Department of Human Services | Autism Benefits, Mental Health and Substance Use Disorder Services

Autism Benefits

Autism Spectrum Disorder (ASD) is a collection of neurodevelopmental disorders characterized by communication challenges, repetitive behaviors and limited social skills. ASD services are available to any NJ FamilyCare Medicaid child member, under the age of 21, who has been diagnosed with ASD, defined by ICD-10-CM diagnosis codes F84.0 through F84.9.

Services effective January 1, 2020 for the NJ FamilyCare EPSDT Autism benefit include: Physical Therapy, Occupational Therapy, Speech Therapy, Alternative Communication Assessment and Devices and Sensory Integration.

NEW Coverage of Applied Behavior Analysis (ABA) Therapy

Effective April 1, 2020, NJ FamilyCare Medicaid will reimburse Medicaid-enrolled Applied Behavior Analysis (ABA) therapy providers for Autism Spectrum Disorder (ASD) treatment services, including behavior identification assessments, supporting assessments, adaptive behavior treatment, individual and group, and family adaptive behavior treatment.

ASD is a collection of neurodevelopmental disorders characterized by communication challenges, repetitive behaviors and limited social skills. ASD services are available to any NJ FamilyCare Medicaid child member, under the age of 21, who has been diagnosed with ASD, defined by ICD-10-CM diagnosis codes F84.0 through F84.9.

For questions and concerns related to the Autism Benefit, please contact the Medicaid/NJ FamilyCare Autism Inquiry Helpline at (609)588-8522 or MAHS.ASDinquiries@dhs.nj.gov

Resources

DMAHS Guide to Autism Services

DMAHS Guide to Autism Services - Chinese

DMAHS Guide to Autism Services - Hindi

DMAHS Guide to Autism Services - Portuguese

DMAHS Guide to Autism Services - Spanish

DMAHS Guide to Autism Services - Tagalog

Provider Newsletter for the Provision of Applied Behavior Analysis (ABA) Therapy Services 4-1-20

Expanded Mental Health and Substance Use Disorder Benefits

The following changes apply to NJ FamilyCare members enrolled in Managed Long Term Services and Supports (MLTSS), Special Needs Plans (FIDE-SNPs), or clients of the Division of Developmental Disabilities (DDD)

What are these changes, and how do they affect me?

Effective October 1, 2018, additional mental health and substance use disorder treatment services covered by your health plan and include, but are not limited to:

Outpatient individual, group and family therapy for both mental health and substance use disorders;
Partial Care/Partial Hospitalization/Acute Partial Hospitalization day programs for both mental health and substance use disorders;
Adult Mental Health Rehabilitation (supervised group homes and apartments);
Hospital-based acute services for both mental health and substance use disorders;
Intensive Outpatient Services for substance use disorders;
Inpatient Medical Detox/Medically Managed Inpatient Withdrawal Management (hospital);
Short Term Residential Treatment for substance use disorders;
Non-hospital medically monitored detox;
Ambulatory Withdrawal Management for substance use disorders; and,
Medication Assisted Treatment for substance use disorders.

See the MLTSS Behavioral Health Dictionary for more service-related information.

How do I access these benefits?

If you are in need of mental health or substance use disorder treatment services, or have questions about these or other health plan services, please call your health plan Member Services’ phone number located on the back of your health plan identification card. Phone numbers for each health plan are also listed on: .

Health Plan and Stakeholder Resources

Presentation: Behavioral Health October 1, 2018 Changes

Frequently Asked Questions for Behavioral Health Changes effective 10/1/18

2018 Mental Health and Substance Use Disorder Service Benefit Plan

Behavioral Health Codes for Health Plan Contracted Services

Health Plan Newsletter (April 2018)

Health Plan Newsletter (November 2017)

Contact information for each NJ FamilyCare health plan is available at:

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