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KMAP BULLETIN: UPDATED: Autism Diagnosis and Diagnosticians Clinical Requirement

Date: 08/31/26

KMAP GENERAL BULLETIN 26140 (PDF)

UPDATED: Effective for dates of service on or after September November 1, 2026, individuals aged 20 years and younger with autism spectrum disorder (ASD) must receive a diagnosis from a Kansas Behavioral Sciences Regulatory Board (BSRB) clinical psychologist or qualified physician. A multidisciplinary diagnostic approach is preferred.

Qualified ASD Diagnostic Providers:

  • 11/112 (Psychologist)
  • 31/316 (Family Practitioner)
  • 31/318 (General Practitioner)
  • 31/326 (Neurologist)
  • 31/339 (Psychiatrist)
  • 31/345 (General Pediatrician [Developmental])
  • 31/349 (Exempt License Physician)
  • 31/351 (Indian Health Services) 

Qualified Kansas BSRB clinical psychologists must meet the following criteria:

  • A doctor’s degree in psychology or equivalent training; and
  • Two (2) years of supervised experience delivering BSRB-approved psychological services.
  • Physicians listed above qualify with documented additional training in ASD diagnosis.

Qualified physicians include:

  • developmental/behavioral pediatricians
  • psychiatrists
  • neurologists
  • primary care physicians with documentation of additional training in the diagnosis of ASD

 

ASD Diagnostic Evaluation Requirements

  1. Diagnostic criteria and symptom severity level according to the most current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM)
  2. Validated ASD diagnostic assessment tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS)

ASD Diagnostic Evaluation Recommendations

  1. Cognitive evaluation through a validated tool such as the Clinical Adaptive test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS), Mullen Scales of Early Learning (MSEL), or Bayley Scales on Infant Development (BSID). Cognitive evaluation that was completed by the school district using a validated tool, may also be included.
  2. An adaptive behavior measure such as the Adaptive Behavior Assessment System (ABAS) or Vineland Adaptive Behavior Scale (VABS) may also be useful in the diagnostic process.

Autism Screening and Treatment

Once an individual is diagnosed with autism spectrum disorder by a qualified diagnostician as per this policy, they are eligible for autism treatment, including applied behavioral analysis (ABA) therapy, without the need for a re-evaluation of their autism spectrum disorder diagnosis. There is also no time limit on how soon they begin autism treatment, including ABA therapy, following their diagnosis of autism spectrum disorder.

Transition Provisions for Current Members

For individuals already approved and receiving autism treatment, including applied behavioral analysis (ABA) therapy, who have been diagnosed with autism spectrum disorder by a  provider diagnostician who does not meet the updated diagnostician and/or diagnostic requirements as per this policy, will have two (2) years to obtain an updated autism spectrum disorder diagnosis by a qualified provider diagnostician. The updated diagnosis does not necessarily need to involve a complete diagnostic evaluation as long as the diagnostic criteria in this policy are met and a qualified diagnostician is confirming the diagnosis. A validated ASD diagnostic tool, used either during the original diagnostic process or during the diagnostic re-evaluation by a qualified provider diagnostician, remains an essential element of the ASD diagnosis. 

Note: The effective date of the policy is September November 1, 2026. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.


For changes resulting from this bulletin, view the updated Mental Health Fee-for-Service Provider Manual, pages 8-47 and 8-48 and Professional Fee-for-Service Provider Manual, pages 8-11 and 8-12.