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Certain Autism Services Now Covered Via Telehealth

For many families caring for children with autism spectrum disorder, the COVID-19 pandemic disrupted usual in-person care.

Earlier this month, Blue Cross Blue Shield of Michigan and Blue Care Network made the decision to temporarily allow providers to use telemedicine to treat some members with autism spectrum disorder utilizing ABA treatment. The changes are in effect until further notice.

“In response to continuing concerns regarding COVID-19 and the use of telehealth for applied behavior analysis (ABA), BCBSM and BCN have reviewed our rules on telehealth so that line therapy can be continued for members that are likely to benefit and will allow our members to continue ABA treatment making use of telehealth when appropriate,” said Dr. Kristyn Gregory, medical director, Behavioral Health

ABA is one behavioral treatment approach most commonly used with children with autism spectrum disorder. It involves a structured environment, predictable routines, and individualized treatment.  Additional interventions complement ABA by including transition, aftercare planning, and significant family involvement. ABA is designed to increase skills related to behavioral deficits, increase social skills and reduce behavioral excesses which can be barriers to learning.

Direct-line interventions via telemedicine are most appropriate for members whose sessions are primarily conversation based, who can use planned lessons, and who engage in minimal problematic behavior that requires physical intervention. A parent or caregiver must be present and nearby for the duration of the virtual session and be available to step in as needed to deliver reinforcers and provide additional prompting as instructed by the direct-line therapist.

“We’ve heard from families who are using telehealth for autism services, and they’re really happy with it and how it’s working for them. This is an indicator for us that this was a good decision,” said Bill Pompos, manager, Medical Management, Behavioral Health.

This coverage applies to Blue Cross’ PPO (commercial), Medicare Plus Blue PPO, BCN HMO (commercial) and BCN Advantage members with autism benefits.

Click here for the guidelines for ABA (97153) interventions delivered via telemedicine. Read about the experiences of parents who have used telehealth to access service here.

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Photo credit: Milos Dimic

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