Following the release of federal guidance on the matter, DHCS issued interim policy guidance on the provision of BHT services to Medi-Cal beneficiaries 0-21 diagnosed with Autism spectrum disorder. Under Federal law, states are required to provide coverage to EPDST eligible individuals for any covered service determined to be medically necessary to correct or ameliorate any physical or behavioral conditions. DHCS intends to include BHT services, including Applied Behavioral Analysis (ABA), as a covered benefit for individuals under 21 with ASD.
The letter defines BHT and provides 12 months of continuity of care for those with ASD getting services outside a Regional Center. Medi-Cal beneficiaries who spent out of pocket for BHT services from licensed providers between 7/7/14 and 9/14/14 are eligible for reimbursement under Conlan. The letter also sets out eligibility criteria for BHT services, covered services, limitations, treatment plans and exclusions
Finally, the letter includes a beneficiary notice from DHCS as well as guidance from CMS dated 7/7/14.