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Autism Spectrum Disorder
Autism occurs in one of every 150 births and at a rate of five boys to every girl.
What behaviors might indicate that a child has an Autism Spectrum Disorder (ASD)?
The following “red flags” may indicate that a child is at risk for developmental problems. Any child exhibiting one or more of these behaviors should be screened as soon as possible by a professional for developmental progress. Pediatricians and primary care physicians can provide this service.
- No big smiles or other warm joyful expressions by six months or thereafter
- No back-and-forth sharing of sounds, smiles or other facial expressions by nine months or thereafter
- No babbling by 12 months
- No back-and-forth gestures, such as pointing, showing, reaching or waving by 12 months
- No words by 16 months
- No two-word meaningful phrases (without imitating or repeating) by 24 months
- Any loss of speech or babbling or social skills at any age
See Appendices A-C in A Handbook for Parents of Children with Autism Spectrum Disorders (ASD) for a complete list of diagnostic criteria for Autism and related disorders.
It is recommended that all infants and toddlers are screened for developmental progress at every well-child visit. There is a special screening designed to detect the early signs of Autism.
Early Intervention assessments and services are made available to children under the age of five years who qualify. See Appendix H in A Handbook for Parents of Children with Autism Spectrum Disorders for contact information of the agencies in Allegheny County who provide these services.
Who pays for the services needed by children with autism spectrum disorders?
The Pa. Autism Insurance Act (Act 62) requires:
- many private insurers to cover the costs of diagnostic assessments for Autism and of services for individuals with Autism who are under the age of 21, up to $36,000 per year;
- the Pennsylvania Department of Public Welfare (DPW) to cover those costs for eligible individuals who have no private insurance coverage, or for individuals whose costs exceed $36,000 that year;
If a child is covered by a private health insurance plan:
- Determine if your child’s insurance coverage is required to pay for Autism services as mandated by Pa. Act 62 by using this flow chart.
- If yes, the first $36,000 per year in medically necessary services will be paid by your private carrier.
- If no, see below.
- Because the cost of Behavioral Health Rehabilitation Services (BHRS) services generally exceeds $36,000 per year, parents of children with an ASD should apply for DPW Medical Assistance (MA) early in the process. See pages 4 through 8 in A Handbook for Parents of Children with Autism Spectrum Disorders for details.
- MA pays for BHRS services through the county managed care organization, which, in Allegheny County, is Community Care Behavioral Health.
If a child is not covered by a private health insurance plan:
The parent or guardian of the child should complete an application to have the child receive Medical Assistance. See pages 4 through 8 in A Handbook for Parents of Children with Autism Spectrum Disorders for details about how to do this.
For answers to questions about Pa. Act 62
What kinds of services will a child with ASD be eligible to receive?
Medical Assistance covers various behavioral health services not generally covered under commercial insurance, including Behavioral Health Rehabilitation Services (BHRS) and Therapeutic Staff Support (TSS) services.
BHRS services are the most commonly recommended services for children with Autism and other Pervasive Developmental Disorders and include a range of individualized behavior management, treatment and rehabilitation services provided in a community setting. Settings may include the child’s home or school, as well as other settings such as camps, recreational venues, or commercial establishments.
Which types of professionals deliver the Behavioral Health Rehabilitation Services (BHRS) that MA pays for?
- Behavior Specialist Consultants
- Mobile Therapists
- Therapeutic Staff Support
See pages 9 through 10 in A Handbook for Parents of Children with Autism Spectrum Disorders for details about these professionals and the services they provide.
How can a parent arrange for BHRS for a child?
There are many agencies located all around the county that are authorized to evaluate children to find out what level of care is best for the child.
See Appendix I in A Handbook for Parents of Children with Autism Spectrum Disorders for the list and contact information for each agency.
What happens next?
Extensive information of interest to parents of children with ASD, including information about the process of arranging for and continuing BHRS for a child with Autism, is available in the A Handbook for Parents of Children with Autism Spectrum Disorders.
Parents or caregivers of children with an ASD are invited to call Community Care Behavioral Health’s Autism Support Line, 1-866-415-1708, to have their questions answered or to get additional information.
A Handbook for Parents of Children with Autism Spectrum Disorders, published by Community Care Behavioral Health in 2008, provided content for this page.
Websites of Interest
Provides individual and confidential support for persons with Autism who live in Pennsylvania.
Provides a place for parents of children with Autism in Western Pennsylvania to communicate with each other and exchange information.
Autism Spectrum Disorders (Pervasive Developmental Disorders)
A detailed booklet that describes Autism symptoms, causes, and treatments, with information on getting help and coping, published by the National Institute of Mental Health, 2004.
Community Care Behavioral Health (CCBHO)
The managed care provider of behavioral health services, including those for children with Autism, in Allegheny County.
The National Dissemination Center for Children with Disabilities is a central source of information on disabilities in infants, toddlers, children, and youth. Information is available in English and Español.
Pennsylvania Department of Public Welfare Autism Services