Welcome

This site was designed as a collaborative portal to maintain information about the Michigan autism insurance legislation benefit.   With the passage of the legislation in Michigan on March 29, 2012, the Autism Alliance of Michigan (AAoM) has taken a leadership role in bringing key stakeholders together, defining how the service delivery model will be staged.  Recently workshops were convened to provide and exchange information about the insurance bill language and to educate universities and providers as to how the legislation impacts the future delivery of evidence-based treatments for autism.  The following key areas were discussed:  university programs and capacity and how to expand programming for Board Certified Behavior Analysts (BCBAs), BCBA program requirements, Applied Behavior Analysis (ABA) overview and procedures, insurance requirements and codes, provider program expansion, and more.
 


We continue to update insurance information as we receive it from providers, employers, and insurers.  There have been a number of questions from parents and providers about recent changes from BCBSM and changes to requirements for using Autism Assessment Evaluation Centers (AAECs).  See the following Frequently Asked Questions about recent changes, and where to find additional information:

  • Q:  What number do I call to get to the right people at BCBSM and BCN? (Added 6/23/13)
  • Q:  What is the requirement at this time for BCBSM/BCN for using AAECs, I thought I needed to go through one of their centers?
    • A:  That was initially true when the benefit was rolled out, but there have been some temporary changes made to the requirement, go to the tab above: Providers/ADOS & Diagnosis--and scroll to the bottom of the page for current AAECs and temporary requirements changes:  ADOS and Diagnosis Information 
  • Q:  My child has already been assessed at school, why do they need to have a medical diagnosis?
    • A:  Autism is a complex medical disorder, and a comprehensive evaluation may be needed for your child to rule out other co-existing conditions.  Also, evaluating speech, sensory concerns, and other issues may lead to improved treatment coordination and outcomes.  More information at:  Medical Diagnosis versus Education Eligibility.    Insurers will not accept the school's eligibility assessment as a medical diagnosis.
  • Q:  I am not sure where to start with trying to get my child covered for insurance.  What do I need to do first?
    • A:  If you have private insurance, you need to determine WHAT TYPE of insurance your employers offers: state-regulated (which is covered by the state insurance mandate), or self-insured (which is not automatically covered by the insurance mandate).  However, employers can choose to self-adopt the coverage (i.e. a rider for employees), but they need to self-adopt the benefit.  Find out more information at:          State Regulated and Self-Funded Insurance, and Self-Adoption
  • Q:  How can my employer find out about self adoption?
  • Q:  Is there really a fund to reimburse insurers for covering autism treatments defined in the law?
    • A:  YES!  The Licensing and Regulatory Affairs (LARA) department with the State of Michigan manages this benefit along with the Office of Finance and Insurance Regulation.  This amounts to $15M, to be voted on for reallocated each year by the legislature.  For more information, go to:  Autism Reimbursement Fund Informatio

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ABA online training options offering outcome data, assistance with training, and credentialing for BCBA...this is excellent for front line therapists (i.e. paraprofessionals, community living support staff, line therapists).  The tool set is utilized by hundreds of organizations and AAOM has partnered with them in support of this evidence-based approach to learning ABA methodology.  Check out the ABA Training Option tab or go to:  ABA Training Options

ISSUES GETTING ACCESS TO INSURANCE Update 10/25/12:   if you are having access issues through your insurer in getting an appointment for a medical diagnosis for autism, thus subsequent treatments, make sure to work through your insurer's escalation procedure (ask them what that is and maintain records of all conversations and correspondence!). The only way insurers know there are issues is to escalate through their process.  Be patient with the person on the other end of the phone--this is a new offering for your carrier, so everyone is learning.   As part of your insurer's process, you may have an option to file a grievance or mediate your concern.  Make sure to follow whatever is required by your insurer to get your concern resolved.  Also, ask that they send or fax you an explanation as to what their position is regarding your inability to access or use the autism benefit so you have that documentation.  This information will be needed if you have to file a complaint with the Department of Insurance and Financial Services (DIFS).   If your issues are still unresolved, you can submit a formal complaint to the Department of Insurance and Financial Services (DIFS) for further review.   The link is:  http://www.michigan.gov/difs/0,5269,7-303-12902_12907---,00.html.

JOIN WITH OTHER PARENTS:  There is a Facebook page available for interested parents to discuss the insurance benefit at:  https://www.facebook.com/pages/Parents-for-Michigan-Autism-Insurance/504169479601758?ref=hl (Parents for Michigan Autism Insurance).  




To check out additional information on autism events, news, and information for Michigan, go to the Autism Alliance of Michigan  (AAoM) Website (link from logo or www.autismallianceofmichigan.org)
 
 
 
 
 View the AAoM Facebook Page (link from logo)
 
 



GRAPHIC OVERVIEW OF INSURANCE LEGISLATION
First Step: Determine whether you have 
State Regulated or Self-Funded Insurance!
(Your employer/insurer should be able to tell you!)

                





To download the above, and flows specific to state-regulated, self-funded, and Medicaid coverage, go to:  Insurance Data Flow Page

To arrange for an on-site insurance benefit presentation for families, providers, insurers, or others interested in this topic,
contact Stacie Rulison at the e-mail address below.



 If you have suggestions, feedback, or any information pertaining to this site, please contact stacie.rulison@aaomi.org