Changes in Accessing Autism Evaluation and Treatment Services in Michigan for 2024

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Changes in Accessing Autism Testing and Treatment Services in Michigan for 2024

Autism Spectrum Disorder (ASD) is a complex developmental condition that involves persistent challenges in social interaction, speech, nonverbal communication, and restricted/repetitive behaviors. Recognizing the need for timely and accurate diagnosis and treatment, there have been significant changes in the evaluation and treatment processes for ASD.

Starting January 1, 2024, these changes aim to provide more opportunities for members to obtain a comprehensive diagnostic autism evaluation before beginning treatment.

How Can Members Obtain An Autism Evaluation Starting January 1st in 2024?

Interpretation: Previously, despite the availability of the bridge authorization process, members were mandated to undergo an assessment by an Approved Autism Evaluation Center (AAEC). However, from January 1, 2024, this requirement has been removed. Now, members have the flexibility to obtain their assessment either through an AAEC or from another qualified provider specializing in autism evaluation.

For Members in Michigan

  • Approved Autism Evaluation Centers (AAEC): Members in Michigan can get evaluated at an AAEC. These centers coordinate the evaluation process across various disciplines and provide the results to the member.

For Members in Michigan and Other States

Diagnostic Evaluation Results

Once members have their diagnostic evaluation results, they need to present these to an autism treatment provider (ABA clinic and BCBA). The treatment provider will then request prior authorization from Blue Cross Behavioral Health for treatment.

Validation of Diagnosis

The diagnosis of ASD must be confirmed through a comprehensive assessment aligning with DSM-5-TRSM criteria. This assessment must be conducted by a licensed physician or psychologist, or another qualified clinician as per state licensure.

Accessing Medical Policy on ASD Services

For detailed information:

  1. Visit the Medical Policy Router Search page at
  2. Enter “Applied Behavioral Analysis” in the Policy/Topic Keyword field and search.
  3. Select “Medical Policy – Autism Spectrum Disorder Services” from the results.

This policy, along with others, is regularly updated.

Bridge Authorization for ABA Treatment

In cases where members face difficulties in completing their autism evaluation, a “bridge authorization” allows them to start Applied Behavior Analysis (ABA) treatment. This authorization is contingent on meeting certain criteria:

  • Submission of sufficient objective measures substantiating the autism diagnosis and the need for ABA services.
  • Understanding that the comprehensive evaluation must be completed within three to six months through an AAEC or qualified independent providers.
  • Awareness that if a diagnosis other than autism is made, ABA service authorization will cease immediately upon receipt of this diagnosis by Blue Cross Behavioral Health.

These changes in the evaluation and treatment of Autism Spectrum Disorder are designed to streamline the diagnostic process and ensure timely and appropriate treatment. By providing multiple avenues for evaluation and introducing the concept of bridge authorization, these changes aim to make the journey easier and more efficient for individuals with autism and their families. Remember, staying informed about these changes is crucial for both members and providers to ensure the best possible care and support.

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