Autism Guide

Autism Spectrum Disorder is a common developmental condition that affects the brain. It has a wide range of symptoms that can vary from person to person. It can cause social, communication and behavioral challenges. It affects 1 in 36 children in the United States.

People with autism often move, learn and process emotions differently. Some do not speak or speak less over time. Some need a lot of help in their daily lives while others need less. There are supports available to help people live better with autism.

Learn more about autism.

• Look for signs. Experts recommend that all children be screened for autism. Symptoms usually start within the first two years of life. Watch for repetitive movements and speech, unusual sensory reactions and developmental delays. Other signs include:
  • Repeating certain actions or phrases
  • Being upset by minor changes in routine
  • Having trouble paying attention
  • Struggling to understand or show emotions
• Early intervention. If you think your child has autism, it’s important to talk to their doctor as soon as possible. Diagnosing autism is difficult because there is no test for it. Your child’s doctor will use your child’s developmental history and behavior to assess them.
• Supports. There are supports that can help children with autism live full lives. Schedule a Well Child visit with your child’s primary doctor to talk about your child’s symptoms.

Your child’s Care Manager can help connect you to services and supports for children with autism. Here are some examples of benefits your child may qualify for:

Benefits

• Behavior Analysis – Services for children with autism to teach and reinforce appropriate behaviors.
• Early Intervention Services – For children ages 0-36 months who have developmental delays and other conditions. Prior authorization required.
  • Includes: One initial evaluation per lifetime, completed by a team; Up to three screenings per year; up to three follow-up evaluations per year; up to two training or support sessions per week
• Medication Management Services – Help understanding the best choices for taking medication. Covered as medically necessary.
• Behavioral Health Assessment Services – Used to detect or diagnose behavioral health disorders.
  • Includes: One initial assessment per year, one reassessment per year, up to 150 minutes of brief behavioral health status assessments per year (no more than 30 minutes in a single day).
• Individual Therapy Services – One-on-one therapy sessions with a mental health professional.
  • Includes: Up to 26 hours per year, as medically necessary.
• Family Therapy Services – Family therapy sessions with a mental health professional.
  • Includes: Up to 26 hours per year, as medically necessary.
• Individual Therapy Sessions for Caregivers – Therapy sessions to address behavioral health needs for caregivers of members.
  • Includes: Unlimited visits with prior authorization.
• Respite Care – Provides caregivers a temporary rest from caregiving.
  •  Includes: Up to 200 hours of in-home respite care and 10 days of out-of-home respite care per year. Some limitations may apply.

Contact your child’s Care Manager for more information about any of these resources. You can also call Member Services at 1-866-799-5321 (TTY 1-800-955-8770), Monday through Friday, 8 a.m. to 8 p.m. Eastern.