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    Data from 2015 calendar year

    Table 1. Number of children (1-6 years old) who received a diagnostic assessment

    MCO Number of children, age 1 to 3 Number of children, age 4 to 6
    Blue Plus 122 540
    HealthPartners 107 443
    Itasca Medical Care 18 98
    Medica 150 856
    PrimeWest 69 227
    South Country Health Alliance 48 236
    UCare 386 1,802
    MCOs Overall 900 4,202


    Table 2. Number of children (1-6 years old) with a diagnosis of autism spectrum disorder (ASD) who received treatments, by MCO

    MCO Number of children with ASD Number of children with treatment(s)
    Blue Plus 125 96
    HealthPartners 122 91
    Itasca Medical Care 21 17
    Medica 283 215
    PrimeWest 56 41
    South Country Health Alliance 34 26
    UCare 539 365
    MCOs Overall 1,180 851


    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 1 1 5 3 29 21
    HealthPartners 0 0 9 7 23 18
    Itasca Medical Care 0 0 0 0 1 1
    Medica 2 1 20 17 52 40
    PrimeWest 0 0 7 5 6 5
    South Country Health Alliance 0 0 2 1 5 2
    UCare 6 4 36 25 83 65
    MHCP overall 9 6 79 58 199 152


    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 22 17 33 25 35 29
    HealthPartners 27 21 36 24 27 21
    Itasca Medical Care 3 2 5 3 12 11
    Medica 68 50 70 57 71 50
    PrimeWest 15 15 12 7 16 9
    South Country Health Alliance 7 6 7 6 13 11
    UCare 134 95 144 94 136 82
    MHCP overall 276 206 307 216 310 213


    Table 4a. Blue Plus: Types of treatments provided to children with ASD by procedure code (n=125)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 4 17 17.0 4.3
    90833 Psychotherapy with e&m, 30 minutes 2 13 13.0 6.5
    90834 Psychotherapy, 45 min 15 71 71.0 4.7
    90837 Psychotherapy, 60 min 25 168 168.0 6.7
    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 23 66 66.0 2.9
    90847 Family Psychotherapy - with patient present 30 57 57.0 1.9
    90849 Multiple Family Group Psychotherapy 5 28 28.0 5.6
    90853 Group Psychotherapy 0 0 0.0 N/A
    90875 Biofeedback Training 0 0 0.0 N/A
    90882 Environmental intervention 1 1 1.0 1.0
    90887 Interpretation of psychiatric and other medical examination 0 0 0.0 N/A
    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) 10 687 2,037.0 203.7
    H2014 Skills Training 28 927 8,490.0 303.2
    H2015 Crisis Assistance 1 1 2.0 2.0
    H2019 Mental Health Behavioral Aide 0 0 0.0 N/A
    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=125)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical therapy 28 344 814 29.1
    053 Speech therapy 47 1,230 1,230 26.2
    054 Occupational therapy 46 905 2,192 47.7


    Table 5a. HealthPartners: Types of treatment provided to children with ASD by procedure code (n=122)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 3 13 13.0 4.3
    90833 Psychotherapy with e&m, 30 minutes 0 0 0.0 N/A
    90834 Psychotherapy, 45 min 5 33 33.0 6.6
    90837 Psychotherapy, 60 min 6 23 23.0 3.8
    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 47 175 175.0 3.7
    90847 Family Psychotherapy - with patient present 37 162 162.0 4.4
    90849 Multiple Family Group Psychotherapy 1 11 11.0 11.0
    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 2 2 2.0 1.0
    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) 24 2,634 7,854.0 327.3
    H2014 Skills Training 13 446 4,966.0 382.0
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 0 0 0.0 N/A
    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=122)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 12 217 620 51.7
    053 Speech Therapy 72 1,839 1,839 25.5
    054 Occupational Therapy 67 1,906 4,569 68.2


    Table 6a. Itasca Medical Care: Types of treatment provided to children with ASD by procedure code (n=21)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 2 2 2.0 N/A
    90833 Psychotherapy with e&m, 30 minutes 0 0 0.0 N/A
    90834 Psychotherapy, 45 min 4 7 7.0 N/A
    90837 Psychotherapy, 60 min 4 36 36.0 9.0
    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 2 2 2.0 N/A
    90847 Family Psychotherapy - with patient present 2 5 5.0 N/A
    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
    90882 Environmental intervention 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 1 1 1.0 N/A
    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 13 1,028 11,150.0 857.7
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 4 310 3,159.0 N/A
    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=21)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 2 28 31.0 N/A
    053 Speech Therapy 3 23 23.0 7.7
    054 Occupational Therapy 5 62 170.0 34.0


    Table 7a. Medica: Types of treatment provided to children with ASD by procedure code (n=283)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 12 19 19.0 1.6
    90833 Psychotherapy with e&m, 30 minutes 2 11 11.0 5.5
    90834 Psychotherapy, 45 min 37 213 213.0 5.8
    90837 Psychotherapy, 60 min 35 200 200.0 5.7
    90839 Psychotherapy for crisis, first 60 minutes 1 1 1.0 1.0
    90840 Psychotherapy for crisis, additional 30 minutes 1 1 1.0 1.0
    90846 Family Psychotherapy - without patient present 93 342 342.0 3.7
    90847 Family Psychotherapy - with patient present 70 311 311.0 4.4
    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
    90882 Environmental intervention 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 9 9 9.0 1.0
    90899 Unlisted Psychiatric Service 54 163 163.0 3.0
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 53 4,487 13,382.0 252.5
    H2014 Skills Training 53 1,146 10,806.0 203.9
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 6 179 1,626.0 271.0
    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=283)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 37 1,007 2,211.0 59.8
    053 Speech Therapy 147 4,206 4,207.0 28.6
    054 Occupational Therapy 138 3,658 8,985.0 65.1


    Table 8a. PrimeWest: Types of treatment provided to children with ASD by procedure code (n=56)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 6 15 15.0 2.5
    90833 Psychotherapy with e&m, 30 minutes 0 0 0.0 N/A
    90834 Psychotherapy, 45 min 9 59 59.0 6.6
    90837 Psychotherapy, 60 min 9 34 34.0 3.8
    90839 Psychotherapy for crisis, first 60 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 7 11 11.0 1.6
    90847 Family Psychotherapy - with patient present 6 20 20.0 3.3
    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 5 6 6.0 1.2
    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 7 254 2,476.0 353.7
    H2015 Crisis Assistance 1 2 5.0 5.0
    H2019 Mental Health Behavioral Aide 0 0 0.0 N/A


    Table 8b. PrimeWest: Types of treatment provided to children with ASD by category of service (n=56)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 9 226 490.0 54.4
    053 Speech Therapy 29 614 614.0 21.2
    054 Occupational Therapy 33 794 1,833.0 55.5


    Table 9a. South Country Health Alliance: Types of treatment provided to children with ASD by procedure code (n=34)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 3 7 7.0 2.3
    90833 Psychotherapy with e&m, 30 minutes 1 1 1.0 1.0
    90834 Psychotherapy, 45 min 9 16 16.0 1.8
    90837 Psychotherapy, 60 min 10 68 68.0 6.8
    90839 Psychotherapy for crisis, first 60 minutes 0 0 0.0 N/A
    90846 Family Psychotherapy - without patient present 3 6 6.0 2.0
    90847 Family Psychotherapy - with patient present 8 16 16.0 2.0
    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 1 1 1.0 N/A
    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 15 478 3,218.0 214.5
    H2015 Crisis Assistance 0 0 0.0 N/A
    H2019 Mental Health Behavioral Aide 6 137 1,064.0 177.3


    Table 9b. South Country Health Alliance: Types of treatment provided to children with ASD by category of service (n=34)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 3 40 59.0 19.7
    053 Speech Therapy 12 166 166.0 13.8
    054 Occupational Therapy 13 391 678.0 52.2


    Table 10a. UCare: Types of treatments provided to children with ASD by procedure code (n=539)

    Procedure code Description Unique number of children receiving service Count of services Total units paid Average units
    90832 Psychotherapy, 30 min 19 174 174.0 9.2
    90833 Psychotherapy with e&m, 30 minutes 6 15 15.0 2.5
    90834 Psychotherapy, 45 min 40 155 155.0 3.9
    90837 Psychotherapy, 60 min 55 419 419.0 7.6
    90839 Psychotherapy for crisis, first 60 minutes 1 1 1.0 1.0
    90840 Psychotherapy for crisis, additional 30 minutes 1 1 1.0 1.0
    90846 Family Psychotherapy - without patient present 142 370 370.0 2.6
    90847 Family Psychotherapy - with patient present 117 460 460.0 3.9
    90849 Multiple Family Group Psychotherapy 6 22 22.0 3.7
    90853 Group Psychotherapy 5 22 22.0 4.4
    90875 Biofeedback Training 0 0 0.0 N/A
    90887 Interpretation of psychiatric and other medical examination 23 29 29.0 1.3
    90899 Unlisted Psychiatric Service 3 5 5.0 1.7
    99499 Psychiatric Consultation (Unlisted evaluation and management) 0 0 0.0 N/A
    H2012 Behavioral Health Day Treatment (General Day Treatment) 54 3,564 10,633.0 196.9
    H2014 Skills Training 103 4,646 47,495.0 461.1
    H2015 Crisis Assistance 4 5 26.0 6.5
    H2019 Mental Health Behavioral Aide 14 825 8,654.0 618.1
    T1018 School-based individualized education program services, bundled 1 1 32.0 32.0


    Table 10b. UCare: Types of treatments provided to children with ASD by category of service (n=539)

    Category of service Description Unique number of children receiving service Count of services Total units paid Average units
    051 Physical Therapy 54 903 1,496.0 27.7
    053 Speech Therapy 240 5,426 5,426.0 22.6
    054 Occupational Therapy 224 5,671 14,167.0 63.2


    Notes

    1) Data are limited to final version of Minnesota Health Care Programs-paid claims with service dates between Jan. 1, 2015, through Dec. 31, 2015, 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, 2015.

    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; 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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