Autism spectrum disorder
We’re here to provide support and access to high quality treatment if an Autism Spectrum Disorder is suspected or diagnosed. We know that early intervention can make a big difference. We’re available to help you navigate the process – from screening to diagnosis to treatment, and beyond.
For information about your Autism Spectrum Disorder benefit and in-network providers, call our Behavioral Health Department at 800.673.8043 (TTY 711).
Coverage
The primary treatment for someone who has been diagnosed with Autism Spectrum Disorder is Applied Behavior Analysis (ABA). To find out whether your plan covers ABA, please log into your member account at www.priorityhealth.com or call our Behavior Health Department at 800.673.8043 (TTY 711). Not all plans include coverage for this level of care. Some self-funded plans do not include ABA coverage. Federal guidelines for Medicare do not allow for coverage of ABA. If you have Priority Health Medicaid, please contact your local Community Mental Health agency.
Finding care
Prior to getting referred for Applied Behavior Analysis, a child is screened by a provider (typically a pediatrician) who will gather information, complete the developmental checklist and refer out for a comprehensive diagnostic evaluation should risk factors for an Autism Spectrum Disorder diagnosis be identified.
Types of Care
The comprehensive diagnostic evaluation is completed by a provider who is trained to collect information about you or your child’s behavior from a variety of professionals/settings, observe behavior, interview the parent, and use the information to inform a diagnosis. A diagnosis of Autism Spectrum Disorder is required in order to be eligible for Applied Behavior Analysis. If a diagnosis of Autism Spectrum Disorder is identified and Applied Behavior Analysis is recommended – the next step is to find an in-network provider who takes your health plan.
For information about your Autism Spectrum Disorder benefit and in-network providers, call our Behavioral Health Department at 800.673.8043 (TTY 711).
Applied Behavior Analysis (ABA) is the most commonly used treatment approach with children and adults who have an Autism Spectrum Disorder diagnosis. ABA is a skills-focused treatment that addresses challenges that can be present in areas of communication, social skills, adaptive skills, and behaviors.
The first step to accessing ABA treatment is to find an in-network provider and set up an initial assessment. The provider will reach out to Priority Health to obtain prior authorization before this initial assessment. At the time of the assessment, the provider will meet with you and your child to observe behaviors, identify areas of need, review areas that require intervention, and develop a treatment plan.
When a treatment plan is ready, the provider will contact Priority Health to get authorization for the services.
An essential component of ABA services is parent training. Research supports the need for parents to be engaged closely in the treatment in order to reinforce the skills being taught, to help the child learn how to use the skills across environments, and to help the parent feel confident and equipped to support their child’s unique needs.
The provider will review the treatment plan every six months. At this time, the provider will make changes to treatment plan and level of service as needed. Priority Health will review the updated treatment plan to continue authorizing services at the requested level. Priority Health and your ABA provider will work together to ensure that the authorization is set and there is no lapse in care.
For information about your Autism Spectrum Disorder benefit and in-network providers, call our Behavioral Health Department at 800.673.8043 (TTY 711).