Table 1. Number of children (1-6 years old) who received a diagnostic assessment
| MCO | Number of children (Age 1 - 3) | Number of children (Age 4 - 6) |
|---|---|---|
| Blue Plus | 125 | 545 |
| HealthPartners | 112 | 583 |
| Itasca Medical Care | 14 | 86 |
| Medica | 149 | 837 |
| PrimeWest | 66 | 242 |
| South Country Health Alliance | 47 | 238 |
| UCare | 396 | 1,634 |
| MCOs overall | 909 | 4,165 |
Table 2. Number of children (1-6 years old) with a diagnosis of autism spectrum disorder (ASD) who received treatments
| MCO | Number of children with ASD | Number of children with treatments |
|---|---|---|
| Blue Plus | 111 | 101 |
| HealthPartners | 122 | 113 |
| Itasca Medical Care | 10 | 10 |
| Medica | 181 | 161 |
| PrimeWest | 43 | 41 |
| South Country Health Alliance | 35 | 32 |
| UCare | 394 | 352 |
| MCOs overall | 896 | 810 |
Table 3a. Number of children (1-3 years old) with a diagnosis of ASD who received treatments, by MCO and age
| MCO | 1-year-olds with ASD | 1-year-olds receiving treatment | 2-year-olds with ASD | 2-year-olds receiving treatment | 3-year-olds with ASD | 3-year-olds receiving treatment |
|---|---|---|---|---|---|---|
| Blue Plus | 0 | 0 | 6 | 5 | 22 | 19 |
| HealthPartners | 0 | 0 | 11 | 9 | 22 | 22 |
| Itasca Medical Care | 0 | 0 | 1 | 1 | 3 | 3 |
| Medica | 3 | 2 | 16 | 13 | 46 | 44 |
| PrimeWest | 0 | 0 | 3 | 2 | 7 | 7 |
| South Country Health Alliance | 1 | 1 | 4 | 3 | 4 | 4 |
| UCare | 5 | 4 | 30 | 28 | 78 | 64 |
| MHCP overall | 9 | 7 | 71 | 61 | 182 | 163 |
Table 3b. Number of children (4-6 years old) with a diagnosis of ASD who received treatments, by MCO and age
| MCO | 4-year-olds with ASD | 4-year-olds receiving treatment | 5-year-olds with ASD | 5-year-olds receiving treatment | 6-year-olds with ASD | 6-year-olds receiving treatment |
|---|---|---|---|---|---|---|
| Blue Plus | 21 | 20 | 31 | 29 | 31 | 28 |
| HealthPartners | 27 | 24 | 30 | 29 | 32 | 29 |
| Itasca Medical Care | 1 | 1 | 3 | 3 | 2 | 2 |
| Medica | 42 | 36 | 38 | 34 | 36 | 32 |
| PrimeWest | 10 | 9 | 11 | 11 | 12 | 12 |
| South Country Health Alliance | 7 | 5 | 12 | 12 | 7 | 7 |
| UCare | 87 | 76 | 92 | 84 | 102 | 96 |
| MHCP overall | 195 | 171 | 217 | 202 | 222 | 206 |
Table 4a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=111)
| Procedure code | Description | Count | Total units paid |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 104 | 104.0 |
| 90833 | Psychotherapy with e&m, 30 minutes | 7 | 7.0 |
| 90834 | Psychotherapy, 45 min | 82 | 82.0 |
| 90837 | Psychotherapy, 60 min | 131 | 131.0 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 2 | 2.0 |
| 90846 | Family Psychotherapy - without patient present | 81 | 81.0 |
| 90847 | Family Psychotherapy - with patient present | 112 | 112.0 |
| 90849 | Multiple Family Group Psychotherapy | 8 | 8.0 |
| 90853 | Group Psychotherapy | 5 | 5.0 |
| 90875 | Biofeedback Training | 0 | 0.0 |
| 90887 | Interpretation of psychiatric and other medical examination | 2 | 2.0 |
| 90899 | Unlisted Psychiatric Service | 0 | 0.0 |
| 99499 | Psychiatric Consultation (Unlisted evaluation and management) | 0 | 0.0 |
| H2012 | Behavioral Health Day Treatment (General Day Treatment) | 466 | 1,385.0 |
| H2014 | Skills Training | 857 | 5,809.0 |
| H2015 | Crisis Assistance | 0 | 0.0 |
| H2019 | Mental Health Behavioral Aide | 104 | 920.0 |
| T1018 | School-based individualized education (IEP) services | 4,284 | 4,462.0 |
Table 4b. Blue Plus: Types of treatments provided to children with ASD by category of service (n=111)
| Category of Service | Description | Count | Total units paid |
|---|---|---|---|
| 051 | Physical Therapy | 493 | 1,075.0 |
| 053 | Speech Therapy | 1,262 | 1,262.0 |
| 054 | Occupational Therapy | 1,165 | 2,823.0 |
Table 5a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=122)
| Procedure code | Description | Count | Total units paid |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 24 | 24.0 |
| 90833 | Psychotherapy with e&m, 30 minutes | 0 | 0.0 |
| 90834 | Psychotherapy, 45 min | 94 | 94.0 |
| 90837 | Psychotherapy, 60 min | 118 | 118.0 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 0 | 0.0 |
| 90846 | Family Psychotherapy - without patient present | 136 | 136.0 |
| 90847 | Family Psychotherapy - with patient present | 140 | 140.0 |
| 90849 | Multiple Family Group Psychotherapy | 7 | 7.0 |
| 90853 | Group Psychotherapy | 0 | 0.0 |
| 90875 | Biofeedback Training | 0 | 0.0 |
| 90887 | Interpretation of psychiatric and other medical examination | 6 | 6.0 |
| 90899 | Unlisted Psychiatric Service | 5 | 5.0 |
| 99499 | Psychiatric Consultation (Unlisted evaluation and management) | 0 | 0.0 |
| H2012 | Behavioral Health Day Treatment (General Day Treatment) | 2,308 | 6,874.0 |
| H2014 | Skills Training | 479 | 3,722.0 |
| H2015 | Crisis Assistance | 0 | 0.0 |
| H2019 | Mental Health Behavioral Aide | 60 | 686.0 |
| T1018 | School-based individualized education (IEP) services | 3,096 | 3,321.0 |
Table 5b. HealthPartners: Types of treatment provided to children with ASD by category of service (n=122)
| Category of Service | Description | Count | Total units paid |
|---|---|---|---|
| 051 | Physical Therapy | 844 | 1,599.0 |
| 053 | Speech Therapy | 2,043 | 2,043.0 |
| 054 | Occupational Therapy | 2,292 | 5,248.0 |
Table 6a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=10)
| Procedure code | Description | Count | Total units paid |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 0 | 0.0 |
| 90833 | Psychotherapy with e&m, 30 minutes | 0 | 0.0 |
| 90834 | Psychotherapy, 45 min | 0 | 0.0 |
| 90837 | Psychotherapy, 60 min | 2 | 2.0 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 0 | 0.0 |
| 90846 | Family Psychotherapy - without patient present | 0 | 0.0 |
| 90847 | Family Psychotherapy - with patient present | 0 | 0.0 |
| 90849 | Multiple Family Group Psychotherapy | 0 | 0.0 |
| 90853 | Group Psychotherapy | 0 | 0.0 |
| 90875 | Biofeedback Training | 0 | 0.0 |
| 90887 | Interpretation of psychiatric and other medical examination | 0 | 0.0 |
| 90899 | Unlisted Psychiatric Service | 0 | 0.0 |
| 99499 | Psychiatric Consultation (Unlisted evaluation and management) | 0 | 0.0 |
| H2012 | Behavioral Health Day Treatment (General Day Treatment) | 0 | 0.0 |
| H2014 | Skills Training | 410 | 4,016.0 |
| H2015 | Crisis Assistance | 0 | 0.0 |
| H2019 | Mental Health Behavioral Aide | 0 | 0.0 |
| T1018 | School-based individualized education (IEP) services | 261 | 274.0 |
Table 6b. Itasca Medical Care: Types of treatment provided to children with ASD by category of service (n=10)
| Category of Service | Description | Count | Total units paid |
|---|---|---|---|
| 051 | Physical Therapy | 0 | 0.0 |
| 053 | Speech Therapy | 22 | 22.0 |
| 054 | Occupational Therapy | 28 | 75.0 |
Table 7a. Medica: Types of treatment provided to children with ASD by procedure code (n=181)
| Procedure code | Description | Count | Total units paid |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 23 | 23.0 |
| 90833 | Psychotherapy with e&m, 30 minutes | 4 | 4.0 |
| 90834 | Psychotherapy, 45 min | 141 | 141.0 |
| 90837 | Psychotherapy, 60 min | 70 | 70.0 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 0 | 0.0 |
| 90846 | Family Psychotherapy - without patient present | 176 | 176.0 |
| 90847 | Family Psychotherapy - with patient present | 204 | 204.0 |
| 90849 | Multiple Family Group Psychotherapy | 30 | 30.0 |
| 90853 | Group Psychotherapy | 16 | 16.0 |
| 90875 | Biofeedback Training | 4 | 4.0 |
| 90887 | Interpretation of psychiatric and other medical examination | 9 | 9.0 |
| 90899 | Unlisted Psychiatric Service | 90 | 90.0 |
| 99499 | Psychiatric Consultation (Unlisted evaluation and management) | 0 | 0.0 |
| H2012 | Behavioral Health Day Treatment (General Day Treatment) | 3,174 | 8,122.0 |
| H2014 | Skills Training | 570 | 3,973.0 |
| H2015 | Crisis Assistance | 0 | 0.0 |
| H2019 | Mental Health Behavioral Aide | 9 | 57.0 |
| T1018 | School-based individualized education (IEP) services | 4,624 | 4,677.0 |
Table 7b. Medica: Types of treatment provided to children with ASD by category of service (n=181)
| Category of Service | Description | Count | Total units paid |
|---|---|---|---|
| 051 | Physical Therapy | 647 | 1,427.0 |
| 053 | Speech Therapy | 2,463 | 2,463.0 |
| 054 | Occupational Therapy | 2,205 | 5,688.0 |
Table 8a. PrimeWest: Types of treatment provided to children with ASD by procedure code (n=43)
| Procedure code | Description | Count | Total units paid |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 16 | 16.0 |
| 90833 | Psychotherapy with e&m, 30 minutes | 0 | 0.0 |
| 90834 | Psychotherapy, 45 min | 27 | 27.0 |
| 90837 | Psychotherapy, 60 min | 64 | 64.0 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 0 | 0.0 |
| 90846 | Family Psychotherapy - without patient present | 9 | 9.0 |
| 90847 | Family Psychotherapy - with patient present | 46 | 46.0 |
| 90849 | Multiple Family Group Psychotherapy | 0 | 0.0 |
| 90853 | Group Psychotherapy | 0 | 0.0 |
| 90875 | Biofeedback Training | 0 | 0.0 |
| 90887 | Interpretation of psychiatric and other medical examination | 5 | 5.0 |
| 90899 | Unlisted Psychiatric Service | 0 | 0.0 |
| 99499 | Psychiatric Consultation (Unlisted evaluation and management) | 2 | 2.0 |
| H2012 | Behavioral Health Day Treatment (General Day Treatment) | 0 | 0.0 |
| H2014 | Skills Training | 311 | 3,409.0 |
| H2015 | Crisis Assistance | 0 | 0.0 |
| H2019 | Mental Health Behavioral Aide | 0 | 0.0 |
| T1018 | School-based individualized education (IEP) services | 1,559 | 1,729.0 |
Table 8b. PrimeWest: Types of treatment provided to children with ASD by category of service (n=43)
| Category of Service | Description | Count | Total units paid |
|---|---|---|---|
| 051 | Physical Therapy | 242 | 469.0 |
| 053 | Speech Therapy | 418 | 418.0 |
| 054 | Occupational Therapy | 556 | 1,075.0 |
Table 9a. South Country Health Alliance: Types of treatment provided to children with ASD by procedure code (n=35)
| Procedure code | Description | Count | Total units paid |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 4 | 4.0 |
| 90833 | Psychotherapy with e&m, 30 minutes | 11 | 11.0 |
| 90834 | Psychotherapy, 45 min | 19 | 19.0 |
| 90837 | Psychotherapy, 60 min | 54 | 54.0 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 0 | 0.0 |
| 90846 | Family Psychotherapy - without patient present | 9 | 9.0 |
| 90847 | Family Psychotherapy - with patient present | 57 | 57.0 |
| 90849 | Multiple Family Group Psychotherapy | 0 | 0.0 |
| 90853 | Group Psychotherapy | 0 | 0.0 |
| 90875 | Biofeedback Training | 0 | 0.0 |
| 90887 | Interpretation of psychiatric and other medical examination | 1 | 1.0 |
| 90899 | Unlisted Psychiatric Service | 0 | 0.0 |
| 99499 | Psychiatric Consultation (Unlisted evaluation and management) | 0 | 0.0 |
| H2012 | Behavioral Health Day Treatment (General Day Treatment) | 0 | 0.0 |
| H2014 | Skills Training | 388 | 2,461.0 |
| H2015 | Crisis Assistance | 0 | 0.0 |
| H2019 | Mental Health Behavioral Aide | 106 | 593.0 |
| T1018 | School-based individualized education (IEP) services | 1,741 | 2,520.0 |
Table 9b. South Country Health Alliance: Types of treatment provided to children with ASD by category of service (n=35)
| Category of Service | Description | Count | Total units paid |
|---|---|---|---|
| 051 | Physical Therapy | 50 | 51.0 |
| 053 | Speech Therapy | 236 | 236.0 |
| 054 | Occupational Therapy | 276 | 465.0 |
Table 10a. UCare: Types of treatments provided to children with ASD by procedure code (n=394)
| Procedure code | Description | Count | Total units paid |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 50 | 50.0 |
| 90833 | Psychotherapy with e&m, 30 minutes | 8 | 8.0 |
| 90834 | Psychotherapy, 45 min | 206 | 206.0 |
| 90837 | Psychotherapy, 60 min | 342 | 342.0 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 0 | 0.0 |
| 90846 | Family Psychotherapy - without patient present | 287 | 287.0 |
| 90847 | Family Psychotherapy - with patient present | 434 | 434.0 |
| 90849 | Multiple Family Group Psychotherapy | 41 | 41.0 |
| 90853 | Group Psychotherapy | 16 | 16.0 |
| 90875 | Biofeedback Training | 0 | 0.0 |
| 90887 | Interpretation of psychiatric and other medical examination | 17 | 17.0 |
| 90899 | Unlisted Psychiatric Service | 0 | 0.0 |
| 99499 | Psychiatric Consultation (Unlisted evaluation and management) | 0 | 0.0 |
| H2012 | Behavioral Health Day Treatment (General Day Treatment) | 2,899 | 8,484.0 |
| H2014 | Skills Training | 3,878 | 31,543.0 |
| H2015 | Crisis Assistance | 1 | 1.0 |
| H2019 | Mental Health Behavioral Aide | 329 | 3,648.0 |
| T1018 | School-based individualized education (IEP) services | 14,263 | 15,347.0 |
Table 10b. UCare: Types of treatments provided to children with ASD by category of service (n=394)
| Category of Service | Description | Count | Total units paid |
|---|---|---|---|
| 051 | Physical Therapy | 640 | 941.0 |
| 053 | Speech Therapy | 4,272 | 4,272.0 |
| 054 | Occupational Therapy | 4,481 | 10,764.0 |
1) Data are limited to final version of Minnesota Health Care Programs-paid claims with service dates between Jan. 1, 2014, through Dec. 31, 2014, inclusive.
2) Analysis was limited to children enrolled in a managed-care organization. MCO assignment was selected based on the MCO in which the recipient had the most months of enrollment during the year. If a person was enrolled in fee-for-service for more months than he or she was enrolled in an MCO during the year, then he or she was excluded from this analysis.
3) Both Managed Care and FFS claims were included in the analysis if the recipient was enrolled in an MCO for the majority of the year.
4) Age was calculated as of Dec. 31, 2014.
5) Analysis was limited to children aged 1 through 6.
6) Diagnostic assessments were identified using procedure codes 90791, 90702 and 90785.
7) Children with a diagnosis of autism spectrum disorder (ASD) were identified with claims having a diagnosis code of 299.0 (Autistic disorder) and 299.8 (Other specified pervasive developmental disorders).
8) Treatments for children with a diagnosis of ASD were identified with claims having a procedure code beginning with 908 (codes 90839 and 90875 did not appear in the CY2013 report); having a procedure code of H2014, T1018, H2015, H2019, H2012, 99499; or claims with category of service of 051 (Physical Therapy), 053 (Speech Therapy), and 054 (Occupational Therapy).
9) All treatment claims were de-duplicated using standard operating procedures.
10) Analysis was designed in adherence to Minn. Stat. 256B.69, Subd. 32a. (see below).
Initiatives to improve early screening, diagnosis, and treatment of children with autism spectrum disorder and other developmental conditions.
(a) The commissioner shall require managed care plans and county-based purchasing plans, as a condition of contract, to implement strategies that facilitate access for young children between the ages of one and three years to periodic developmental and social-emotional screenings, as recommended by the Minnesota Interagency Developmental Screening Task Force, and that those children who do not meet milestones are provided access to appropriate evaluation and assessment, including treatment recommendations, expected to improve the child's functioning, with the goal of meeting milestones by age five.
(b) The following information from encounter data provided to the commissioner shall be reported on the department's public Web site for each managed care plan and county-based purchasing plan annually by July 31 of each year beginning in 2014:
(1) the number of children who received a diagnostic assessment;
(2) the total number of children ages one to six with a diagnosis of autism spectrum disorder who received treatments;
(3) the number of children identified under clause (2) reported by each 12-month age group beginning with age one and ending with age six; and
(4) the types of treatments provided to children identified under clause (2) listed by billing code, including the number of units billed for each child.
