US Federal authorities clarify Medicare cover for autism services

In the United States the Federal Centers for Medicare & Medicaid Services have announced that comprehensive autism services must be covered for children under all state Medicaid and Children’s Health Insurance Program plans.

The policy requires cover over a full range of autism services under the “early and periodic screening, diagnostic and treatment services” provision (EPSDT) of the law. This  benefit covers any services that are medically necessary to correct or ameliorate physical or behavioral conditions in children up to age 21.

A report on this change can be found in Kaiser Health News. The report goes on to quote a 2007 study that estimates the lifetime costs of caring for someone with autism at more than $3 million1. This cost should be compared to an annual cost of $50,000 for some intensive early interventions – and nearly half of children who receive early interventions can achieve mainstream status2.

This is good news for parents in America who may be struggling to access early treatment for a child who has an ASD diagnosis. The relative costs quoted in the report also show that as well as helping to unlock the potential of these children, the early recognition and treatment of this condition makes sound economic sense.

1 Study published in 2007 in the Archives of Pediatrics and Adolescent Medicine
2 Study published in 2005 in the American Journal of Mental Retardation

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