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Beline Obeid

Autism insurance coverage begins in fall



August 30, 2012
Q. I have been hearing a lot about the new autism insurance benefit. What will this mean for my family?

A.Passing the autism legislation is the first step for Michigan children with autism to have insurance coverage for needed services and treatment. In October, insurance coverage for Autism Spectrum Disorders goes into effect under Michigan law. To qualify for coverage, a medical diagnosis that the child has an autism spectrum disorder (autism, pervasive developmental disorder-PDD, or Asperger's) must be documented. Services covered under the new autism insurance benefit include applied behavior analysis, behavior therapy that is the evidence-based treatment of choice for individuals with autism, occupational therapy for sensory-based interventions, physical therapy and speech and language therapy.

Key points:

u Coverage is provided for children, up to 18 years of age, with the medical diagnosis of autism or autism spectrum disorder. School reports will not be accepted. Schools do not diagnose autism; they determine eligibility for autism services within the school system. The diagnosis must be made by a licensed psychologist or physician using standard diagnostic tools. Check with your insurer now to make sure you obtain your child's diagnosis from a designated provider or center. Your child's current diagnostic report may not be accepted depending on when and by whom it was completed.

u Therapies can only be provided by: board certified behavior analyst for applied behavior analysis; licensed speech and language pathologist for speech therapy, and an occupational therapist for sensory-based needs. Check with your insurer about which therapists can be used for intervention.

u The law applies to companies with insurance plans that are state-regulated, not self-funded. Make sure you know what type of plan you have to determine your eligibility for coverage. Call your employer or insurer now to check.

Michigan currently lacks enough providers to immediately serve the needs of all Michigan's autistic children. There are only about 30 board certified behavior analysts in Michigan providing services to families with autism. Plan ahead to make sure you have the medical documentation you need and identify qualified service providers to access services as soon as they become available under your insurance plan.

Susan Benson is the Wayne Regional Director for Judson Center. To learn about autism services offered through the center visit judsoncenter. org. or the Judson Center Grosse Pointe FaceBook page.

The Family Center, a 501(c) (3), non-profit organization, serves as the community's centralized hub for information, resources and referral for families and professionals.

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