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In order to have services reimbursed under the Federal Medicaid program, a service must
meet the definition of a coverable service under section 1905(a) of the Social Security
Act. Treatment for ASD is not specifically referenced as a section 1905(a) service.
However, some treatment modalities, or components of such treatment modalities, are
within the scope of the federal Medicaid program under the following service categories:
section 1905(a)(6) Other Licensed Practitioner (OLP), section 1905(a)(13) Preventive
Services, and section 1905(a)(11) Therapies :. States may provide services to address ASD
under each of these benefit categories. States will need to determine what, if any, steps
are needed to implement this policy clarification. In keeping with the role of the Medicaid
state plan as a comprehensive written statement of the nature and scope of services
available under the state’s Medicaid program, a SPA is strongly encouraged to articulate
the state’s menu of services for ASD treatment.
(FAQ10728)
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