144 By Senator Ring 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 A bill to be entitled An act relating to autism; creating s. 381.988, F.S.; requiring a physician, to whom

More information

Board Certified Behavior Analyst and Approved Autism Evaluation Centers. Blue Cross Blue Shield of Michigan Blue Care Network Provider Outreach

Board Certified Behavior Analyst and Approved Autism Evaluation Centers. Blue Cross Blue Shield of Michigan Blue Care Network Provider Outreach Board Certified Behavior Analyst and Approved Autism Evaluation Centers Blue Cross Blue Shield of Michigan Blue Care Network Provider Outreach September 2015 Enrollment Process 2 Enrollment Available networks:

More information

Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder

Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Policy Number: Original Effective Date: MM.12.022 01/01/2016 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration

More information

ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law

ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law ILLINOIS: Frequently Asked Questions About the Autism Insurance Reform Law What does Public Act 95 do? Broadly speaking, the Act does two main things: 1. It requires many private insurers to begin covering

More information

Autism Spectrum Disorder

Autism Spectrum Disorder Autism Spectrum Disorder Benefit information Premera Blue Cross (Premera) administers the Autism Spectrum Disorder (ASD) benefit for all eligible members. This unique benefit provides coverage for behavioral

More information

WVPEIA/WVCHIP Applied Behavior Analysis (ABA) Billing and Payment Policy

WVPEIA/WVCHIP Applied Behavior Analysis (ABA) Billing and Payment Policy WVPEIA/WVCHIP Applied Behavior Analysis (ABA) The practice of Applied Behavior Analysis is defined as the application of the principals, methods, and procedures of the experimental analysis of behavior

More information

How To Get A Health Care Benefit Plan In New Jersey

How To Get A Health Care Benefit Plan In New Jersey State of New Jersey DEPARTMENT OF BANKING AND INSURANCE PO BOX 325 TRENTON, NJ 08625-0325 JON S. CORZINE NEIL N. JASEY Governor TEL (609) 292-7272 Commissioner BULLETIN NO: 10-02 TO: ALL HOSPITAL, MEDICAL

More information

sad EFFECTIVE DATE: 10 01 2013 POLICY LAST UPDATED: 06 02 2015

sad EFFECTIVE DATE: 10 01 2013 POLICY LAST UPDATED: 06 02 2015 Medical Coverage Policy Autism Spectrum Disorders Mandate sad EFFECTIVE DATE: 10 01 2013 POLICY LAST UPDATED: 06 02 2015 OVERVIEW Applied behavioral analysis (ABA) is the process of systematically applying

More information

HB 159 mandates that private insurance provides the following for individuals diagnosed with Autism spectrum Disorders:

HB 159 mandates that private insurance provides the following for individuals diagnosed with Autism spectrum Disorders: HB 159 mandates that private insurance provides the following for individuals diagnosed with Autism spectrum Disorders: "Applied behavior analysis" means the design, implementation, and evaluation of environmental

More information

University of Michigan Group: 007005187-0000, 0001 Comprehensive Major Medical (CMM) Benefits-at-a-Glance

University of Michigan Group: 007005187-0000, 0001 Comprehensive Major Medical (CMM) Benefits-at-a-Glance University of Michigan Group: 007005187-0000, 0001 Comprehensive Major Medical (CMM) Benefits-at-a-Glance This is intended as an easy-to-read summary and provides only a general overview of your benefits.

More information

ATAM Brief: Highlights and Text of the New Minnesota Autism Laws Passed by the Legislature in 2013

ATAM Brief: Highlights and Text of the New Minnesota Autism Laws Passed by the Legislature in 2013 ATAM Brief: Highlights and Text of the New Minnesota Autism Laws Passed by the Legislature in 2013 Reference: HF 1233 Health and Human Services Omnibus Bill Article 7, Sec. 14. [256B.0949] AUTISM EARLY

More information

Insurance Coverage for Autism Spectrum Disorder; HB 2744

Insurance Coverage for Autism Spectrum Disorder; HB 2744 Insurance Coverage for Autism Spectrum Disorder; HB 2744 HB 2744 requires health insurance coverage for the diagnosis and treatment of Autism Spectrum Disorder (ASD) in children under the age of 12 years

More information

Disorders Mandate. Medical Coverage Policy Autism Spectrum EFFECTIVE DATE: 10/01/2013 POLICY LAST UPDATED: 08/05/2014

Disorders Mandate. Medical Coverage Policy Autism Spectrum EFFECTIVE DATE: 10/01/2013 POLICY LAST UPDATED: 08/05/2014 Medical Coverage Policy Autism Spectrum Disorders Mandate EFFECTIVE DATE: 10/01/2013 POLICY LAST UPDATED: 08/05/2014 OVERVIEW Applied behavioral analysis (ABA) is the process of systematically applying

More information

Sixty-second Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 4, 2011

Sixty-second Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 4, 2011 Sixty-second Legislative Assembly of North Dakota In Regular Session Commencing Tuesday, January 4, 2011 SENATE BILL NO. 2155 (Senator J. Lee) AN ACT to create and enact two new sections to chapter 43-32

More information

WVPEIA/AccessWV/WVCHIP Applied Behavior Analysis (ABA)

WVPEIA/AccessWV/WVCHIP Applied Behavior Analysis (ABA) WVPEIA/AccessWV/WVCHIP Applied Behavior Analysis (ABA) Billing and Payment Policy The practice of Applied Behavior Analysis is defined as the application of the principals, methods, and procedures of the

More information

Be it enacted by the People of the State of Illinois,

Be it enacted by the People of the State of Illinois, AN ACT regarding disabled persons. Be it enacted by the People of the State of Illinois, represented in the General Assembly: Section 5. The State Employees Group Insurance Act of 1971 is amended by changing

More information

What is Autism? Autism. Maryland Autism Technical Advisory Group. Autism is a medical condition, brought on through no fault of the family.

What is Autism? Autism. Maryland Autism Technical Advisory Group. Autism is a medical condition, brought on through no fault of the family. Maryland Autism Technical Advisory Group Judith Ursitti, CPA Director, State Government Affiars Autism Speaks What is Autism? Autism is a medical condition, brought on through no fault of the family. Autism

More information

Member s responsibility (deductibles, copays, coinsurance and dollar maximums)

Member s responsibility (deductibles, copays, coinsurance and dollar maximums) MICHIGAN CATHOLIC CONFERENCE January 2015 Benefit Summary This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional limitations

More information

CALIFORNIA. 2. When does the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect?

CALIFORNIA. 2. When does the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect? CALIFORNIA FREQUENTLY ASKED QUESTIONS ABOUT THE AUTISM INSURANCE REFORM LAW 1. Generally speaking, what does the California law do? The law requires that every health care plan contract that provides hospital,

More information

CENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance

CENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance CENTRAL MICHIGAN UNIVERSITY - Premier Plan (PPO1) 007000285-0002 0004 Effective Date: July 1, 2015 Benefits-at-a-Glance This is intended as an easy-to-read summary and provides only a general overview

More information

Public Act No. 15-226

Public Act No. 15-226 Public Act No. 15-226 AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR MENTAL OR NERVOUS CONDITIONS. Be it enacted by the Senate and House of Representatives in General Assembly convened: Section 1. Section

More information

About Special Kids Webinar. Mandate for Autism: What

About Special Kids Webinar. Mandate for Autism: What About Special Kids Webinar Indiana's Insurance Mandate for Autism: What is It and How to Use It! Getting therapies & treatments covered for a child with Autism in Indiana I di i f i b f t t i th US th

More information

MEDICAL POLICY SUBJECT: APPLIED BEHAVIOR ANALYSIS FOR THE TREATMENT OF AUTISM SPECTRUM DISORDERS

MEDICAL POLICY SUBJECT: APPLIED BEHAVIOR ANALYSIS FOR THE TREATMENT OF AUTISM SPECTRUM DISORDERS MEDICAL POLICY SUBJECT: APPLIED BEHAVIOR ANALYSIS FOR PAGE: 1 OF: 7 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product covers

More information

Making it happen HOW TO ACCESS BEHAVIORAL HEALTH TREATMENT SERVICES FROM PRIVATE HEALTH INSURANCE FOR INDIVIDUALS WITH AUTISM A GUIDE FOR PARENTS

Making it happen HOW TO ACCESS BEHAVIORAL HEALTH TREATMENT SERVICES FROM PRIVATE HEALTH INSURANCE FOR INDIVIDUALS WITH AUTISM A GUIDE FOR PARENTS Making it happen HOW TO ACCESS BEHAVIORAL HEALTH TREATMENT SERVICES FROM PRIVATE HEALTH INSURANCE FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDERS A GUIDE FOR PARENTS SECTION 1 SECTION 2 SECTION 3 SECTION

More information

ROLE OF SCHOOL PSYCHOLOGIST AS A RELATED SERVICE PROVIDER

ROLE OF SCHOOL PSYCHOLOGIST AS A RELATED SERVICE PROVIDER ROLE OF SCHOOL PSYCHOLOGIST AS A RELATED SERVICE PROVIDER I. Related Services Definition - IDEA According to the Individuals with Disabilities Education Act, psychological services include: Administering

More information

ValueOptions Autism Care Management Product. Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer

ValueOptions Autism Care Management Product. Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer ValueOptions Autism Care Management Product Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer Autism Spectrum Disorders Background 2 Autism Spectrum Disorders within

More information

Personal Insurance Administrators. Transition of Care (TOC) Approval Guidelines

Personal Insurance Administrators. Transition of Care (TOC) Approval Guidelines Personal Insurance Administrators Transition of Care (TOC) Approval Guidelines 1 Contents Purpose... 3 Medical Care Eligible for Transition of Care (TOC) Approval... 3 TOC Approval Notice... 5 Ancillary

More information

Applied Behavioral Analysis Therapy (ABA)

Applied Behavioral Analysis Therapy (ABA) Applied Behavioral Analysis Therapy (ABA) For all Group Health plans with a benefit (except Microsoft) ABA requires preauthorization for initial and continued therapy. Specific coverage may be defined

More information

2015-2016 Academic Catalog

2015-2016 Academic Catalog 2015-2016 Academic Catalog Autism Behavioral Studies Professors: Kuykendall, Rowe, Director Assistant Professors: Fetherston, Mitchell, Sharma, Sullivan Bachelor of Science in Autism Behavioral Studies

More information

NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES 11 NYCRR 440 (INSURANCE REGULATION 201)

NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES 11 NYCRR 440 (INSURANCE REGULATION 201) NEW YORK STATE DEPARTMENT OF FINANCIAL SERVICES 11 NYCRR 440 (INSURANCE REGULATION 201) PROVIDER REQUIREMENTS FOR INSURANCE REIMBURSEMENT OF APPLIED BEHAVIOR ANALYSIS I, Benjamin M. Lawsky, Superintendent

More information

Self-Funded Health Plans:

Self-Funded Health Plans: Self-Funded Health Plans: Establishing an Autism Benefit Lorri Unumb, Esq. Autism Speaks lorri.unumb@autismspeaks.org What is Autism? Autism is a medical condition, brought on through no fault of the family.

More information

Florida Medicaid and Implementation of SB 2654

Florida Medicaid and Implementation of SB 2654 Florida Medicaid and Implementation of SB 2654 Shachi Mankodi Counsel to the Chief of Staff Florida Agency for Health Care Administration Autism Compact Presentation September 18, 2008 Overview What is

More information

Understanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act

Understanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act Understanding the Mental Health Parity Law An employer s guide to the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 Spring 2009 A b r i e f o v e r v i e w o f

More information

SUBCHAPTER JJ. AUTISM SPECTRUM DISORDER COVERAGE DIVISION 1. GENERAL PROVISIONS 28 TAC 21.4401-21.4404

SUBCHAPTER JJ. AUTISM SPECTRUM DISORDER COVERAGE DIVISION 1. GENERAL PROVISIONS 28 TAC 21.4401-21.4404 Part I. Texas Department of Insurance Page 1 of 8 SUBCHAPTER JJ. AUTISM SPECTRUM DISORDER COVERAGE DIVISION 1. GENERAL PROVISIONS 28 TAC 21.4401-21.4404 INTRODUCTION. The Texas Department of Insurance

More information

Clarification of Medicaid Coverage of Services to Children with Autism

Clarification of Medicaid Coverage of Services to Children with Autism DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 CMCS Informational Bulletin DATE: July 7, 2014

More information

Q & A: Connor's Law and Autism Insurance Reform

Q & A: Connor's Law and Autism Insurance Reform Q & A: Connor's Law and Autism Insurance Reform The following Q & A is intended to help parents navigate complicated insurance issues. It expands on information available in the NH Council on ASD s brochure,

More information

10-144 Chapter 101 MAINECARE BENEFITS MANUAL CHAPTER II SECTION 68 OCCUPATIONAL THERAPY SERVICES ESTABLISHED 9/1/87 LAST UPDATED 1/1/14

10-144 Chapter 101 MAINECARE BENEFITS MANUAL CHAPTER II SECTION 68 OCCUPATIONAL THERAPY SERVICES ESTABLISHED 9/1/87 LAST UPDATED 1/1/14 MAINECARE BENEFITS MANUAL TABLE OF CONTENTS 68.01 PURPOSE... 1 PAGE 68.02 DEFINITIONS... 1 68.02-1 Functionally Significant Improvement... 1 68.02-2 Long-Term Chronic Pain... 1 68.02-3 Maintenance Care...

More information

Alabama Autism Task Force Preliminary Recommendations

Alabama Autism Task Force Preliminary Recommendations Alabama Autism Task Force Preliminary Recommendations Having reviewed the findings to date from the Alabama Autism Collaborative Group (AACG), The Alabama Autism Task Force proposes the following changes

More information

Documentation Guidelines for ADD/ADHD

Documentation Guidelines for ADD/ADHD Documentation Guidelines for ADD/ADHD Hope College Academic Success Center This document was developed following the best practice recommendations for disability documentation as outlined by the Association

More information

American Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717

American Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717 AMENDMENT #4 American Maritime Officers Medical Plan Employer Identification Number: 13-5600786 Plan Number: 501 Group Number: 0081717 This Amendment is duly adopted and effective as of October 1, 2014.

More information

Potential Autism Spectrum Disorder Benefit

Potential Autism Spectrum Disorder Benefit Potential Autism Spectrum Disorder Board of Trustees March 27, 2014 Presentation Summary Recap of BOT interest Update on Autism Spectrum Disorder (ASD) Design Development Comparison of Proposed and HB

More information

Provider Additions and Maintenance

Provider Additions and Maintenance Working with Anthem Subject Specific Webinar Series Provider Additions and Maintenance Access to Audio Portion of Conference: Dial-In Number: 877-497-8913 Conference Code: 1322819809# Please Mute Your

More information

STATE OF MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE SERVICES

STATE OF MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE SERVICES In the matter of STATE OF MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE SERVICES Before the Commissioner of Financial and Insurance Services XXXXX Petitioner File No.

More information

CONSULTATIVE BEHAVIORAL INTERVENTION (CBI) SERVICES SPC 512.10. Applies to CLTS (SED, DD only)

CONSULTATIVE BEHAVIORAL INTERVENTION (CBI) SERVICES SPC 512.10. Applies to CLTS (SED, DD only) CONSULTATIVE BEHAVIORAL INTERVENTION (CBI) SERVICES DEFINITION SPC 512.10 Applies to CLTS (SED, DD only) Consultative Behavioral Intervention (CBI) Services use behavioral treatment methods to change socially

More information

Administrative Guide

Administrative Guide Community Plan KanCare Program Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide Doc#: PCA15026_20150129 UHCCommunityPlan.com Welcome to UnitedHealthcare This administrative

More information

# Category Standard Provisional Standard Notes/Comments

# Category Standard Provisional Standard Notes/Comments Page1 1 Service Definition/ Required Components Therapeutic Rehabilitation Program is rehabilitative service for adults with SMI and children with SED designed to maximize reduction of mental disability

More information

MEDICAL POLICY No. 91579-R4

MEDICAL POLICY No. 91579-R4 *Note: This policy incorporates the previously separate policy Pervasive Developmental Disabilities #91543. Summary of Changes Due to the Patient Protection and Affordable Care Act (PPACA), applied behavioral

More information

1 The following is adapted from Division of Mental Retardation Services, State of Tennessee, Provider Manual,

1 The following is adapted from Division of Mental Retardation Services, State of Tennessee, Provider Manual, Procedure: Applied Behavioral Analysis Origin Date: 01/10/06 / Revised 07/08/09 Approved by Wendy Long, M.D. Page 1 of 5 Applied Behavioral Analysis Medical Necessity Guidelines I. Description of Service

More information

PROVIDER BULLETIN No. 05-05

PROVIDER BULLETIN No. 05-05 PROVIDER BULLETIN No. 05-05 February 15, 2005 TO: FROM: BY: RE: Speech Therapy Providers Mary Steiner, Interim Administrator, Medicaid Division Marsha Rekart, Program Specialist Medicaid coverage of speech

More information

Funding Options for Services

Funding Options for Services PO Box 10806 Austin, TX 78766 www.spectrumsocial.net (512) 524-5482 Funding Options for Services This resource is provided to families as a guide for pursuing possible funding options and should not be

More information

Autistic Disorder Asperger s Disorder Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)

Autistic Disorder Asperger s Disorder Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS) Medical Policy Manual Topic: Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder Date of Origin: January 2012 Section: Behavioral Health Last Reviewed Date: January 2015 Policy No:

More information

MEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY

MEDICAID SERVICES MANUAL TRANSMITTAL LETTER CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL TRANSMITTAL LETTER October 19, 2015 TO: FROM: SUBJECT: CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL CHANGES CHAPTER

More information

TENNCARE MEDICAL NECESSITY GUIDELINES Procedure: Applied Behavioral Analysis Page 2 of 5

TENNCARE MEDICAL NECESSITY GUIDELINES Procedure: Applied Behavioral Analysis Page 2 of 5 Procedure: Applied Behavioral Analysis Origin Date: 1/10/2006, Revised 01/27/ 2015 Approved by: Vaughn Frigon, M.D. Page 1 of 5 Applied Behavioral Analysis Medical Necessity Guidelines I. Description of

More information

Provider Qualifications

Provider Qualifications Provider Qualifications The following establishes general qualifications for providers by type of service. Additional qualifications may need to be met depending on the program and related funding source

More information

this^j?day of March 2015 by Joseph Garcia Special Deputy Director

this^j?day of March 2015 by Joseph Garcia Special Deputy Director STATE OF MICHIGAN DEPARTMENT OF INSURANCE AND FINANCIAL SERVICES Before the Director of Insurance and Financial Services In the matter of: Petitioners v File No. 146715-001 Blue Cross Blue Shield of Michigan

More information

Wisconsin Health Insurance Law Changes

Wisconsin Health Insurance Law Changes Wisconsin Health Insurance Law Changes Section 601.41 concerns the use of a uniform application for individual health insurance and contains the following provisions: 1. OCI is required by rule to prescribe

More information

Please see Section VIII. for Additional Information:

Please see Section VIII. for Additional Information: The Florida Senate BILL ANALYSIS AND FISCAL IMPACT STATEMENT (This document is based on the provisions contained in the legislation as of the latest date listed below.) Prepared By: The Professional Staff

More information

AMENDMENT TO THE REGULATIONS OF THE COMMISSIONER OF EDUCATION. Pursuant to sections 207, 6503-a, 6504, 6507, 6509, 8800, 8801, 8802, 8803,

AMENDMENT TO THE REGULATIONS OF THE COMMISSIONER OF EDUCATION. Pursuant to sections 207, 6503-a, 6504, 6507, 6509, 8800, 8801, 8802, 8803, AMENDMENT TO THE REGULATIONS OF THE COMMISSIONER OF EDUCATION Pursuant to sections 207, 6503-a, 6504, 6507, 6509, 8800, 8801, 8802, 8803, 8804, 8805, 8806, 8807 and 8808 of the Education Law, Chapter 554

More information

Infant & Toddler Connections of Virginia DRAFT Provider Qualifications 1 Table

Infant & Toddler Connections of Virginia DRAFT Provider Qualifications 1 Table Infant & Toddler Connections of Virginia DRAFT Provider Qualifications 1 Table Audiologist Master s degree plus state licensure Specialist Associate Assistant Screening Audiology, Certified Therapeutic

More information

Credentialing and Provider Maintenance

Credentialing and Provider Maintenance Anthem Blue Cross and Blue Shield Credentialing and Provider Maintenance Stacy Smith stacy.smith@bcbswi.com May 25, 2011 Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of

More information

COMMUNITY BLUE GROUP BENEFITS CERTIFICATE SG

COMMUNITY BLUE GROUP BENEFITS CERTIFICATE SG COMMUNITY BLUE GROUP BENEFITS CERTIFICATE SG This contract is between you and Blue Cross Blue Shield of Michigan. Because we are an independent corporation licensed by the Blue Cross and Blue Shield Association

More information

POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES. I. Policy Statement

POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES. I. Policy Statement BOARD OF EDUCATION POLICY 4060 MEDICAID REIMBURSEMENT FOR HEALTH-RELATED SERVICES Effective: July 1, 2009 I. Policy Statement The Board of Education recognizes its responsibilities to provide services

More information

SENATE BILL NO. 2155

SENATE BILL NO. 2155 .00.0000 Sixty-second of North Dakota SENATE BILL NO. Introduced by Senator J. Lee A BILL for an Act to create and enact two new sections to chapter - of the North Dakota Century Code, relating to certification

More information

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES

NEW HAMPSHIRE CODE OF ADMINISTRATIVE RULES. PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES CHAPTER He-M 1300 SPECIALIZED SERVICES PART He-M 1301 MEDICAL ASSISTANCE SERVICES PROVIDED BY EDUCATION AGENCIES Statutory Authority: RSA 186-C:27; I-II He-M 1301.01 Purpose. The purpose of these rules

More information

AUTISM SPECTRUM DISORDER TREATMENTS

AUTISM SPECTRUM DISORDER TREATMENTS AUTISM SPECTRUM DISORDER TREATMENTS Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage

More information

Issued and entered this 14 th day of October 2008 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND

Issued and entered this 14 th day of October 2008 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND STATE OF MICHIGAN DEPARTMENT OF LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE REGULATION Before the Commissioner of Financial and Insurance Regulation In the matter of XXXXX Petitioner File

More information

AN ACT RELATING TO HEALTH INSURANCE; AMENDING A SECTION OF THE NEW MEXICO INSURANCE CODE TO PROVIDE FOR FREEDOM OF CHOICE OF

AN ACT RELATING TO HEALTH INSURANCE; AMENDING A SECTION OF THE NEW MEXICO INSURANCE CODE TO PROVIDE FOR FREEDOM OF CHOICE OF AN ACT RELATING TO HEALTH INSURANCE; AMENDING A SECTION OF THE NEW MEXICO INSURANCE CODE TO PROVIDE FOR FREEDOM OF CHOICE OF HOSPITAL AND PRACTITIONER TO INCLUDE LICENSED PROFESSIONAL MENTAL HEALTH COUNSELORS

More information

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES

NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES NEW YORK STATE MEDICAID PROGRAM REHABILITATION SERVICES POLICY GUIDELINES Version 2015-1 Page 1 of 11 Table of Contents SECTION I REQUIREMENTS FOR PARTICIPATION IN MEDICAID 3 QUALIFIED PRACTITIONERS. 3

More information

Countryway Insurance Company P.O. Box 4851, Syracuse, New York 13221-4851

Countryway Insurance Company P.O. Box 4851, Syracuse, New York 13221-4851 Dear Insured: Please read this letter carefully because it provides specific information concerning how a medical claim under personal injury protection coverage will be handled, including specific requirements

More information

[Provider or Facility Name]

[Provider or Facility Name] [Provider or Facility Name] SECTION: [Facility Name] Residential Treatment Facility (RTF) SUBJECT: Psychiatric Security Review Board (PSRB) In compliance with OAR 309-032-0450 Purpose and Statutory Authority

More information

BCBSM MENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE PROGRAM

BCBSM MENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE PROGRAM BCBSM MENTAL HEALTH AND SUBSTANCE ABUSE MANAGED CARE PROGRAM Professional Provider Participation Agreement This agreement (Agreement) is between Blue Cross Blue Shield of Michigan (BCBSM), and the provider

More information

Chapter. Funding for Treatment of Hearing Impairments

Chapter. Funding for Treatment of Hearing Impairments . Chapter Funding for Treatment of Hearing Impairments Chapter 5 Funding for Treatment of Hearing Impairments Hearing services and devices are paid for directly by hearing impaired people or by private

More information

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Current Approved State Plan Language Limitations on Attachment 3.1-A Page 9 Type of Service Covered for Medi-Cal eligibles under 21 years

More information

Dickinson Wright, PLLC 03956-006

Dickinson Wright, PLLC 03956-006 Dickinson Wright, PLLC 03956-006 Flexible Blue SM Plan 3 Medical Coverage with Preventive Care and Mammography Benefits Benefits-at-a-Glance This is intended as an easy-to-read summary and provides only

More information

Psychological and Neuropsychological Testing

Psychological and Neuropsychological Testing Psychological and Neuropsychological Testing I. Policy University Health Alliance (UHA) will reimburse for Psychological and Neuropsychological Testing (PT/NPT) when it is determined to be medically necessary

More information

L o n g Te r m D i s a b i l i t y I n s u r a n c e. O p t i o n s

L o n g Te r m D i s a b i l i t y I n s u r a n c e. O p t i o n s L o n g Te r m D i s a b i l i t y I n s u r a n c e O p t i o n s Long Term Disability Insurance Group Insurance for School Employees INTRODUCTION This booklet will help you understand MESSA's Optional

More information

Chapter 7 Section 3.18

Chapter 7 Section 3.18 Medicine Chapter 7 Section 3.18 Issue Date: August 10, 2012 Authority: 10 USC 1079(a), Section 705 NDAA FY 2013 Public Law No: 112-239, 32 CFR 199.4(c), and 32 CFR 199.6 1.0 CPT 1 PROCEDURE CODES 1181F,

More information

Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan Medicare Plus Blue Home infusion therapy Applies to: Medicare Plus Blue PPO SM Medicare Plus Blue Group PPO SM X Both Home infusion therapy Home infusion therapy is the continuous, slow administration

More information

Chapter 7 Section 3.19. Applied Behavior Analysis (ABA) For Non- Active Duty Family Members (NADFMs) Who Participate In The ABA Pilot

Chapter 7 Section 3.19. Applied Behavior Analysis (ABA) For Non- Active Duty Family Members (NADFMs) Who Participate In The ABA Pilot Medicine Chapter 7 Section 3.19 Applied Behavior Analysis (ABA) For Non- Active Duty Family Members Issue Date: August 10, 2012 Authority: 10 USC 1079(a), Section 705 NDAA FY 2013 Public Law No: 112-239,

More information

Maximizing Coverage Under the New Jersey Autism & Other Developmental Disabilities Insurance Mandate: A Guide for Parents and Professionals

Maximizing Coverage Under the New Jersey Autism & Other Developmental Disabilities Insurance Mandate: A Guide for Parents and Professionals Maximizing Coverage Under the New Jersey Autism & Other Developmental Disabilities Insurance Mandate: A Guide for Parents and Professionals About Autism New Jersey Autism New Jersey is the state s leading

More information

Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage

Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage Revised October 2012 Note: This information was developed to provide consumers with general information

More information

Maine Bureau of Insurance Form Filing Review Requirements Checklist H21 - Group Basic Hospital Expense (11) (Amended 11/2011)

Maine Bureau of Insurance Form Filing Review Requirements Checklist H21 - Group Basic Hospital Expense (11) (Amended 11/2011) Maine Bureau of Insurance Form Filing Review Requirements Checklist H21 - Group Basic Hospital Expense (11) (Amended 11/2011) REVIEW REQUIREMENTS REFERENCE DESCRIPTION OF REVIEW STANDARDS REQUIREMENTS

More information

Autism Spectrum Disorder: ABA Services Delivery Model for Medicaid & PEBB Gail Kreiger, BSN Manager, Healthcare Benefits and Utilization Management

Autism Spectrum Disorder: ABA Services Delivery Model for Medicaid & PEBB Gail Kreiger, BSN Manager, Healthcare Benefits and Utilization Management Autism Spectrum Disorder: ABA Services Delivery Model for Medicaid & PEBB Gail Kreiger, BSN Manager, Healthcare Benefits and Utilization Management Health Care Services May 2, 2013 What: A benefit for

More information

Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders

Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders Most Frequently Asked Questions about Applied Behavior Analysis Services for the Treatment of Children under 21 with Autism Spectrum Disorders Common Abbreviations ABA Applied Behavior Analysis AHCA The

More information

Please stand by. There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 2/9/2016 1

Please stand by. There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 2/9/2016 1 Please stand by There is no audio being streamed right now. We are doing a audio/sound check before we begin the presentation 2/9/2016 1 Webinar Tips Today s webinar is a one-way audio broadcast through

More information

FAQs Regarding Insurance Funding for Behavioral Health Treatment for Autism and PDD September 28, 2012

FAQs Regarding Insurance Funding for Behavioral Health Treatment for Autism and PDD September 28, 2012 FAQs Regarding Insurance Funding for Behavioral Health Treatment for Autism and PDD September 28, 2012 Please note that this document provides information about a situation that continues to evolve. As

More information