REVISED 26140, General

KMAP General Bulletin 26140, effective for dates of service on or after November 1, 2026, establishes updated clinical requirements for autism spectrum disorder (ASD) diagnosis under the Kansas Medical Assistance Program. Individuals aged 20 years and younger with ASD must receive a formal diagnosis from a Kansas Behavioral Sciences Regulatory Board (BSRB) licensed clinical psychologist or a qualified physician. Qualified physician types include developmental/behavioral pediatricians, psychiatrists, neurologists, and primary care physicians with documented additional training in ASD diagnosis. Qualified BSRB psychologists must hold a doctoral degree in psychology or equivalent training and have completed two years of supervised BSRB-approved psychological services. ASD diagnostic evaluations must include: (1) application of the most current DSM diagnostic criteria and symptom severity level, and (2) a validated ASD diagnostic assessment tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS). Cognitive evaluation using tools such as the CAT/CLAMS, Mullen Scales, or Bayley Scales is recommended but not required, as is an adaptive behavior measure such as the ABAS or Vineland Adaptive Behavior Scale. Once a qualified diagnostician renders an ASD diagnosis, the individual is eligible for ABA therapy and other autism treatment without re-evaluation and with no time limit on treatment initiation. Members currently receiving ABA therapy whose prior diagnosis was rendered by a diagnostician who does not meet the updated requirements have two years from the effective date to obtain a compliant diagnosis from a qualified provider. A provisional diagnosis exception applies when a beneficiary experiences a minimum 12-month wait for a formal diagnosis due to access barriers. In that circumstance, a master's-level practitioner may render a provisional ASD diagnosis, which is valid for up to 24 months or until a formal diagnosis is issued by an MD, DO, or PhD, whichever occurs first. KanCare MCOs are responsible for tracking this timeline as a care coordination matter, and KanCare will re-evaluate the exception clause every six months. MCO implementation timelines may vary from the November 1, 2026 effective date, with system status tracked in the KanCare Open Claims Resolution Log.