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    Data from 2016 calendar year

    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 400 1,890
    HealthPartners 71 401
    Itasca Medical Care 18 91
    Medica 266 1,373
    PrimeWest 58 275
    South Country Health Alliance 62 241
    UCare 8 62
    MCOs overall 883 4,333


    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 treatment(s)
    Blue Plus 545 405
    HealthPartners 113 76
    Itasca Medical Care 10 7
    Medica 610 429
    PrimeWest 81 58
    South Country Health Alliance 57 40
    UCare 13 7
    MCOs Overall 1,429 1,022


    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 5 3 58 49 91 69
    HealthPartners 2 1 10 7 20 15
    Itasca Medical Care 0 0 0 0 2 1
    Medica 6 3 43 34 126 96
    PrimeWest 0 0 7 6 15 12
    South Country Health Alliance 0 0 5 4 11 8
    UCare 0 0 0 0 4 2
    MHCP overall 13 7 123 100 269 203


    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 119 88 125 90 147 106
    HealthPartners 27 21 26 15 28 17
    Itasca Medical Care 0 0 2 2 6 4
    Medica 125 90 161 114 149 92
    PrimeWest 13 9 19 13 27 18
    South Country Health Alliance 11 6 13 10 17 12
    UCare 5 2 2 1 2 2
    MHCP overall 300 216 348 245 376 251


    Table 4a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=545)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 19 68 68.0 3.6
    90833 Psychotherapy with e&m, 30 minutes 7 14 14.0 2.0
    90834 Psychotherapy, 45 min 64 290 290.0 4.5
    90836 Psychotherapy with e&m, 45 min 2 2 2.0 1.0
    90837 Psychotherapy, 60 min 88 485 485.0 5.5
    90839 Psychotherapy for crisis, first 60 minutes 1 1 1.0 1.0
    90840 Psychotherapy for crisis, additional 30 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 132 401 401.0 3.0
    90847 Family Psychotherapy - with patient present 105 458 458.0 4.4
    90849 Multiple Family Group Psychotherapy 3 8 8.0 2.7
    90853 Group Psychotherapy 4 22 22.0 5.5
    90875 Biofeedback Training 1 1 1.0 1.0
    90882 Environmental intervention 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 3 3 3.0 1.0
    90899 Unlisted Psychiatric Service 12 45 45.0 3.8
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 49 3,357 9,842.0 200.9
    H2014 Skills Training 79 3,506 37,698.0 477.2
    H2015 Crisis Assistance 1 2 4.0 4.0
    H2019 Mental Health Behavioral Aide 11 508 4,545.0 413.2
    T1018 School-based individualized education program services, bundled 0 0 0.0 N/A


    Table 4b. Blue Plus: Types of treatments provided to children with ASD by category of service (n=545)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 67 1,262 2,828 42.2
    053 Speech Therapy 266 6,385 6,385 24.0
    054 Occupational Therapy 253 6,260 15,261 60.3


    Table 5a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=113)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 1 5 5.0 5.0
    90833 Psychotherapy with e&m, 30 minutes 2 8 8.0 4.0
    90834 Psychotherapy, 45 min 5 29 29.0 5.8
    90836 Psychotherapy with e&m, 45 min 0 0 0.0 N/A
    90837 Psychotherapy, 60 min 8 14 14.0 1.8
    90839 Psychotherapy for crisis, first 60 minutes 0 0 0.0 N/A
    90840 Psychotherapy for crisis, additional 30 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 32 136 136.0 4.3
    90847 Family Psychotherapy - with patient present 23 80 80.0 3.5
    90849 Multiple Family Group Psychotherapy 1 4 4.0 4.0
    90853 Group Psychotherapy 0 0 0.0 N/A
    90875 Biofeedback Training 0 0 0.0 N/A
    90882 Environmental intervention 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 3 3 3.0 1.0
    90899 Unlisted Psychiatric Service 1 2 2.0 2.0
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 19 1,603 4,770.0 251.1
    H2014 Skills Training 6 703 6,361.0 1,060.2
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 1 10 63.0 63.0
    T1018 School-based individualized education program services, bundled 0 0 0.0 N/A


    Table 5b. HealthPartners: Types of treatment provided to children with ASD by category of service (n=113)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 13 394 901 69.3
    053 Speech Therapy 61 1,187 1,187 19.5
    054 Occupational Therapy 56 1,137 2,837 50.7


    Table 6a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=10)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 1 1 1.0 1.0
    90833 Psychotherapy with e&m, 30 minutes 0 0 0.0 N/A
    90834 Psychotherapy, 45 min 1 1 1.0 1.0
    90836 Psychotherapy with e&m, 45 min 0 0 0.0 N/A
    90837 Psychotherapy, 60 min 1 1 1.0 1.0
    90839 Psychotherapy for crisis, first 60 minutes 0 0 0.0 N/A
    90840 Psychotherapy for crisis, additional 30 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 0 0 0.0 N/A
    90847 Family Psychotherapy - with patient present 0 0 0.0 N/A
    90849 Multiple Family Group Psychotherapy 0 0 0.0 N/A
    90853 Group Psychotherapy 1 4 4.0 4.0
    90875 Biofeedback Training 0 0 0.0 N/A
    90882 Environmental intervention 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 1 1 1.0 1.0
    90899 Unlisted Psychiatric Service 0 0 0.0 N/A
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 0 0 0.0 N/A
    H2014 Skills Training 6 370 4,721.0 786.8
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 3 197 1,928.0 642.7
    T1018 School-based individualized education program services, bundled 0 0 0.0 N/A


    Table 6b. Itasca Medical Care: Types of treatment provided to children with ASD by category of service (n=10)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 1 19 19.0 19.0
    053 Speech Therapy 0 0 0.0 N/A
    054 Occupational Therapy 2 20 56.0 28.0


    Table 7a. Medica: Types of treatment provided to children with ASD by procedure code (n=610)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 19 32 32.0 1.7
    90833 Psychotherapy with e&m, 30 minutes 6 24 24.0 4.0
    90834 Psychotherapy, 45 min 50 292 292.0 5.8
    90836 Psychotherapy with e&m, 45 min 0 0 0.0 N/A
    90837 Psychotherapy, 60 min 60 413 413.0 6.9
    90839 Psychotherapy for crisis, first 60 minutes 1 1 1.0 1.0
    90840 Psychotherapy for crisis, additional 30 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 200 768 768.0 3.8
    90847 Family Psychotherapy - with patient present 122 479 479.0 3.9
    90849 Multiple Family Group Psychotherapy 3 23 23.0 7.7
    90853 Group Psychotherapy 5 27 27.0 5.4
    90875 Biofeedback Training 0 0 0.0 N/A
    90882 Environmental intervention 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medial examination 7 7 7.0 1.0
    90899 Unlisted Psychiatric Service 140 289 289.0 2.1
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 117 10,988 32,745.0 279.9
    H2014 Skills Training 85 2,656 26,153.0 307.7
    H2015 Crisis Assistance 1 2 7.0 7.0
    H2019 Mental Health Behavioral Aide 7 230 2,002.0 286.0
    T1018 School-based individualized education program services, bundled 0 0 0.0 N/A


    Table 7b. Medica: Types of treatment provided to children with ASD by category of service (n=610)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 46 803 1,968 42.8
    053 Speech Therapy 309 8,843 8,843 28.6
    054 Occupational Therapy 280 8,279 22,272 79.5


    Table 8a. PrimeWest: Types of treatment provided to children with ASD by procedure code (n=81)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 8 53 53.0 6.6
    90833 Psychotherapy with e&m, 30 minutes 0 0 0.0 N/A
    90834 Psychotherapy, 45 min 19 156 156.0 8.2
    90836 Psychotherapy with e&m, 45 min 0 0 0.0 N/A
    90837 Psychotherapy, 60 min 26 152 152.0 5.8
    90839 Psychotherapy for crisis, first 60 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 10 15 15.0 1.5
    90847 Family Psychotherapy - with patient present 11 17 17.0 1.5
    90849 Multiple Family Group Psychotherapy 4 20 20.0 5.0
    90853 Group Psychotherapy 0 0 0.0 N/A
    90875 Biofeedback Training 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medial examination 5 5 5.0 1.0
    90899 Unlisted Psychiatric Service 14 69 72.0 5.1
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 0 0 0.0 N/A
    H2014 Skills Training 11 341 1,623.0 147.5
    H2015 Crisis Assistance 1 1 1.0 1.0
    H2019 Mental Health Behavioral Aide 1 20 238.0 238.0
    T1018 School-based individualized education program services, bundled 0 0 0.0 N/A


    Table 8b. PrimeWest: Types of treatment provided to children with ASD by category of service (n=81)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 11 353 717 65.2
    053 Speech Therapy 34 796 796 23.4
    054 Occupational Therapy 38 1,026 2,606 68.6


    Table 9a. South Country Health Alliance: Types of treatment provided to children with ASD by procedure code (n=57)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 4 27 27.0 6.8
    90833 Psychotherapy with e&m, 30 minutes 1 3 3.0 3.0
    90834 Psychotherapy, 45 min 8 24 24.0 3.0
    90836 Psychotherapy with e&m, 45 min 0 0 0.0 N/A
    90837 Psychotherapy, 60 min 11 102 102.0 9.3
    90839 Psychotherapy for crisis, first 60 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 5 7 7.0 1.4
    90847 Family Psychotherapy - with patient present 11 21 21.0 1.9
    90849 Multiple Family Group Psychotherapy 0 0 0.0 N/A
    90853 Group Psychotherapy 2 11 11.0 5.5
    90875 Biofeedback Training 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 1 1 1.0 1.0
    90899 Unlisted Psychiatric Service 2 3 3.0 1.5
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 0 0 0.0 N/A
    H2014 Skills Training 16 478 2,468.0 154.3
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 2 42 304.0 152.0
    T1018 School-based individualized education program services, bundled 0 0 0.0 N/A


    Table 9b. South Country Health Alliance: Types of treatment provided to children with ASD by category of service (n=57)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 4 132 206 51.5
    053 Speech Therapy 21 552 552 26.3
    054 Occupational Therapy 22 618 1,263 57.4


    Table 10a. UCare: Types of treatments provided to children with ASD by procedure code (n=13)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 0 0 0.0 N/A
    90833 Psychotherapy with e&m, 30 minutes 0 0 0.0 N/A
    90834 Psychotherapy, 45 min 1 1 1.0 1.0
    90836 Psychotherapy with e&m, 45 min 0 0 0.0 N/A
    90837 Psychotherapy, 60 min 0 0 0.0 N/A
    90839 Psychotherapy for crisis, first 60 minutes 0 0 0.0 N/A
    90840 Psychotherapy for crisis, additional 30 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 0 1 1.0 N/A
    90847 Family Psychotherapy - with patient present 1 25 25.0 25.0
    90849 Multiple Family Group Psychotherapy 0 0 0.0 N/A
    90853 Group Psychotherapy 0 0 0.0 N/A
    90875 Biofeedback Training 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 0 0 0.0 N/A
    90899 Unlisted Psychiatric Service 1 1 1.0 1.0
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 0 0 0.0 N/A
    H2014 Skills Training 3 154 1,712.0 570.7
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 1 17 86.0 86.0
    T1018 School-based individualized education program services, bundled 0 0 0.0 N/A


    Table 10b. UCare: Types of treatments provided to children with ASD by category of service (n=13)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 0 0 0 N/A
    053 Speech Therapy 3 5 5 1.7
    054 Occupational Therapy 2 10 27 13.5


    Notes

    1) Data are limited to final version of Minnesota Health Care Programs-paid claims with service dates between Jan. 1, 2016, through Dec. 31, 2016, 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 recipient was enrolled in fee-for-service for the most months during the year, then he or she was excluded from this analysis.

    3) Only managed-care claims were included in analysis.

    4) Age was calculated as of Dec. 31, 2016.

    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, 299.8, F84.0, F84.2, F84.3, F84.5, F84.8 or F84.9.

    8) Treatments for children with a diagnosis of ASD were identified with claims having a procedure code beginning with 908; having a procedure code of H2014, H2015, H2019, H2012, 99499; or claims with category of service of 051 (Physical Therapy), 053 (Speech Therapy) and 054 (Occupational Therapy). The service count is a sum of all the unique services for all the children in each respective MCO. These counts were de-duplicated using standard DHS procedures.

    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).

    Minnesota Statutes 256B.69, Subd. 32a.

    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.

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