JOIN AOTA

CMS Clarification on Medicaid Coverage of Services to Children with Autism


7/8/2014

The Centers for Medicare & Medicaid Services (CMS) released an informational bulletin with respect to services available under the Medicaid program to children with autism spectrum disorder (ASD). 

The bulletin notes that much of the current national discussion focuses on Applied Behavioral Analysis (ABA), which is only one particular treatment modality, but there are other recognized treatments for children with ASD including occupational therapy (OT). According to the bulletin it is up to the states to make sure all covered services are available as well as to assure that families of enrolled children are aware of and have access to the broad range of services to meet the individual child’s needs such as OT.  

The bulletin specifically indicates that OT services to address ASD may be covered under several different benefit categories including Other Licensed Practitioner services (OLP) and Therapy services. 

The Informational Bulletin can be accessed on Medicaid.gov under Federal Policy Guidance at http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdf.