Getting an Autism Diagnosis: What Lake County Families Should Know

Wondering whether your child should be evaluated for autism, or what comes after a diagnosis? You don't have to figure it out alone. This guide pulls together what Lake County families most often ask us about getting a diagnosis before ABA therapy.

Do you need an autism diagnosis before starting ABA?

In Florida, ABA covered by Medicaid requires a Comprehensive Diagnostic Evaluation (CDE) and prior authorization before therapy begins, and most private plans require an autism diagnosis too (Florida AHCA). If your child hasn't been evaluated yet, you can still call us. We'll explain how the evaluation process works, suggest questions to bring to your child's pediatrician, and stay in touch while you wait.

What is a Comprehensive Diagnostic Evaluation (CDE)?

A CDE is the detailed evaluation Florida Medicaid requires before ABA can be authorized. It's completed by a qualified professional, confirms the diagnosis and recommends services. Many commercial plans ask for similar documentation. AHCA calls the CDE "the national practice standard necessary to diagnose autism" and other developmental or behavioral conditions, and to recommend the right treatment.

Who can perform a CDE?

A CDE can be done by one practitioner or a team. Either way, it must be led by a licensed practitioner working within their medical, developmental, or psychological scope of practice, using evidence-based methods. Your child also needs a referral that includes a physician's order for BA services (AHCA coverage policy). The policy says the referral can come from:

• A primary care physician (family practice, internal medicine, or pediatrics)
• A board-certified or board-eligible developmental-behavioral pediatrician, neurodevelopmental pediatrician, pediatric neurologist, or psychiatrist
• A child psychologist

What does a CDE include?

A CDE may include parent and teacher input, tools such as the ADOS-2 or CARS-2, and hearing, vision, or medical testing. The report must include findings and treatment recommendations. One plan serving our region, Sunshine Health, adds that the CDE must state a formal diagnosis and that school accommodation recommendations alone aren't enough (Sunshine Health).

Good to know: AHCA says one CDE is usually enough for the whole treatment period. A plan may ask for an update if your child's needs change or your family moves to Florida from another state.

What signs might lead families to ask about an evaluation?

Every child is different. Our article What Is ABA Therapy? walks through the diagnostic criteria, the three levels of autism, and why signs can be subtler in girls. If something you read sounds familiar, bring your questions to your child's pediatrician.

What should you gather once you have a diagnosis?

• Your child's autism diagnosis or Comprehensive Diagnostic Evaluation (CDE) report
• Your insurance or Medicaid card (front and back)
• A physician referral or prescription, if your plan requires one
• Your child's recent IEP or school reports (optional)
• Any previous therapy reports (optional)

Don't have everything yet? Reach out anyway. Part of our job is telling you what's missing and how to get it. See Getting started for every step from first call to first session, and Does Florida Medicaid Cover ABA Therapy? for the Medicaid process.

Where can Lake County families find support while they wait?

Families in Lake County can reach out to UCF CARD (the University of Central Florida Center for Autism and Related Disabilities) for free support and information during the evaluation process. We serve families in Leesburg, Tavares, Eustis, Mount Dora, Lady Lake and Clermont.

How long does it take?

Timelines depend mostly on your insurance and how long its authorization takes. We'll give you an honest estimate on the first call and keep you updated at every step, so you're never left wondering where things stand.

This article is general information, not medical advice. Please talk with your child's doctor about evaluation, and check with your plan about its requirements.

Frequently asked questions

References

1. Florida Agency for Health Care Administration. Behavior Analysis Services Information. https://ahca.myflorida.com/medicaid/medicaid-policy-quality-and-operations/medicaid-policy-and-quality/medicaid-policy/medical-and-behavioral-health-coverage-policy/behavioral-health-and-health-facilities/behavior-analysis-services-information.html
2. Florida AHCA. Florida Medicaid Behavior Analysis Services Coverage Policy (December 2024; Rule 59G-4.125, F.A.C.). https://ahca.myflorida.com/content/download/25728/file/Florida%20Medicaid%20Behavior%20Analysis%20Services%20Coverage%20Policy.pdf
3. Sunshine Health. BA CDE Documentation Requirements. https://www.sunshinehealth.com/newsroom/ba-cde-docs.html
4. UCF Center for Autism and Related Disabilities (UCF CARD). https://ucf-card.org/