Spring 2009

Autism-related services to be covered for certain plans

Effective April 1, 2009, Blue Cross and Blue Shield of Florida (BCBSF) and its HMO subsidiary, Health Options, will include coverage for services related to autistic spectrum disorders for certain contracts issued or renewed on or after that date.

The move is in compliance with Florida Senate Bill 2654, Section 3, Section 641.31098, that requires health insurance plans to cover these services for fully insured large groups (51+) and self-funded government plans (counties, cities, school districts, county commissioners, etc.). This mandate does not include individual or small group health insurance plans, non-government self-insured (ASO) groups, Cover Florida or the Blue Cross Blue Shield Service Benefit Plan for federal employees and will vary for BlueCard^® members.

As defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, autism spectrum disorder refers to any of the following disorders:

• Autistic Spectrum Disorder (ASD)

• Asperger’s Syndrome

• Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS)

• Childhood Disintegrative Disorder

To be eligible for coverage, children must be under 18 years of age, or still in high school, and have been diagnosed as having autism spectrum disorder developmental disability at 8 years of age or younger.

Benefit coverage for autism spectrum disorders include the following:

• Well-baby and well-child screening for diagnosing the presence of autism spectrum disorder

• Treatment through speech therapy, occupational therapy, physical therapy and applied behavior analysis provided by certified behavior analysts, psychologists, clinical social workers and others

Physicians and providers should submit claims for autism services separately from treatment and testing for other conditions.

Members are encouraged to go to our online participating provider directory at www.bcbsfl.com for verification and to seek the services of in-network providers to obtain the highest level of benefits. Members who use non-participating providers are subject to additional out-of-pocket expenses, including balance billing.

For BlueSelect and BlueCare enrolled members, providers should continue to refer to MHNet for authorization and coordination of behavioral services by calling (800) 835-2094.