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Autism Benefits

Autism Coverage

The following benefits are provided to UVM faculty, staff and retirees through The University of Vermont's healthcare coverage with Blue Cross and Blue Shield of Vermont.

Graphic of Child Playing with BlocksOverview of Coverage for Autism

  • Coverage began July 1, 2012 and will be expanded effective July 1, 2013.
  • The expanded program provides coverage for a broad spectrum of early childhood developmental disorders, including autism, from birth until an individual's 21st birthday, under the Vermont Early Childhood Developmental Disorders Mandate.
  • Prior to July 1, 2013, coverage is limited to individuals from the age of 18 months until 6 years (and not yet enrolled in first grade).
  • Coverage requires prior approval. Call Blue Cross and Blue Shield of Vermont customer service at 888-222-7886 for information about the benefit or the approval process.

Details of Coverage for Autism

Evaluation for Autism Spectrum Disorder (ASD)

  • Evaluation for autism spectrum disorder is eligible under medical benefits when the medical necessity criteria of the Autism Medical Policy is met. (Call 888-222-7886 with questions or to request a copy of the Autism Medical Policy.)
  • Prior approval is required.

Physical, Speech and Occupational Therapy (PT/ST/OT)

  • Physical therapy, speech therapy and occupational therapy services for the treatment of autism require prior approval after the initial evaluation.
  • Approved PT/ST/OT services for the treatment of autism are not subject to the 30-day aggregate.

Prescription Drugs

  • Medications for the treatment of autism are eligible under the member's medical and/or pharmacy benefits.

Applied Behavioral Analysis (ABA)

  • Prior appoval from Vermont Collaborative Care (VCC) is required for all ABA services. This requirement applies to VHP Open Access, J Plan, J Carve-Out and Medi-Comp III plans.
  • ABA is the process of applying interventions that are based on the principles of learning (e.g., positive reinforcement) derived from experimental psychology research to systematically change behavior. It can also be used to teach new skills and demonstrate that the interventions used are responsible for the observable improvements in behavior. To inititate prior approval and access services, contact VCC at 888-222-7886.

Mental Health Service for the Treatment of Autism

  • Prior approval from Vermont Collaborative Care (VCC) is required for all mental health services. To inititate prior approval and access services, contact VCC at 888-222-7886.

 

Last modified April 26 2013 04:40 PM