The CMS has moved to clarify confusion about a bulletin it released in July on coverage for comprehensive autism treatment under Medicaid and the Children's Health Insurance Program. Uncertainty centered on whether the CMS was mandating coverage for applied-behavior analysis therapy, a costly treatment.
ABA treatment, believed to be the most effective for people with autism, involves behavioral specialists leading patients through drills to help with speaking and social skills.
Annual ABA therapy cost for one patient ranges from $25,000 to $70,000. Experts say demanding ABA for every Medicaid- or CHIP-covered child could cost states and the federal government hundreds of millions of dollars per year.