Today McKesson Health Solutions announced the release of Applied Behavior Analysis (ABA) criteria for autism spectrum disorders in its Behavioral Health InterQual® solution, the leading evidence-based clinical decision support criteria.
“Before now, most providers and health plans did not have a set of standards on treatment plans for autism spectrum disorders,” said Robert Small, MD, Associate Medical Director of Behavioral Health for McKesson Health Solutions. “McKesson took the lead and created proprietary criteria for ABA treatment, founded on literature and validated by expert consensus1, to facilitate shared decision support for providers and payers.”
Autism treatment has been growing in demand and cost along with most behavioral healthcare services. Autism diagnoses have increased ten-fold in the last 40 years2, with the average lifetime cost of supporting an individual with an autism spectrum disorder estimated at $2.4 million3. Healthcare reform mandates greater access to treatment through the Affordable Care Act. More Americans have access to health coverage and no-cost preventive services, including early autism screenings4 and other behavioral health treatments.
The Mental Health Parity and Addiction Equity Act final rule of 2013 eliminated the ability to limit benefits or dollar amounts to control costs. Today 37 states and Washington, D.C., require insurance carriers that sell policies on their insurance exchanges to cover behavioral health treatments that include autism therapy.5 Shared evidence-based guidelines on autism treatment can help payers and providers cope with this trend.
InterQual Criteria includes both initiation and continuation of services content. In addition, the pediatric rehabilitation subset of InterQual Outpatient Rehabilitation & Chiropractic Criteria also helps clients that support the care and treatment of autism. It addresses coordination and therapy needs of individuals with autism spectrum disorders who frequently receive treatments by providers from several different disciplines–such as applied behavior analysis, physical therapy, occupational therapy, and speech therapy–that target the same core symptoms or functional deficits.
In many cases, the school system or early intervention agency provides some services, while the health plan covers other services. In these situations, care coordination is imperative to help prevent overlapping, inconsistent, or even conflicting treatment interventions. InterQual’s proprietary Applied Behavioral Analysis Criteria, along with all InterQual criteria, is available in CareEnhance® Review Manager and via InterQual Mobile to help ensure the right care at the right time at the right cost—anywhere, anytime.
For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, and follow us on Twitter at @McKesson_MHS.
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About McKesson Corporation
McKesson Corporation, currently ranked 15th on the FORTUNE 500, is a healthcare services and information technology company dedicated to making the business of healthcare run better. McKesson partners with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. McKesson helps its customers improve their financial, operational, and clinical performance with solutions that include pharmaceutical and medical-surgical supply management, healthcare information technology, and business and clinical services. For more information, visit www.mckesson.com.
1 Dr. Weitlauf et al., Therapies
for Children with Autism Spectrum Disorder: Behavioral Interventions
Update, Comparative
Number 137, Effectiveness Review
(August 2014).
2 “Prevalence
of Autism Spectrum Disorder among Children Aged 8 Years – Autism and
Developmental Disabilities Monitoring Network,” Centers for Disease
Control Morbidity and Mortality Weekly Report (2014).
3
“Costs
of Autism Spectrum Disorders in the United Kingdom and the United States.”
JAMA Pediatrics (2014).
4 “The
Affordable Healthcare Act: What Autism Families Need to Know” Autism
Health Insurance Project (2014).
5 Ibid.
