Autism Spectrum Disorder (ASD) is a developmental disability that can cause significant social, communication and behavioral challenges. A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified, and Asperger syndrome. Currently, the Center for Disease Control and Prevention estimates that approximately 1 in 68 children have been identified with ASD.
Autism Spectrum Disorder and Medicaid
In response to the increased interest and activity related to ASD, CMS has provided a series of information and guidance intended to increase awareness and understanding of ASD and the role that Medicaid can play in supporting beneficiaries with this diagnosis.
On July 7, 2014, CMS released an Informational Bulletin (PDF, 143.2 KB) to provide information on the options available under the federal Medicaid program for furnishing services to eligible individuals with ASD. The Informational Bulletin outlines the Medicaid coverage categories that are available to cover services to treat ASD. The Bulletin also discusses requirements related to services for individuals eligible for the Medicaid benefit for children (also known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT)) and how states currently furnishing services to treat ASD under a section 1915(c) waiver or section 1915(i) Medicaid state plan amendment may have to transition those individuals to EPSDT coverage.
In addition, on September 24, 2014, CMS released a set of Frequently Asked Questions (PDF, 607.49 KB) (FAQs) to respond to questions raised by states and stakeholders regarding autism services. Additional questions may be directed to the autism services mailbox at AutismServicesQuestions@cms.hhs.gov.
Reports and Research
In January, 2014, CMS released a report entitled, Autism Spectrum Disorders (ASD) State of the States of Services and Supports for People with ASD (PDF, 2.28 MB) which provides a nationwide summary of state services for people with Autism Spectrum Disorder (ASD) and policies related to people with ASD. The report provides information on existing programs and policies in all 50 states and the District of Columbia. The report stemmed from the Interagency Autism Coordinating Committee’s (IACC’s) 2010 and 2011 Strategic Plans. (Note: Due to the size of this report, smaller files of state profiles organized by geographical region and the background information are also available upon request from the Contracting Officer’s Representative listed on the report cover.)
Finally, in 2010, CMS released an environmental scan of the scientific evidence regarding the efficacy, effectiveness, safety, and availability of ASD-related psychosocial services and supports for children, transitioning youth, and adults with ASD. This report, entitled Autism Spectrum Disorders Services: Final Report on Environmental Scan (PDF, 2.22 MB) describes findings from the literature review, including data on the evidence base for interventions for individuals with autism across the age span as well as data on the significant costs associated with caring for individuals with autism.