Re-evaluation for ABA autism treatment services will not be required every three years, for all BCBSM and BCN members

After careful consideration, Blue Cross Blue Shield of Michigan and Blue Care Network have decided that a re-evaluation of applied behavior analysis autism treatment after every three years will be required only in the following instances:

• When a member has shown only minimal progress in autism treatment
• When there is a significant question about the continued accuracy of a member's diagnosis or treatment plan

A component of the state's autism mandate is that insurance companies may require a re-evaluation for members at three-year intervals of ABA autism treatment. Because the mandate began three years ago, in 2012, many members are now approaching the time that the re-evaluation would be required.

Blue Cross and BCN have decided that the mandatory review is not needed for many members who are in ABA autism treatment. We expect that the members who do need re-evaluation and redirection of their ABA treatment will come to our attention through the continuous monitoring, evaluation and utilization management that providers are doing together with our behavioral health care managers. In addition, Blue Cross and BCN may require that a member undergo annual developmental testing as a standardized method of measuring treatment progress.

Additional information on this topic will be included in upcoming issues of the corporation's provider newsletters, as follows:

• The November 2015 issue of The Record, which will be available electronically by Nov. 1, 2015
• The November-December 2015 issue of BCN Provider News, which will be available electronically at the end of October

Providers are encouraged to subscribe to both newsletters in order to get current information about autism policies and other topics. To subscribe, visit bcbsm.com/providers and click Newsletters.