Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered for children, from birth to age nineteen (19) or up to age twenty-two (22) if enrolled in high school, in accordance with state mandated benefits as follows: o Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well-Child or well-baby screening and/or o Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Important Infor ation These services are only Covered when a treatment plan is provided to our Health Services Department prior to services being obtained. The Health Services Department will review the treatment plans in accordance with state mandated benefits. m Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. Limitation – Services received under the federal Individuals with Disabilities Education Improvement Act of 2004 and related state laws that place responsibility on state and local school boards for providing specialized education and related services to children three (3) to twenty-two (22) years of age who have Autism Spectrum Disorder are not Covered under this Plan. H Exclusion ome Health Care Services/Home Intravenous Services and Supplies This benefit has one or more exclusions as specified in the Exclusions section. u Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Pri r Auth Re uired Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. o q Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted laboratory facility for analysis. to an appr...
Autism Spectrum Disorder. We will provide coverage for the following services when such services are prescribed or ordered by a participating network licensed physician or a licensed psychologist and are determined by us to be Medically Necessary for the screening, diagnosis, and treatment of autism spectrum disorder. For purposes of this [section], “autism spectrum disorder” means any pervasive developmental disorder defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders at the time services are rendered, including autistic disorder; Asperger’s disorder; Rett’s disorder; childhood disintegrative disorder; and pervasive developmental disorder not otherwise specified (PDD-NOS).
Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: · Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or · Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. Limitation – Services received under the federal Individuals with Disabilities Education Improvement Act of 2004 and related state laws that place responsibility on state and local school boards for providing specialized education and related services to children 3 to 22 years of age who have Autism Spectrum Disorder are not Covered under this Plan.
Autism Spectrum Disorder. (ASD) shall mean a condition determined by a licensed psychologist, licensed physician, licensed physician’s assistant, or certified registered nurse practitioner (CRNP), based on the most recent criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) applicable at the time of diagnosis.
Autism Spectrum Disorder. Diagnosis, treatment and behavioral therapy is limited per Contract Period to $50,000 up to age 8 years and $25,000 from ages 9 to 21 years as stated in Exhibit , Schedule of Benefits.
Autism Spectrum Disorder. Covered Services include Medically Necessary services that are generally recognized and accepted procedures for screening, diagnosing and treating Autism Spectrum Disorders for Members under the age of 18 or, if enrolled in high school, until such Member reaches the age of 22. Covered Services must be provided by a duly licensed physician, psychologist or Behavior Analyst (including an Assistant Behavior Analyst and/or Autism Behavior Interventionist) or other provider that is supervised by the licensed physician, psychologist or behavior analyst and are subject to HPN’s Managed Care Program. With the exception of the specific limitation on benefits for Applied Behavior Analysis (“ABA”) as outlined in Attachment A Benefit Schedule, benefits for all Covered Services for the treatment of Autism Spectrum Disorders are payable to the same extent as other Covered Services and Covered Drugs under the Plan. Covered Services for the treatment of Autism Spectrum Disorder do not include services provided through school services.
Autism Spectrum Disorder. Covered Services include Medically Necessary services that are generally recognized and accepted procedures for screening, diagnosing and treating Autism Spectrum Disorders for Members under the age of 18 or, if enrolled in high school, until such Member reaches the age of 22. Covered Services must be provided by a duly licensed physician, psychologist or Behavior Analyst or other provider that is supervised by the licensed physician, psychologist or behavior analyst and are subject to HPN’s Managed Care Program. With the exception of the specific limitation on benefits for Applied Behavior Analysis (“ABA”) as outlined in Attachment A Benefit Schedule, benefits for all Covered Services for the treatment of Autism Spectrum Disorders are payable to the same extent as other Covered Services and Covered Drugs under the Plan. Covered Services for the treatment of Autism Spectrum Disorder do not include services provided through school services.
Autism Spectrum Disorder. A Clinical Guide for General Practitioners
Autism Spectrum Disorder. Intellectual Disability (ASD-ID) for MCPAP- a statewide program in the Commonwealth to assist behavioral health providers and medical professionals in supporting the mental and behavioral health of individuals up to age 26 with Autism Spectrum Disorder - Intellectual Disability (ASD-ID). Through ASD-ID, providers can consult with a Licensed Applied Behavior Analyst and ASD-ID-specialized prescribers. ASD-ID improves ESP and emergency department providers’ competencies in behavioral assessment and intervention, parent coaching, and in making effective referrals for patients who need community-based services and provides access to pharmacological consultation on an emergency basis. Behavioral Health Urgent Care – the delivery of same-day or next-day appointments for evaluation or assessment for new clients and urgent appointments for existing clients; psychopharmacology appointments and Medication Assisted Treatment (MAT) within a timeframe defined by EOHHS; all other treatment appointments within 14 calendar days; and extended availability outside of weekday hours between 9am and 5pm, as specified by EOHHS by certain Mental Health Centers (MHC), approved by the Contractor as Behavioral Health Urgent Care Providers, as specified by EOHHS. Covered Individual Experiencing Homelessness – any Covered Individual who lacks a fixed, regular, and adequate nighttime residence who: (1) has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping group; or (2) is living in a supervised publicly or privately operated emergency shelter designated to provide temporary living arrangements, including congregate shelters, transitional housing, and hotels and motels paid for by charitable organizations or by federal, state, or local government programs for low-income individuals. Covered Individual at Risk of Homelessness – any Covered Individual who does not have sufficient resources or support networks (e.g., family, friends, faith-based or other social networks) immediately available to prevent them from moving to an emergency shelter or another place not designed for or ordinarily used as a regular sleeping accommodation for human beings. Engagement Rate – the number of Participants in the Care Management Program as a percent of the total number of Enrollees successfully engaged for whom the C...
Autism Spectrum Disorder. A neurobiological medical condition including, without limitation, autistic disorder, Asperger’s Disorder and Pervasive Developmental Disorder Not Otherwise Specified.
