Autism Evaluation Requirements: What to Expect

Autism Evaluation Requirements: What to Expect

Evaluations of children with autism may include one or more different assessments. The results of the evaluation will be required to obtain therapy services paid for by insurance companies, get services from public schools, and qualify for government benefits. The types of assessments that are conducted as well as who conduct those assessments will determine whether or not the evaluation report will meet the requirements for specific types of services.

If you think your child may have autism, it's important to schedule an appointment with an insured provider to see if you qualify for ABA services. Learn what to expect here. Click To Tweet

Qualifying for Applied Behavior Analysis (ABA)

Applied Behavior Analysis (ABA) therapy for a child with autism is paid for by the parents’ medical insurance company, which also establishes the evaluation requirements for ABA services. The child’s evaluation must be provided to the insurance company to get approval for ABA services.

Public schools will conduct an evaluation of a child who may have autism to determine whether or not they qualify for services under the Individuals with Disabilities Education Act (IDEA). However, in many cases insurance companies will not accept assessments that are conducted by school district personnel. Insurance companies typically require that an assessment be completed by a medical professional, specifically a licensed psychologist or licensed medical doctor.

Insurance Coverage & Autism Diagnosis

Insurance companies may also not approve an autism diagnosis if the diagnosis was based solely upon a parent interview or a questionnaire completed by the parents. They require that assessments of the child be completed as well. Finally, although the cognitive functioning level is not one of the criteria that the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) includes in the definition of autism, some insurance companies will also require an evaluation of the child’s cognitive functioning level.

Parents can find out what their insurance companies will require for an autism diagnosis by contacting the insurance company directly. The insurance company should have written clinical guidelines that outline the specific requirements for an autism diagnosis. ABA providers can also advise parents what type of testing will be required for their insurance company.

Types of Autism Diagnosis Assessments

Prior to scheduling a formal autism evaluation, pediatricians, other professionals, and parents can screen their child for autism using the Modified Checklist for Autism in Toddlers – Revised (M-CHAT-R). The tool consists of 20 questions and is used for toddlers between the ages of 16 and 30 months. The results of this tool can be used to determine whether a child may need further evaluation for autism.

Two of the most frequently used assessments for autism are the Autism Diagnostic Observation ( ADOS-2), which is considered the “gold standard” of autism assessments, and the Childhood Autism Rating Scale (CARS-2). The autism evaluation may also include parent interviews or questionnaires, evaluations of speech skills and motors skills, as well as an evaluation of cognitive functioning.

Schedule Your Autism Evaluation Today

It may take time to get an appointment for an autism evaluation so it’s important to know what specific testing your insurance company will require when you schedule the appointment. You will want to be sure that the provider who is going to complete the evaluation will include all of the testing needed to ensure that your child will be able to receive the services they need.

Please contact us if you need specific information about the testing required by your insurance company.