Autism Spectrum Disorder
Effective January 1, 2018 the Department of Community Health (DCH), Medicaid Division, will provide coverage for Autism Spectrum Disorders (ASD) services for individuals under the age of 21. ASD coverage is provided for assessment and treatment services according to severity and is based on medical necessity. Members must have a documented DSM-V diagnosis of ASD from a licensed physician, psychologist or other licensed professional as designated by the Medical Composite Board to be eligible for Adaptive Behavior Services (ABS). Services to treat ASD include assessment and treatment provided to Medicaid member in accordance with early and periodic screening, Diagnostic and Treatment (EPSDT) standards and according to medical necessity. Services must be recommended by a licensed physician or other licensed practitioner of the healing arts acting within their scope of practice under state law to prevent the progression of ASD, prolong life, and promote the physical and mental health of the individual. Georgia is enrolling board certified behavioral analysts to provide ABS.
How to submit a Prior Authorization for ASD Services
Prior Authorization User Guide