Children screened, diagnosed and treated for autism spectrum disorder

Data from 2018 calendar year

Table 1. Number of children (1-6 years old) who received a diagnostic assessment

Table 2. Number of children (1-6 years old) with a diagnosis of autism spectrum disorder (ASD) who received treatments

Table 3a. Number of children (1-3 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 3b. Number of children (4-6 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 4a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=799)

Table 4b. Blue Plus: Types of treatments provided to children with ASD by category of service (n=799)

Table 5a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=339)

Table 5b. HealthPartners: Types of treatment provided to children with ASD by category of service (n=339)

Table 6a. Hennepin Health: Types of treatment provided to children with ASD by procedure code (n=23)

Table 6b. Hennepin Health: Types of treatment provided to children with ASD by category of service (n=23)

Table 7a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=19)

Table 7b. Itasca Medical Care: Types of treatment provided to children with ASD by category of service (n=19)

Table 8a. Medica: Types of treatment provided to children with ASD by procedure code (n=0)

Table 8b. Medica: Types of treatment provided to children with ASD by category of service (n=0)

Table 9a. PrimeWest: Types of treatment provided to children with ASD by procedure code (n=108)

Table 9b. PrimeWest: Types of treatment provided to children with ASD by category of service (n=108)

Table 10a. South Country Health Alliance: Types of treatment provided to children with ASD by procedure code (n=93)

Table 10b. South Country Health Alliance: Types of treatment provided to children with ASD by category of service (n=93)

Table 11a. UCare: Types of treatments provided to children with ASD by procedure code (n=695)

Table 11b. UCare: Types of treatments provided to children with ASD by category of service (n=695)

Notes

• Data are limited to final version Minnesota Health Care Programs (MHCP) paid claims with service dates between Jan. 1, 2018, and Dec. 31, 2018, inclusive.
• Analysis was limited to children enrolled in a managed care organization (MCO). MCO assignment was selected based on the MCO in which the recipient had the most months of enrollment during the year. Recipients enrolled in fee-for-service (FFS) for the most months during the year were excluded from this analysis.
• Only managed care claims were included in analysis.
• Age was calculated as of Dec. 31, 2018.
• Analysis was limited to children aged 1 through 6.
• Diagnostic Assessments were identified using procedure codes 90791, 90792, 90785, 96101, 96102, 96103 and 90887.
• Children with a diagnosis of autism spectrum disorder (ASD) were identified with claims having an ICD10CM diagnosis code of F84.0, F84.2, F84.3, F84.5, F84.8 or F84.9.
• Treatments for children with a diagnosis of ASD were identified with claims having a procedure code beginning with 908 or equal to H0031, H2012, H2014, H2015, H2019, 99499 (CTSS and other mental health services); having a procedure code of T1013 or T1018 (IEP services); having a procedure code of 0359T, 0362T-0369T, T1024, T1027, H0032 (EIDBI services); or having category of service of 051 (Physical Therapy), 053 (Speech Therapy), or 054 (Occupational Therapy). The service count is the sum of all the unique services for all the children in each respective MCO. These counts were deduplicated using standard DHS procedures.
• All treatment claims were deduplicated using standard operating procedures.
• Analysis was designed in adherence to Minn. Stat. 256B.69, subd. 32a. (see below).

Minn. Stat. 256B.69, subd. 32a

Initiatives to improve early screening, diagnosis, and treatment of children with autism spectrum disorder and other developmental conditions.

(a) The commissioner shall require managed care plans and county-based purchasing plans, as a condition of contract, to implement strategies that facilitate access for young children between the ages of one and three years to periodic developmental and social-emotional screenings, as recommended by the Minnesota Interagency Developmental Screening Task Force, and that those children who do not meet milestones are provided access to appropriate evaluation and assessment, including treatment recommendations, expected to improve the child's functioning, with the goal of meeting milestones by age five.

(b) The following information from encounter data provided to the commissioner shall be reported on the department's public Web site for each managed care plan and county-based purchasing plan annually by July 31 of each year beginning in 2014:

(1) the number of children who received a diagnostic assessment;

(2) the total number of children ages one to six with a diagnosis of autism spectrum disorder who received treatments;

(3) the number of children identified under clause (2) reported by each 12-month age group beginning with age one and ending with age six; and

(4) the types of treatments provided to children identified under clause (2) listed by billing code, including the number of units billed for each child.

Data from 2017 calendar year

Table 1. Number of children (1-6 years old) who received a diagnostic assessment

Table 2. Number of children (1-6 years old) with a diagnosis of autism spectrum disorder (ASD) who received treatments

Table 3a. Number of children (1-3 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 3b. Number of children (4-6 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 4a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=539)

Table 4b. Blue Plus: Types of treatments provided to children with ASD by category of service (n=539)

Table 5a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=208)

Table 5b. HealthPartners: Types of treatment provided to children with ASD by category of service (n=208)

Table 6a. Hennepin Health: Types of treatment provided to children with ASD by procedure code (n=12)

Table 6b. Hennepin Health: Types of treatment provided to children with ASD by category of service (n=12)

Table 7a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=11)

Table 7b. Itasca Medical Care: Types of treatment provided to children with ASD by category of service (n=11)

Table 8a. Medica: Types of treatment provided to children with ASD by procedure code (n=24)

Table 8b. Medica: Types of treatment provided to children with ASD by category of service (n=24)

Table 9a. PrimeWest: Types of treatment provided to children with ASD by procedure code (n=81)

Table 9b. PrimeWest: Types of treatment provided to children with ASD by category of service (n=81)

Table 10a. South Country Health Alliance: Types of treatment provided to children with ASD by procedure code (n=64)

Table 10b. South Country Health Alliance: Types of treatment provided to children with ASD by category of service (n=64)

Table 11a. UCare: Types of treatments provided to children with ASD by procedure code (n=354)

Table 11b. UCare: Types of treatments provided to children with ASD by category of service (n=354)

Notes

1) Data are limited to final version of Minnesota Health Care Programs-paid claims with service dates between Jan. 1, 2017, through Dec. 31, 2017, inclusive.

2) Analysis was limited to children enrolled in a managed-care organization. MCO assignment was selected based on the MCO in which the recipient had the most months of enrollment during the year. If a recipient was enrolled in fee-for-service for the most months during the year, then he or she was excluded from this analysis.

3) Only managed-care claims were included in analysis.

4) Age was calculated as of Dec. 31, 2017.

5) Analysis was limited to children aged 1 through 6.

6) Diagnostic assessments were identified using procedure codes 90791, 90792, 90785, 96101, 96102, 96103 and 90887.

7) Children with a diagnosis of autism spectrum disorder (ASD) were identified with claims having a diagnosis code of 299.0, 299.8, F84.0, F84.2, F84.3, F84.5, F84.8 or F84.9.

8) Treatments for children with a diagnosis of ASD were identified with claims having a procedure code beginning with 908 or equal to H0031, H2012, H2014, H2015, H2019, 99499 (CTSS and other mental health services); having a procedure code of T1013 or T1018 (IEP services); having a procedure code of 0359T, 0362T-0369T, T1024, T1027, H0032 (EIDBI services); or having category of service of 051 (Physical Therapy), 053 (Speech Therapy), or 054 (Occupational Therapy). The service count is the sum of all of the unique services for all of the children in each respective MCO. These counts were de-duplicated using standard DHS procedures.

9) All treatment claims were de-duplicated using standard operating procedures.

10) Analysis was designed in adherence to Minn. Stat. 256B.69, Subd. 32a. (see below).

Minnesota Statutes 256B.69, Subd. 32a.

Initiatives to improve early screening, diagnosis, and treatment of children with autism spectrum disorder and other developmental conditions.

(a) The commissioner shall require managed care plans and county-based purchasing plans, as a condition of contract, to implement strategies that facilitate access for young children between the ages of one and three years to periodic developmental and social-emotional screenings, as recommended by the Minnesota Interagency Developmental Screening Task Force, and that those children who do not meet milestones are provided access to appropriate evaluation and assessment, including treatment recommendations, expected to improve the child's functioning, with the goal of meeting milestones by age five.

(b) The following information from encounter data provided to the commissioner shall be reported on the department's public Web site for each managed care plan and county-based purchasing plan annually by July 31 of each year beginning in 2014:

(1) the number of children who received a diagnostic assessment;

(2) the total number of children ages one to six with a diagnosis of autism spectrum disorder who received treatments;

(3) the number of children identified under clause (2) reported by each 12-month age group beginning with age one and ending with age six; and

(4) the types of treatments provided to children identified under clause (2) listed by billing code, including the number of units billed for each child.

Data from 2016 calendar year

Table 1. Number of children (1-6 years old) who received a diagnostic assessment

Table 2. Number of children (1-6 years old) with a diagnosis of autism spectrum disorder (ASD) who received treatments

Table 3a. Number of children (1-3 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 3b. Number of children (4-6 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 4a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=545)

Table 4b. Blue Plus: Types of treatments provided to children with ASD by category of service (n=545)

Table 5a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=113)

Table 5b. HealthPartners: Types of treatment provided to children with ASD by category of service (n=113)

Table 6a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=10)

Table 6b. Itasca Medical Care: Types of treatment provided to children with ASD by category of service (n=10)

Table 7a. Medica: Types of treatment provided to children with ASD by procedure code (n=610)

Table 7b. Medica: Types of treatment provided to children with ASD by category of service (n=610)

Table 8a. PrimeWest: Types of treatment provided to children with ASD by procedure code (n=81)

Table 8b. PrimeWest: Types of treatment provided to children with ASD by category of service (n=81)

Table 9a. South Country Health Alliance: Types of treatment provided to children with ASD by procedure code (n=57)

Table 9b. South Country Health Alliance: Types of treatment provided to children with ASD by category of service (n=57)

Table 10a. UCare: Types of treatments provided to children with ASD by procedure code (n=13)

Table 10b. UCare: Types of treatments provided to children with ASD by category of service (n=13)

Notes

1) Data are limited to final version of Minnesota Health Care Programs-paid claims with service dates between Jan. 1, 2016, through Dec. 31, 2016, inclusive.

2) Analysis was limited to children enrolled in a managed-care organization. MCO assignment was selected based on the MCO in which the recipient had the most months of enrollment during the year. If a recipient was enrolled in fee-for-service for the most months during the year, then he or she was excluded from this analysis.

3) Only managed-care claims were included in analysis.

4) Age was calculated as of Dec. 31, 2016.

5) Analysis was limited to children aged 1 through 6.

6) Diagnostic assessments were identified using procedure codes 90791, 90702 and 90785.

7) Children with a diagnosis of autism spectrum disorder (ASD) were identified with claims having a diagnosis code of 299.0, 299.8, F84.0, F84.2, F84.3, F84.5, F84.8 or F84.9.

8) Treatments for children with a diagnosis of ASD were identified with claims having a procedure code beginning with 908; having a procedure code of H2014, H2015, H2019, H2012, 99499; or claims with category of service of 051 (Physical Therapy), 053 (Speech Therapy) and 054 (Occupational Therapy). The service count is a sum of all the unique services for all the children in each respective MCO. These counts were de-duplicated using standard DHS procedures.

9) All treatment claims were de-duplicated using standard operating procedures.

10) Analysis was designed in adherence to Minn. Stat. 256B.69, Subd. 32a. (see below).

Minnesota Statutes 256B.69, Subd. 32a.

Initiatives to improve early screening, diagnosis, and treatment of children with autism spectrum disorder and other developmental conditions.

(a) The commissioner shall require managed care plans and county-based purchasing plans, as a condition of contract, to implement strategies that facilitate access for young children between the ages of one and three years to periodic developmental and social-emotional screenings, as recommended by the Minnesota Interagency Developmental Screening Task Force, and that those children who do not meet milestones are provided access to appropriate evaluation and assessment, including treatment recommendations, expected to improve the child's functioning, with the goal of meeting milestones by age five.

(b) The following information from encounter data provided to the commissioner shall be reported on the department's public Web site for each managed care plan and county-based purchasing plan annually by July 31 of each year beginning in 2014:

(1) the number of children who received a diagnostic assessment;

(2) the total number of children ages one to six with a diagnosis of autism spectrum disorder who received treatments;

(3) the number of children identified under clause (2) reported by each 12-month age group beginning with age one and ending with age six; and

(4) the types of treatments provided to children identified under clause (2) listed by billing code, including the number of units billed for each child.

Data from 2015 calendar year

Table 1. Number of children (1-6 years old) who received a diagnostic assessment

Table 2. Number of children (1-6 years old) with a diagnosis of autism spectrum disorder (ASD) who received treatments, by MCO

Table 3a. Number of children (1-3 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 3b. Number of children (4-6 years old) with a diagnosis of ASD who received treatments, by MCO and age

Table 4a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=125)

Table 4b. Blue Plus: Types of treatments provided to children with ASD by category of service (n=125)

Table 5a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=122)

Table 5b. HealthPartners: Types of treatment provided to children with ASD by category of service (n=122)

Table 6a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=21)

Table 6b. Itasca Medical Care: Types of treatment provided to children with ASD by category of service (n=21)

Table 7a. Medica: Types of treatment provided to children with ASD by procedure code (n=283)