Accessing the Autism Spectrum Disorder (ASD) Benefit

STEP 1A: What needs to happen before contacting MCCMH

• A full medical and physical examination/screening must be completed by a medical doctor (child pediatrician, family PCP, etc.) within the past year indicating that further evaluation of ASD is recommended. The medical evaluation must show that hearing and vision have been evaluated and determined not to be a contributing factor to the individual’s presentation of ASD. This step typically occurs during a well-child visit with the pediatrician or family physician. You will need to email proof of a full medical and physical examination to [email protected] to start the process. Please include your name and contact phone number in the email.

STEP 1B: Contacting MCCMH

• Once you have submitted your documentation, you can call the MCCMH Customer Service Department at 1-855-996-2264 to be registered in our system, verify eligibility for Medicaid services, and then be transferred to a MCO clinician to complete the telephone screening. You will be scheduled for an intake appointment with an Autism Case Management Provider.
• Once ASD screening is verified, MCO will schedule the individual for an intake appointment with an Autism Case Management Program:

– Easterseals MORC-Macomb

– Specialized Children & Family Services (SCFS)

– Hope Network Autism CSM

• If ABA services have been previously provided to an individual through the Autism Benefit in another Region of Michigan (another PIHP), please provide this information to the MCO Clinician so that previous treatment can be verified. Please obtain a copy of any previous ASD diagnostic evaluation in preparation for the intake appointment.
• If Medicaid insurance cannot be verified, the individual will be referred to their private insurance carrier or to MDHHS (Michigan Department of Health and Human Services) to apply for Medicaid insurance (if applicable). Enrollment in the Autism Benefit is dependent on eligibility of Medicaid insurance.

STEP 2: Autism Case Management Intake Appointment

• Attend the intake appointment to complete the Person-Centered Planning (PCP) process to develop the Individualized Plan of Service (IPOS) that will confirm ASD presentation, gather support documentation of past treatment, and establish goals the individual will focus on during service delivery.

Please be sure to bring all documentation to your intake appointment, including the following:

• Medical exams, neurological, diagnostic reports, mental health treatment/recommendations, school/academic reports, IEP’s, 504 plans, etc.
• Once the intake is completed, the individual seeking services will be assigned to a case manager who will assist the family in securing an ASD diagnostic evaluation.
• If the individual is covered by private insurance in addition to Medicaid insurance, the Case Manager will assist the individual and/or family in obtaining an Explanation of Benefits (EOB) and determining the perimeters for securing diagnostic testing and ABA services through the private insurance carrier. * Please know that Medicaid insurance is the payer of last resort and private insurance is the primary payer.

STEP 3: Autism Evaluation and Applied Behavioral Analysis

Select the link to watch the video: https://youtu.be/sg9GDtYwxk8

• Attend the appointment and complete the evaluation to determine eligibility and medical necessity for Autism services.
• Eligibility re-determination for the ASD Benefit is reassessed every three years through another Diagnostic Evaluation.
• If approved for the ASD Benefit, the family works with the Case manager to choose an ABA provider from the MCCMH provider network.
• Referrals are sent to the ABA Provider(s) chosen by the family. The family and case manager are notified upon acceptance of the case by the ABA Provider and a Behavioral Assessment Appointment is then scheduled.
• ASD Diagnosis: Next Steps. Select the link to watch the video. https://youtu.be/yxDheu_JW_o

STEP 4: Behavioral Assessment Appointment

• Complete the Behavioral Assessment with the chosen ABA provider which will be developed into an individualized Treatment Plan for ABA therapy.
• A collateral meeting will be held with the ABA Provider, the family, and the case manager to determine the amount, scope and duration of treatment (weekly ABA treatment schedule). The IPOS will be completed by the Case manager.

STEP 5: ABA Therapy

• The case manager will then submit an authorization request to the MCO Department for approval. MCO will have 14 days to process this request for approval before ABA services can begin.

Questions about Medicaid Autism Benefit?

Contact Janet Marra, Autism Clinical Coordinator

[email protected]