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KMAP BULLETIN: UPDATED: Autism Diagnosis and Diagnosticians Clinical Requirement
Kansas Medicaid (KanCare)·KS · Pediatrics, Psychiatry, Neurology +2 more·Medical Policy
Effective date
Nov 1, 2026
We identified it
Sep 2, 2026
Summary
Effective November 1, 2026, KMAP requires that autism spectrum disorder (ASD) diagnoses for individuals aged 20 years and younger must be provided by a Kansas BSRB clinical psychologist or a qualified physician with documented ASD training. Diagnoses must include DSM criteria assessment and validated diagnostic tools (ADOS or CARS); cognitive and adaptive behavior evaluations are recommended. Billing teams must verify diagnostician credentials and ensure claims include appropriate provider qualifications before submission.
Action Required
Before November 1, 2026: (1) Billing team must implement credentialing verification system to confirm all ASD diagnostic providers meet KMAP requirements (BSRB clinical psychologist with doctorate + 2 years supervised experience, OR qualified physician with documented ASD training in listed specialties: family medicine, general practice, neurology, psychiatry, developmental pediatrics, or exempt license physician). (2) Update encounter forms and billing software to require documentation that evaluation included DSM diagnostic criteria assessment and validated ASD tool (ADOS or CARS). (3) Add check box or field to capture cognitive assessment and adaptive behavior measure documentation. (4) Create internal audit checklist to verify compliance before claim submission for patients age 20 and under with ASD diagnosis. (5) Communicate requirements to all providers submitting ASD evaluations. Claims submitted without documented provider qualifications and required assessment components will be denied by KMAP.