Kansas Moved Its Autism Diagnosis Rule to November 1 and Narrowed Who Qualifies
KMAP General Bulletin 26140, reissued in August, delays the start from September 1 to November 1, drops exempt-license physicians from the list and names the physician specialties that qualify. Current ABA clients diagnosed by anyone else get two years to be re-confirmed.
Kansas Medicaid's rule on who may diagnose autism now starts November 1, 2026, not September 1. The updated KMAP General Bulletin 26140 moved the date and, in the same revision, tightened the list of who qualifies. That's 42 days from publication.
From that date, members aged 20 and younger “must receive a diagnosis from a Kansas Behavioral Sciences Regulatory Board (BSRB) clinical psychologist or qualified physician.”
What changed between the two versions
- Date: September 1 became November 1.
- Removed: provider type 31/349, Exempt License Physician.
- Narrowed: 31/345 “General Pediatrician” became “General Pediatrician [Developmental].”
- Specified: the original let any listed physician qualify “with documented additional training in ASD diagnosis.” The update names them: developmental/behavioral pediatricians, psychiatrists, neurologists, and primary care physicians with documented additional ASD training.
The qualifying provider types are 11/112 (psychologist), 31/316 (family practitioner), 31/318 (general practitioner), 31/326 (neurologist), 31/339 (psychiatrist), 31/345 (general pediatrician, developmental) and 31/351 (Indian Health Services). A qualifying psychologist needs a doctoral degree or equivalent training and two years of supervised experience in BSRB-approved psychological services.
What the diagnosis must contain
- DSM diagnostic criteria and symptom severity level.
- A validated ASD diagnostic tool, “such as” the ADOS or the CARS.
A cognitive evaluation (CAT/CLAMS, Mullen, Bayley, or a school district evaluation using a validated tool) and an adaptive measure (ABAS or Vineland) are recommended, not required.
The turn: the transition runs on an unstated clock
Children already approved and receiving ABA whose diagnosis came from a non-qualifying clinician “will have two (2) years to obtain an updated autism spectrum disorder diagnosis by a qualified diagnostician.” It needn't be a full re-evaluation, but a validated tool, from the original evaluation or the re-confirmation, “remains an essential element.”
The bulletin doesn't say when the two years start. Reading November 1 as the start is reasonable, but it isn't written down.
The limits
The bulletin states that KanCare managed care plans' implementation “may vary from the date noted,” and points to the KanCare Open Claims Resolution Log for each plan's status. Nurse practitioners, physician assistants and master's-level clinicians aren't on the list. That they can't diagnose for this purpose is our reading of an exhaustive-looking list, not a sentence in the bulletin. The changes appear in the Mental Health Provider Manual at pages 8-47 and 8-48 and the Professional Provider Manual at 8-11 and 8-12.
What you must know or do
- Intake staff: from November 1, check the diagnosing clinician's credential on every new referral against the seven provider types above, and check the report names a validated tool.
- Clinical directors: list every current client with who diagnosed them and which tool was used. Anyone outside the list needs a qualified re-confirmation inside two years. Anyone with no ADOS, CARS or equivalent on file will need one.
- Owners: ask each KanCare plan in writing for its implementation date and check the Open Claims Resolution Log, since a plan may not start on November 1.
- Start the re-confirmation queue early. Qualifying diagnosticians are the bottleneck, and two years of re-confirmations will land on the same small pool.