Autism spectrum disorder
Effective July 1, 2017, Select Health will provide Autism Spectrum Disorder (ASD) coverage for members, under 21 years of age. This benefit includes ASD services rendered by Board Certified Behavior Analysts and Board Certified Assistant Behavior Analysts, as well as by licensed independent practitioners (LIPs) who are approved by SC Department of Disabilities and Special Needs (SCDDSN) to provide Evidence Based Treatment (an ABA alternative therapy modality).
The following LIPs providers are permitted to render ASD services for Select Heath members once approved by SCDDSN and registered with SC Department of Health and Human Services and Select Health:
Licensed Independent Practitioners (LIPs) – masters or doctoral:
- Licensed Psychologist
- Licensed Psycho-Educational Specialist (LPES)
- Licensed Independent Social Worker-Clinical Practice (LISW-CP)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Professional Counselor (LPC)
- ASD services may also be rendered by school districts that enroll with SCDHHS as ASD group providers.
Autism Spectrum Disorder (ASD) Service Array
Behavior identification assessment
- Comprehensive testing/assessment report, which establishes an ASD diagnosis (medical necessity) must be completed and on file.
- Observational behavior follow-up assessment
- Exposure behavior follow-up assessment
- Adaptive behavior treatment by protocol
- Adaptive behavior treatment with protocol modification
- Family adaptive behavior treatment guidance
Services must be recommended by a licensed psychologist (Ph.D., Psy.D) or licensed psychoeducational specialist (LPES) and may be provided in the member’s home, clinical setting, or other settings authorized by SCDHHS.
Prior authorization requirements
- Prior authorization is required for all ASD services - assessments and treatments.
- Detailed assessment of members already diagnosed with ASD must be provided.
- Select Health will adhere to InterQual criteria and medical necessity requirements as for each service in the SCDHHS Autism Spectrum Disorder Services manual.
- To request prior authorization, providers must complete the ASD Treatment Request form, below and fax it to 1-888-796-5521 or submit the request on-line through NaviNet. For questions, contact Select Health Behavioral Health Utilization Management (SHSC BH UM) at 1-866-341-8765.
For claims filing instructions, consult the claim filing manual.