Earlier this month, the Centers for Medicare & Medicaid Services (CMS) released its ‘state toolkit’ on applied behavior analysis (ABA) benefit management – State Medicaid & Children’s Health Insurance Program Applied Behavior Analysis Toolkit). The toolkit was released with the purpose of supporting “state Medicaid and Children’s Health Insurance Program (CHIP) agencies in making decisions regarding ABA service provision for Medicaid and CHIP beneficiaries with autism spectrum disorder (ASD).”

The toolkit provides recommendations on the autism diagnostic process, treatment planning, medical necessity, prior authorization, and Medicaid managed care. Interestingly, the toolkit also advises against any ‘cookie-cutter’ approaches to treatment, emphasizing that comprehensive autism assessments may require 20 hours or more to complete initial evaluations. It does stress…