Benefits and Covered Services

Autism Services

Behavioral Health Treatment (BHT) for Autism Spectrum Disorder (ASD)

This treatment includes applied behavior analysis and other evidence-based services this means the services have been reviewed and have been shown to work. The services should develop or restore, as much as possible, the daily functioning of a Member with ASD.

BHT services must be medically necessary and prescribed by a licensed doctor or a licensed psychologist. The services must be approved by SFHP and given in a way that follows the Member’s Plan-approved treatment plan.

You may qualify for BHT services if:

  • You are under 21 years of age; and
  • Have a diagnosis of ASD; and
  • Have behaviors that interfere with home or community life (some examples include anger, violence, self-injury, running away, or difficulty with living skills, play and/or communication skills).

You do not qualify for BHT services if you:

  • Are not medically stable; or
  • Need 24-hour medical or nursing services; or
  • Have an intellectual disability (ICF/ID) and need procedures done in a hospital or an intermediate care facility.

If you have any questions regarding Mental Health Services and specific Autism services please contact Carelon Behavioral Health. You may also contact SFHP at 1(415) 547-7800 or 1(800) 288-5555.

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