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Autism Spectrum Disorder (ASD)

Autism page image

On September 15, 2014, Care1st Health Plan, as a part of the Managed Medi-Cal Plans in California, is now covering Behavioral Health Treatment (BHT) for Medi-Cal beneficiaries, under the age of 21, with Autism Spectrum Disorder.

Care1st Health Plan will be managing this benefit directly. Referrals are not to go to the Medical Groups or IPAs. PCPs will follow the screening process below and submit a referral for the Diagnostic Evaluation for children whom you believe are likely to have Autism Spectrum Disorder.

Key Highlights for PCPs

Behavioral Health services include Mental Health, Substance Use Disorder, and Behavioral Health Treatment for Autism Spectrum Disorder.

Step Description
Step 1: Screening PCP completes Early Periodic Screening, Diagnosis, and Treatment (EPSDT), which should include a validated screening tool for ASD, and makes referral for Autism Spectrum Disorder Diagnostic Evaluation to Care1st as appropriate
Step 2: Diagnostic Evaluation Care1st provides referral and authorizes Autism Spectrum Disorder Diagnostic Evaluation with Licensed Clinical Psychologist or other appropriate provider

Please submit your referral form to Care1st directly for the Autism Spectrum Disorder Diagnostic Evaluation if your screening leads you to believe the child is likely to have Autism Spectrum Disorder.

Below are Frequently Asked Questions and answers that will help guide you through this new benefit:

Who is eligible for the Diagnostic Evaluation?

  • Medi-Cal Beneficiaries
  • Ages 0-21

Who is eligible for Behavioral Health Treatment for Autism Spectrum Disorder (ASD)?

  • Medi-Cal Beneficiaries
  • Ages 0-21
  • Diagnosed with Autism Spectrum Disorder

What is my responsibility?

PCPs have the responsibility to identify members for Autism Spectrum Disorder (ASD) as part of the Early Periodic Screening, Diagnosis, and Treatment benefit, and when appropriate, refer for an ASD Comprehensive Diagnostic Evaluation.

How do I refer for the Autism Spectrum Diagnostic Evaluation?

  • PCPs are to complete a valid screening tool that indicates the member might have Autism Spectrum Disorder.
  • Download, fill-in and FAX us a Service Authorization Request form (Specialty Referral)
    (Check the 'Autism Diagnostic Evaluation' box.)
  • Care1st Health Plan FAX number:
    • 844.283.3298

What happens after the diagnostic evaluation?

  • After the Diagnostic Evaluation, if the child is diagnosed with Autism Spectrum Disorder, they are referred for a functional assessment to determine what forms of Behavioral Health Treatment (as described per the Department of Health Care Services and the Department of Managed Care in the APL 14-011) that would be therapeutic for the member.
  • The appropriate referral and authorization is made by Care1st to obtain such services

Where can I get more information?