While Medical Assistance in Minnesota has provided supports for children with autism, it has not offered autism-specific, early intensive developmental and behavioral intervention services believed to be critical for children with autism spectrum disorder. Evidence shows that earlier intervention increases the possibility of positive long-term outcomes and optimal success.
Currently, the average age of identification for autism spectrum disorders in Minnesota is 4 years and up. DHS recognizes that many children are still not identified until they are older and may need services throughout childhood and into early adulthood. While the new benefit is for individuals from birth up to age 21, priority is placed on reaching children ages 0 to 7 to have the greatest possible impact and to capitalize on the early learning window of opportunity.
• Unlike most other states, Minnesota's Early Intensive Developmental and Behavioral Intervention Benefit recognizes a range of intensive treatment options based in developmental and behavioral science that show promise for individuals with autism and related conditions.
• Minnesota also recognized that solid evidence is lacking in the field of autism for what treatments work best for individual children, at what ages and in what doses for each child. Therefore, Minnesota will be studying the outcomes of a range of treatment modalities, intensities and dosages to learn what works best, for which children, as well as what role parental involvement might play in these outcomes. Minnesota hopes to be a leader in forwarding evidence in the emerging field of autism diagnostics and treatment.
The first year total cost is projected to be $15 million, split between the state and federal government. As more children are served, the annual cost will grow in proportion to the numbers served, with a continued state-federal match. These early investments are expected to reduce costs over an individual's lifetime, as early interventions decrease the need for more intensive long-term supports.
• Rigorous, comprehensive evaluation to determine medical necessity for the new benefit. This ensures the needs of individuals with this complex condition will be comprehensively evaluated, monitored and addressed in a coordinated fashion and that referrals to other critical services will be made as needed and redirected if progress is not being made.
• Individualized treatment for each child and family. Autism spectrum disorder ranges from mild to severe so effective treatment will not be the same for each child. Minnesota is also home to large, rich and diverse multicultural and linguistic communities. The child's goals and family participation will be individualized based on the child's developmental status and identified needs and the values, goals, preferences, culture and language of the child's family.
• Culturally sensitive and responsive. The new benefit will help to determine the most effective treatment that can be carried out within the context of the children's family, culture and community and coordination with current education, medical, therapeutic and social services.
• The benefit is a work in progress because autism diagnosis and treatment is an emerging field of science. No roadmaps exist for creating an autism benefit of this scope. While evidence is just emerging, prevalence continues to rise and families living with autism now have urgent needs. Minnesota will continue to work intensively with stakeholders to develop details of the benefit as the benefit is rolled out beginning July 2015.
As part of the bipartisan Reform 2020 initiative to reform Medical Assistance, the Dayton Administration and the Legislature committed, beginning in 2012, to work with stakeholders to develop services for children with a diagnosis of autism spectrum disorder. The 2013 Legislature approved a health care benefit for individuals with autism spectrum disorder and the state 2014-15 budget included $12.7 million to provide a high-quality, medically necessary, intensive intervention health care benefit based in current best practices in developmental and behavioral science.
In July 2014, the Centers for Medicare and Medicaid Services directed that all states must provide medically necessary treatment of autism and related conditions from birth to age 21 under Early Periodic Screening Diagnosis and Treatment.
On March 27, 2015, CMS approved the Early Intensive Developmental and Behavioral Intervention Benefit developed in Minnesota with an extensive stakeholder input process.