Welcome to Behaviorbabe
Ethical Advocate for Accurate Application & Dissemination of Behavior Analysis

Welcome to Behaviorbabe

Ethical Advocate for Accurate Application & Dissemination of Behavior Analysis

In response to increased interest and activity with respect to services available to children with autism spectrum disorder (ASD), CMS is providing information on approaches available under the federal Medicaid program for providing services to eligible individuals with ASD.

Early Periodic Screening Detection and Treatment (EPSDT) Benefit Requirements Section 1905(r) of the Act defines the EPSDT benefit to include a comprehensive array of preventive, diagnostic, and treatment services for low-income infants, children and adolescents under age 21. 

States are required to arrange for and cover for individuals eligible for the EPSDT benefit any Medicaid coverable service listed in section 1905(a) of the Act that is determined to be medically necessary to correct or ameliorate any physical or behavioral conditions. The EPSDT benefit is more robust than the Medicaid benefit package required for adults and is designed to assure that children receive early detection and preventive care, in addition to medically necessary treatment services, so that health problems are averted or diagnosed and treated as early as possible. All children, including children with ASD, must receive EPSDT screenings designed to identify health and developmental issues, including ASD, as early as possible. Good clinical practice requires ruling out any additional medical issues and not assuming that a behavioral manifestation is always attributable to the ASD. EPSDT also requires medically necessary diagnostic and treatment services. When a screening examination indicates the need for further evaluation of a child’s health, the child should be appropriately referred for diagnosis and treatment without delay. Ultimately, the goal of EPSDT is to assure that children get the health care they need, when they need it – the right care to the right child at the right time in the right setting.

School districts can receive Medicaid reimbursement for health-related services provided to special education students, but they don't often have the internal resources needed to claim those reimbursements. They have developed an online application that allows Medicaid providers to complete time studies, document the delivery of health-related services, and submit claims electronically. The web-enabled school-based claiming application currently supports over 2,500 school districts in 9 states, as well as various state and local agencies. For more information, CLICK HERE

Resources (Massachusetts)

For School-based Medicaid Program, please review the materials posted on the School-based Medicaid site, specifically the SBMP Publications and SBMP Provider Bulletins pages. https://www.mass.gov/masshealth-school-based-medicaid-program https://www.mass.gov/lists/sbmp-program-bulletins 

Please note that MA Department of Elementary and Secondary Education (DESE) will be publishing a revised Parental Consent form due to Free Care expansion.