Behavioral health treatment for autism spectrum disorder
Behavioral health treatment (BHT) for autism spectrum disorder (ASD) needs prior authorization of coverage from KFHC and must be prescribed and provided by a participating provider. This treatment includes applied behavior analysis and other evidence-based services. This means the services have been reviewed and have been shown to work. The services should develop or restore, as much as possible, the daily functioning of a Member with ASD.
BHT services must be:
- Medically necessary.
- Prescribed by a licensed doctor or a licensed psychologist.
- Approved by KFHC.
- Given in a way that follows the Member's Plan approved treatment plan.
You may qualify for BHT services if:
- You are under 21 years of age.
- Have a diagnosis of ASD.
- Have behaviors that interfere with home or community life. Some examples include anger, violence, self-injury, running away, or difficulty with living skills, play and/or communication skills.
You do not qualify for BHT services if you:
- Are not medically stable.
- Need 24-hour medical or nursing services.
- Need 24-hour medical or nursing services.
- Have an intellectual disability (ICF/ID) and need procedures done in a hospital or an intermediate care facility.
Cost to member
There is no cost to members for these services. You can call KFHC if you have any questions or ask your Primary Care Provider for screening, diagnosis and treatment of ASD.
Outpatient mental health services
Outpatient mental health services do not require prior authorization of coverage from KFHC. Outpatient mental health services must be prescribed and provided by a participating provider.
The following services are covered when they are medically necessary. These services are for the treatment of mild to moderate mental health conditions, which include:
- Individual and group mental health testing and treatment (psychotherapy).
- Psychological testing to evaluate a mental health condition.
- Outpatient services to monitor drug therapy.
- Outpatient services that include lab work, drugs, and supplies.
- Psychiatric consultation.
You can still get specialty mental health services from the County Mental Health Department. For emergency mental health concerns, you can always call the Kern County Mental Health Crisis Hotline at 800.991.5272.
Exclusion: Mental health services for relational problems are not covered. This includes counseling for couples or families for conditions listed as relational problems.*
*As defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV).
Substance use disorder preventive services
Alcohol misuse screening services are covered by KFHC for all members ages 18 and older. These services must be prescribed and provided by a participating provider. These services for alcohol misuse cover:*
- One expanded screening for risky alcohol use per year.
- Three 15-minute brief intervention sessions to address risky alcohol use per year
Exclusion: KFHC does not cover services for major alcohol problems, but you may be referred to the County Alcohol and Drug Program.
*Screening, Brief Intervention, and Referral to Treatment (SBIRT)