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Spectrum: Access to virtual autism therapy in US could narrow post-COVID

By Laura Dattaro

Virtual autism therapy will continue to be covered by Medicare through at least the end of 2023, according to a proposed rule issued last week — but the long-term future of the benefit is less clear.

The draft rule, posted by the Centers for Medicare and Medicaid Services (CMS) on 7 July, recommends adding to a Medicare telehealth list codes used to bill for applied behavior analysis (ABA), the predominant behavioral therapy for autism. If approved, the rule would last through the end of 2023 to give CMS more time to evaluate data on the effectiveness of virtual ABA, according to the notice.

CMS initially approved coverage of remote ABA only for the duration of the pandemic public health emergency that was declared on 31 January 2020 and extended every 90 days since. The emergency measure was set to expire today, but the Department of Health and Human Services (HHS) said it would give states 60 days’ notice — something it has not yet done. HHS is still committed to that notice period, an agency spokesperson told Spectrum.

Many clinicians are already struggling to get insurance approvals for people who were diagnosed remotely during the pandemic, says Cy Nadler, associate professor of pediatrics at the University of Missouri – Kansas City, who in 2021 launched an ongoing survey of autism providers’ experiences navigating telehealth.

Most insurance companies require specific diagnostic methods, such as use of a certain assessment tool, before they will cover autism therapies, making it difficult to separate the differing regulations for diagnosis and treatment.

Nadler’s clinic at Children’s Mercy Kansas City has navigated the tension largely by making use of parent-mediated therapy and offering virtual group training sessions for parents, he says — something they had never before provided. But even those approaches rely on continued insurance approval of telehealth.


Read the full article via Spectrum

Children's Mercy Autism Clinic