By Tracy Burton
Mom, Board Certified Pediatrician and Chief Medical Officer at As You Are
Dr. Tracy Burton is a board-certified pediatrician and the Chief Medical Officer at As You Are. With over a decade of experience, Dr. Burton is dedicated to providing timely, compassionate care to families navigating developmental concerns. She completed her medical degree at the University of Alabama School of Medicine and her residency at the University of South Florida. Dr. Burton is licensed to practice in multiple states, including Texas, California, and New York.
This is the final part of our three-part series on adolescent autism re-evaluations. Read part one: Bridging the Adolescent Autism Re-Evaluation Gap or read part two: Telehealth Solutions for Adolescent Re-Evaluations.
In our previous articles, we explored the challenges families face when seeking re-evaluations for adolescents with autism and how telehealth can help address these challenges. Now, let’s look at the various requirements that might prompt a re-evaluation.
Understanding Re-Evaluation Requirements
It’s important to recognize that re-evaluation requirements vary widely across different systems. While we can provide general information, families should always verify specific requirements for their situation.
Insurance Requirements Examples
Many insurance plans require updated autism evaluations to continue coverage for therapies like Applied Behavior Analysis (ABA). For example:
- Some Blue Cross Blue Shield plans may require re-evaluation every 1-2 years
- Certain Medicaid programs might require updated documentation every 1-3 years
- Tricare typically requires re-evaluation every 2 years for continued ABA services
These timeframes represent general patterns we’ve observed, but requirements can change and vary significantly between individual plans—even within the same insurance company.
Educational System Examples
While the Individuals with Disabilities Education Act (IDEA) mandates re-evaluations at least every three years for students receiving special education services, some states and districts have more specific guidelines:
- Many states align with the federal three-year re-evaluation cycle for IEP services
- Some school districts may require updated documentation during key transition periods (elementary to middle school, or middle to high school)
- Certain educational accommodations might require more frequent documentation updates
Where to Find Accurate Information
For the most current and specific requirements, we recommend:
- Insurance coverage: Contact your insurance provider directly and request their current re-evaluation requirements for continued therapy coverage
- Educational services: Consult with your school district’s special education department or your child’s IEP coordinator
- State-specific guidelines: Review your state’s department of education website for their current policies
Our care coordination team can help guide conversations about these requirements, but the most accurate information will always come directly from your insurance provider and school district.
Moving Forward
As we continue to advance understanding of autism across the lifespan, it’s essential that our healthcare services evolve to meet changing needs. By bridging the re-evaluation gap for adolescents, we’re helping ensure that individuals with autism don’t lose critical supports during important developmental years.
For families navigating this journey, know that you don’t have to face these transitions alone. Timely re-evaluations can help maintain the continuity of care that supports your child’s continued growth and development.
We hope this series has helped you understand the importance of adolescent re-evaluations and how telehealth can help address access challenges. If you missed earlier parts of this series:
- Part 1: Bridging the Adolescent Autism Re-Evaluation Gap
- Part 2: Telehealth Solutions for Adolescent Re-Evaluations
Don’t let re-evaluation challenges interrupt your child’s support. Our team can help guide you through the process.
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Have questions about re-evaluations? Our care coordination team is here to help. Contact Us
