“The youth and family/caregiver must be willing to participate in services. Family members do not have to be present during all hours of therapy. Direct family involvement in the treatment program is required at a minimum of weekly but the amount of direct interaction with the treatment provider will vary according to the clinical necessity, progress as documented, and the youth and family goals in the ISP.”

Requiring specified amounts of family/caregiver involvement imposes a more restrictive requirement on the medically necessary treatment for individuals with autism than on other outpatient treatment. Such requirements are likely a violation of Mental Health Parity and Addiction Equity Act (MHPAEA) which requires that treatment limitations on mental health or substance use disorders are no more restrictive than those on the medical or surgical benefit. In addition, clinicians should be able to use their assessment and treatment data along with their clinical judgment to establish the nature and scope of family/caregiver involvement taking into account the family/caregiver’s specific circumstances.