Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. Limitation – Services received under the federal Individuals with Disabilities Education Improvement Act of 2004 and related state laws that place responsibility on state and local school boards for providing specialized education and related services to children 3 to 22 years of age who have Autism Spectrum Disorder are not Covered under this Plan. Heart Artery calcification scans are a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function. These scans are Covered for individuals between the ages of 45-65 years and that have an intermediate risk of developing coronary heart disease as determined by a healthcare provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to access a persons’ ten-year cardiovascular disease risk, including a score calculated using a pool cohort equation. The scans are Covered only once every five years if an eligible member has previously received a heart artery calcium score of zero. Coverage will not be provided for future heart artery calcium scans if an eligible member receives a heart artery calcium score greater than zero. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Healthcare Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Healthcare Services provided by a re...
Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: • Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or • Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. This benefit has one or more exclusions as specified in the Exclusions Section. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted to an approved laboratory facility for analysis. Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. The following Home Health Care Services will be Covered when we approve a Prior Authorization request: • Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider • Total parenteral and enteral nutrition as the sole source of nutrition • Medical Drugs: (Medications obtained through the medical benefit): A Medical Drug is any drug administered by a Health Care Professional and is typically given in the member's home, physician’s office, freestanding (ambulatory) infusion suite, or outpatient facility. Medica...
Autism Spectrum Disorder. We will provide coverage for the following services when such services are prescribed or ordered by a participating network licensed physician or a licensed psychologist and are determined by us to be Medically Necessary for the screening, diagnosis, and treatment of autism spectrum disorder. For purposes of this [section], “autism spectrum disorder” means any pervasive developmental disorder defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders at the time services are rendered, including autistic disorder; Asperger’s disorder; Rett’s disorder; childhood disintegrative disorder; and pervasive developmental disorder not otherwise specified (PDD-NOS).
Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered regardless of age in accordance with state mandated benefits as follows: · Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well- Child or well-baby screening and/or · Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. Limitation – Services received under the federal Individuals with Disabilities Education Improvement Act of 2004 and related state laws that place responsibility on state and local school boards for providing specialized education and related services to children 3 to 22 years of age who have Autism Spectrum Disorder are not Covered under this Plan.
Autism Spectrum Disorder. (ASD) shall mean a condition determined by a licensed psychologist, licensed physician, licensed physician’s assistant, or certified registered nurse practitioner (CRNP), based on the most recent criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) applicable at the time of diagnosis.
Autism Spectrum Disorder. The diagnosis and treatment for Autism Spectrum Disorder is covered for children, from to age nineteen (19) or up to age twenty-two (22) if enrolled in high school, in accordance with state mandated benefits as follows: o Diagnosis for the presence of Autism Spectrum Disorder when performed during a Well-Child or well-baby screening and/or o Treatment through speech therapy, occupational therapy, physical therapy and Applied Behavioral Analysis (ABA) to develop, maintain, restore and maximize the functioning of the individual, which may include services that are habilitative or rehabilitative in nature These services are only Covered when a treatment plan Autism Spectrum Disorder Services must be provided by Practitioners/Providers who are certified, registered or licensed to provide these services. the federal Individuals with Disabilities Education Improvement Act of 2004 and related state laws that place responsibility on state and local school boards for providing specialized education and related services to children three (3) to twenty-two (22) years of age who have Autism Spectrum Disorder are not Covered under this Plan. Home Health Care Services are Health Care Services provided to you when you are confined to the home due to physical illness. Home Health Care Services requires Prior Authorization and your Practitioner’s/Provider’s approved plan of care. Any Practitioner’s/Provider’s prescription and Prior Authorization must be renewed at the end of each 60-day period. We will not impose a limitation on the number of related hours per visit. Home Health Care Services shall include Medically Necessary skilled intermittent Health Care Services provided by a registered nurse or a licensed practical nurse; physical, occupational, and/or respiratory therapist and/or speech pathologist. Intermittent Home Health aide services are only Covered when part of an approved plan of care which includes skilled services. Such services may include collection of specimens to be submitted laboratory facility for analysis. to an approved Medical equipment, Prescription Drugs and Medications, laboratory services and supplies deemed Medically Necessary by a Practitioner/Provider for the provision of health services in the home, except Durable Medical Equipment, will be Covered. be Covered when we approve a o Home health care or home intravenous services as an alternative to Hospitalization, as determined by your Practitioner/Provider o Total parenteral and ente...
Autism Spectrum Disorder. Diagnosis, treatment and behavioral therapy is limited per Contract Period to $50,000 up to age 8 years and $25,000 from ages 9 to 21 years as stated in Exhibit , Schedule of Benefits.
Autism Spectrum Disorder. Covered Services include Medically Necessary services that are generally recognized and accepted procedures for screening, diagnosing and treating Autism Spectrum Disorders for Members under the age of 18 or, if enrolled in high school, until such Member reaches the age of 22. Covered Services must be provided by a duly licensed physician, psychologist or Behavior Analyst (including an Assistant Behavior Analyst and/or Autism Behavior Interventionist) or other provider that is supervised by the licensed physician, psychologist or behavior analyst and are subject to HPN’s Managed Care Program. With the exception of the specific limitation on benefits for Applied Behavior Analysis (“ABA”) as outlined in Attachment A Benefit Schedule, benefits for all Covered Services for the treatment of Autism Spectrum Disorders are payable to the same extent as other Covered Services and Covered Drugs under the Plan. Covered Services for the treatment of Autism Spectrum Disorder do not include services provided through school services.
Autism Spectrum Disorder. In its review, the University will determine whether the student submitted documentation regarding current treatment and/or medication; and, if the student did not submit documentation regarding current treatment and/or medication, whether the student’s request was denied. For any student whose request for academic adjustments and/or auxiliary aids and services was denied because they did not submit documentation regarding current treatment and/or medication, the University will explain its recommendation for an appropriate remedy, for OCR’s review and approval.
Autism Spectrum Disorder. A Clinical Guide for General Practitioners
