Autism treatment: 51% of denials overturned

Year by year

By treatment

Treatments with at least 20 decisions, most decisions first. Rates on fewer than 20 decisions aren’t shown.

Recent decisions

The most recent decisions in the data, half overturned and half upheld. Each shows the reviewer’s published findings.

1. Overturned 2025 · Medical necessity · age 0–10 Applied behavior analysis (ABA) · Autism The physician reviewer found that a patient’s parent has requested authorization and coverage for behavior identification assessment (40 units per 6 months); behavior identification supporting assessment (12 units per 6 months); adaptive behavior treatment by…

   The physician reviewer found that a patient’s parent has requested authorization and coverage for behavior identification assessment (40 units per 6 months); behavior identification supporting assessment (12 units per 6 months); adaptive behavior treatment by protocol (20 hours a week); group adaptive behavior treatment by protocol (nine hours per week); adaptive behavior treatment with protocol modification (six hours per week); and familyadaptive behavior treatment (one hour per week). Per the medical records, the patient has autism spectrum disorder, mixed receptive-expressive language disorder, and developmental delay. In this patient’s case, the requested services are in accordance with the generally accepted standards of mental health and substance use disorder care. Additionally, the requested services are clinically appropriate in terms of type, frequency, extent, site, and duration. The requested services are not primarily for the economic benefit of the health care service plan and subscribers or for the convenience of the patient, treating physician, or other health care provider. Therefore, behavior identification assessment (40 units per 6 months); behavior identification supporting assessment (12 units per 6 months); adaptive behavior treatment by protocol (20 hours a week); group adaptive behavior treatment by protocol (nine hours per week); adaptive behavior treatment with protocol modification (six hours per week); and familyadaptive behavior treatment (one hour per week) are medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested services are medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is licensed B.C.B.A., board-certified in psychology and is actively practicing. The reviewer is an expert in the treatment of the enrollee's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-46344

2. Overturned 2025 · Medical necessity · age 0–10 Speech therapy · Autism The physician reviewer found that the parent of a patient has requested authorization and coverage for speech therapy services once a week. This patient has autism with speech impairments. Speech therapy is known to be effective to help children with autism…

   The physician reviewer found that the parent of a patient has requested authorization and coverage for speech therapy services once a week. This patient has autism with speech impairments. Speech therapy is known to be effective to help children with autism and language impairments develop language skills. For speech therapy to be indicated, a formal evaluation and recommendation for services by a licensed speech therapist is required. The patient underwent recent evaluation by a speech therapist, who opined that the patient would benefit from speech therapy due to communication impairment. The evaluation was completed within standards of care, including a history, observation of behaviors, and formal standardized scoring with a validated tool. A subsequent second speech therapy evaluation recommended weekly therapy sessions followed by a re-evaluation for ongoing need for services. All told, both therapists agreed that the patient would benefit from medical speech therapy services and requires ongoing care. The second and more recent evaluation from a speech therapist found that the patient would benefit from continuing once per week sessions to finish the episode of care. Overall, the requested speech therapy services once a week are in accordance with the generally accepted standards of mental health and substance use disorder care, clinically appropriate in terms of type, frequency, extent, site, and duration, and not primarily for the convenience of the patient or provider. For these reasons, the requested speech therapy services once a week are medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested services are medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is an expert in the treatment of the patient’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-46311

3. Upheld 2025 · Medical necessity · age 0–10 Speech therapy · Autism The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of a patient has requested authorization and coverage for speech therapy (four times a month, 45 minutes a week). In this case, the patient underwent an evaluation by a…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of a patient has requested authorization and coverage for speech therapy (four times a month, 45 minutes a week). In this case, the patient underwent an evaluation by a speech language pathologist (SLP) who opined that the patient would benefit from ST due to language impairments. The evaluation was conducted within the standards of care, including a comprehensive history, observation of behaviors, and an attempt at formal standardized scoring using a validated tool. Specific goals were set, and the SLP recommended a frequency of once every two weeks, which is within the standards of care. The frequency of ST services is determined during ST evaluations and requires a ST provider recommendation. A review of the record indicates that there is no other formal opinion by an SLP recommending ST services four times a month, 45 minutes a week, as part of a re-evaluation. In addition, the requested speech therapy (4 times a month, 45 minutes a week) is not in accordance with the generally accepted standards of mental health and substance use disorder care, not clinically appropriate in terms of type, frequency, extent, site, and duration, and primarily for the convenience of the patient or provider. As such, the requested speech therapy (four times a month, 45 minutes a week) is not medically necessary for the treatment of this patient. Final Result: The reviewer determined that the service is not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-46292

4. Overturned 2025 · Medical necessity · age 0–10 Applied behavior analysis (ABA) · Autism The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for applied behavioral analysis (ABA) services provided 6 hours per week, including supervision provided 5 hours per…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for applied behavioral analysis (ABA) services provided 6 hours per week, including supervision provided 5 hours per month, treatment plan development provided for 3 hours over a 6 month period, and home care training provided once per month. According to the Council of Autism Service Providers (CASP) and the ABA Coding Coalition, there are essential components for the case conceptualization process and the treatment plan of a patient. Specifically, CASP indicates that the information necessary for case conceptualization is gathered by assessing the patient’s skills and needs, interviewing caregivers and other treatment providers, reviewing prior documentation, and identifying potential barriers to treatment. The ABA Coding Coalition highlights the treatment plan elements, which include patient information, reason for the referral, brief background information, clinical interview, review of recent assessments/reports, assessment procedures and results, treatment plan, parent/caregiver training, number of hours or units requested, coordination of care, transition plan, discharge plan, and crisis management plan. In this case, the relevant information from caregiver interviews and patient observations is present throughout the patient’s treatment plan. The patient is not enrolled in any other services, has just started kindergarten, and does not yet have an individualized education program. Services are delivered to the patient after school, and the coordination of care and generalization of skills to appropriate environments (including school) is listed in the treatment plan. In addition, each goal lists short-, intermediate-, and long-term criteria and the patient has already met several of the discharge criteria, indicating that the patient is making progress toward discharge. Overall, the patient’s treatment plan aligns with CASP and ABA Coding Coalition requirements. Moreover, the request is for a low number of treatment hours, as the patient is making significant progress. The patient has met 69% of the goals and the request is for six hours per week of direct therapy to address 10 remaining goals (with no new added goals). Per CASP, decisions to adjust treatment intensity should be individualized and based on the patient’s response to treatment. Treatment intensity should reflect the complexity, breadth, and depth of treatment targets, as well as the environment, treatment protocols, and significance of the patient’s needs. Here, the patient is making considerable progress and six hours of direct therapy per week is appropriate to address the breadth of goals in the treatment plan.Further, the requested services meet all of the medical necessity criteria established by researchers. The criteria include a) Diagnostic and Statistical Manual V (DSM-V) autism diagnosis supported by symptoms, b) symptoms of diagnosis causing impairment, c) motivation for change exemplified by family involvement, d) interventions are evidence-based and consistent for type, frequency, and duration of treatment, e) goals are constructed with patient’s family, f) outcomes are measurable, g) occurs in least restrictive environment, h) required for purposes other than convenience of patient or provider, i) measurable reduction in symptoms, j) symptoms are manageable, and k) day-to-day functioning has improved over baseline. All of these elements are present in the patient’s treatment plan. Given these findings, the requested ABA services provided 6 hours per week, including supervision provided 5 hours per month, treatment plan development provided for 3 hours over a 6 month period, and home care training provided once per month are medically necessary to achieve or maintain age-appropriate growth and development, functional capacity, or improve, support, or maintain the patient’s current health condition. Final Result: The reviewer determined that the requested services are medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is a licensed B.C.B.A., board-certified in applied behavior analysis and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-46291

5. Overturned 2025 · Medical necessity · age 0–10 Applied behavior analysis (ABA) · Autism The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient’s parent has requested authorization and coverage for applied behavioral analysis (ABA) therapy provided over 6 months, which includes the following: one-on-one therapy…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient’s parent has requested authorization and coverage for applied behavioral analysis (ABA) therapy provided over 6 months, which includes the following: one-on-one therapy provided 14 hours per week, patient supervision for 3 hours per week, caregiver training for 1 hour per week, and reassessment for 12 hours.Based on the presented medical information and current guidelines, the requested ABA therapy provided over 6 months, which includes the following: one-on-one therapy provided 14 hours per week, patient supervision for 3 hours per week, caregiver training for 1 hour per week, and reassessment for 12 hours, is medically necessary to treat this patient’s autism diagnosis and presenting symptoms.The ABA Coding Coalition highlights that essential treatment plan components include patient information, reason for referral, clinical interview, review of recent assessments, a treatment plan, caregiver training, number of hours or units requested, coordination of care, transition plan, discharge plan, and crisis management plan. The patient’s most current treatment plan includes each of these elements. The treatment plan includes clarification of short-, medium-, and long-term goals. In addition, the provider outlined a plan for coordination of care with providers and the patient’s school, an individualized transition and discharge plan, and barriers to treatment were addressed by adjusting ABA therapy intensity. Overall, the patient’s treatment plan aligns with ABA Coding Coalition requirements.Moreover, the requested services meet medical necessity criteria, including a DSM-5 autism diagnosis supported by symptoms, functional impairment related to symptoms, family involvement and motivation for treatment, use of evidence-based interventions appropriate in type, frequency, and duration, measurable goals and outcomes, delivery in the least restrictive setting, and services not provided for convenience. The records indicate that the patient is making progress with treatment, symptoms are being managed, and day-to-day function has improved over the last authorization period. Given these findings, the requested ABA therapy provided over 6 months, including one-on-one therapy provided 14 hours per week, patient supervision for 3 hours per week, caregiver training for 1 hour per week, and reassessment for 12 hours, is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the requested services are medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in psychology and behavior analysis and is actively practicing. The reviewer is an expert in the treatment of the patient’s medical condition and is knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-46138

6. Overturned 2025 · Medical necessity · age 0–10 Speech therapy · Child health The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of the patient has requested authorization and coverage for weekly group speech therapy. In this case, the patient has been diagnosed with Down syndrome and global…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of the patient has requested authorization and coverage for weekly group speech therapy. In this case, the patient has been diagnosed with Down syndrome and global developmental delay. The patient’s most recent speech-language evaluation noted that progress will be reassessed continually, with adjustments made in frequency and duration. The evaluation report also indicates that the patient is able to interact with familiar individuals but has difficulty engaging with others, initiating play, and communicating effectively. Individual therapy notes indicate that the patient is progressing toward functional goals but continues to have significant expressive and receptive language deficits with social pragmatic difficulties. Continued support is needed to promote ongoing progress and address emerging communication needs. Peer interaction is an important component of improving functional communication skills in this clinical setting. As such, the requested weekly group speech therapy is medically necessary for the treatment of this patient. Final Result: The reviewer determined that the service is medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is an expert in the treatment of the patient’s medical condition and is knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-46132

7. Overturned 2025 · Medical necessity · age 0–10 Speech therapy · Autism The physician reviewer found that the parent of a patient has requested authorization and coverage for speech therapy. The medical records show that there has been steady progress in the patient’s speech and language skills with the help of medical speech…

   The physician reviewer found that the parent of a patient has requested authorization and coverage for speech therapy. The medical records show that there has been steady progress in the patient’s speech and language skills with the help of medical speech therapy. Therapy intensity and duration should be individualized based on the child’s specific needs, the severity of the speech or language disorder, and the child’s progress toward therapy goals. Guidelines from the American Academy of Pediatrics (AAP) recommend early, individualized intervention for speech and language delays in patients with autism, emphasizing that therapy plans should be tailored to the child’s specific symptoms, progress, and family priorities. Major guidelines emphasize early and ongoing intervention. Consistent therapy leads to stronger language, social communication, and joint attention outcomes. Research on autism spectrum disorder language intervention has shown that interruptions reduce generalization. Progress often slows or reverses when therapy pauses, especially at a young age, because skills are not consolidated. Considering the gradual progress illustrated by the speech therapy reports provided, continued speech therapy is currently indicated. All told, the requested speech therapy is medically necessary to achieve or maintain age-appropriate growth and development, attain, regain or maintain functional capacity, or improve, support, or maintain the patient’s current health conditions. Final Result: The reviewer determined that the requested service is medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan's denial should be overturned. Credentials/Qualifications: The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is an expert in the treatment of the patient’s medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-46070

8. Upheld 2025 · Medical necessity · age 31–40 Autism screening · Mental health The physician reviewer found that a patient has requested authorization and coverage for an autism spectrum disorder (ASD) assessment. Formal testing, including neuropsychological testing, for ASD is useful when there is diagnostic confusion given a…

   The physician reviewer found that a patient has requested authorization and coverage for an autism spectrum disorder (ASD) assessment. Formal testing, including neuropsychological testing, for ASD is useful when there is diagnostic confusion given a complicated presentation or a need to quantify disability cognitively prior to cognitive rehabilitation. Major guidelines emphasize that the diagnosis of ASD in adults should be based on comprehensive clinical assessment. However, the validity and reliability of neuropsychiatric assessment tools in adults in older adults are limited. In this case, the patient has a history of attention-deficit hyperactivity disorder, anxiety, depression, obsessive compulsive disorder, excoriation disorder, and Tourette’s syndrome. Additionally, the patient has one child with autism and reports having a second child with autism traits. However, the enrollee is an adult, and there is a lack of records showing diagnostic confusion or that cognitive rehabilitation is clinically indicated. Given these findings, the requested ASD assessment is not medically necessary for the evaluation of this patient. Final Result: The reviewer determined that the requested testing is not medically necessary for the evaluation of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in psychiatry and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-45996

9. Upheld 2025 · Medical necessity · age 11–20 Applied behavior analysis (ABA) · Autism The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for direct applied behavior analysis (ABA) therapy 14 hours per week, supervision 3 hours per week, parent training 1…

   The physician reviewer found that Nature of Statutory Criteria/Case Summary: The patient’s parent has requested authorization and coverage for direct applied behavior analysis (ABA) therapy 14 hours per week, supervision 3 hours per week, parent training 1 hour per week, and re-assessment 12 hours total. Based on the records and medical literature, the requested services are not supported as medically necessary, as there are multiple components of the patient’s treatment plan that require further elaboration. Notably, the treatment plan does include objective outcome measures, as well as a coordination of care plan with the patient’s school and parents and a baseline for all goals. However, the treatment plan does not include short, intermediate, and long term goals, and the discharge and transition plan is broad and not individualized. The Council of Autism Service Providers (CASP) highlights the importance of having a short and long term perspective on the delivery of ABA services. According to CASP, “The primary purpose of ABA services is to bring about changes in socially significant behaviors that lead to improved health status, increased independence, increased autonomy, and a higher quality of life. The behavior analyst must also contextualize this goal for each patient. That is, the behavior analyst should always keep in mind the specific purpose of treatment (e.g., to narrow the gap with peers across all domains, create meaningful change for some behaviors, maintain skills, and prevent deterioration in health status or daily functioning).” The patient’s treatment plan should identify short and long term goals to help ensure the plan of care is on track and that all treatment areas align with these goals. CASP further indicates that “Discharge and transition criteria should be measurable, realistic, and individualized.” The ABA Coding Coalition similarly reports that, “Criteria for discharge should be specified when services begin and refined throughout the treatment process.” In this case, the transition and discharge criteria in the submitted treatment plan is vague, indicating 80% mastery of all targets and generalization of skills, but no specifics as it relates to scores the patient would achieve on standard measures or the step down process as the patient begins to master goals. The patient’s transition and discharge plan requires more specificity with respect to the programming needs of the patient. Moreover, the requested services are not supported as medically necessary based on the criteria established by researchers, which require that interventions are evidence-based and consistent for type, frequency, and duration of treatment, as well as that outcomes are measurable. Here, the lack of short, intermediate, and long term goals in the patient’s treatment plan make it difficult to determine the duration of treatment. Further, the patient’s treatment plan includes non-specific discharge and transition criteria. The patient may make progress, but without short-long term goals and clear transition and discharge criteria it will be unclear if the patient is meeting measurable outcomes toward an eventual transition and then discharge from ABA therapy. Overall, the patient’s treatment plan requires inclusion of short, intermediate, and long term goals, and transition and discharge criteria specific to the patient. For these reasons, the requested direct ABA therapy 14 hours per week, supervision 3 hours per week, parent training 1 hour per week, and re-assessment 12 hours total, are not medically necessary to achieve or maintain age-appropriate growth and development, functional capacity, or improve, support, or maintain the patient’s current health condition. Final Result: The reviewer determined that the requested services are not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is a licensed B.C.B.A., board-certified in psychology and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

   Case MN25-45955

10. Upheld 2025 · Medical necessity · age 21–30 Occupational therapy · Autism The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for 1) in-home speech therapy (ST) and/or 2) in-home occupational therapy (OT). In this case, in regard to ST, the patient…

    The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for 1) in-home speech therapy (ST) and/or 2) in-home occupational therapy (OT). In this case, in regard to ST, the patient underwent an ST evaluation, and the ST provider’s determination was that the patient did not meet the criteria to benefit from medical ST services. The recommendation included considering augmentative and alternative communication device evaluations, which the parent of the patient declined. Thus, the current record does not include an evaluation by an ST provider recommending ST services. Further, the patient has not completed a formal OT evaluation. This OT evaluation is needed to determine the medical appropriateness of OT services. Overall, ST and OT therapy services are medically appropriate when new goals are set that can be achieved. In addition, the therapy services require formal evaluations and recommendations from licensed ST and OT providers. Currently, there is no determination from an ST or OT provider recommending in-home services. Moreover, the requested in-home ST and in-home OT are not medically necessary to protect life, to prevent significant illness or significant disability, or alleviate severe pain through the diagnosis or treatment of disease, illness, or injury, or necessary to achieve age-appropriate growth and development, and attain, maintain, or regain functional capacity. As such, the 1) in-home ST and 2) in-home OT are not medically necessary for the treatment of this patient. Final Result: The reviewer determined that the services are not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in neurology and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

    Case MN25-45647

11. Upheld 2025 · Medical necessity · age 0–10 Speech therapy · Child health The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of a patient has requested authorization and coverage for speech therapy services. Speech therapy is known to be effective to help children with language impairments…

    The physician reviewer found that Nature of Statutory Criteria/Case Summary: The parent of a patient has requested authorization and coverage for speech therapy services. Speech therapy is known to be effective to help children with language impairments develop functional language skills. To determine the need for speech therapy services, a formal evaluation is needed and must be performed by a speech therapist. The evaluation needs to include a patient history, observation of behaviors and formal standardized scoring with a validated tool. Additionally, the patient’s physician needs to provide a referral or prescription for the requested services and a signed plan of care. In this case, the documentation does not support the requested speech therapy services as medically necessary due to a lack of a referral or prescription from a physician for the requested services at the requested frequency and a record of a signed speech therapy plan of care by a physician. Moreover, the speech therapy services are not in accordance with the generally accepted standards of mental health and substance use disorder care, or clinically appropriate in terms of type, frequency, extent, site, and duration. For these reasons, the requested speech therapy services are not medically necessary for the treatment of the patient. Final Result: The reviewer determined that the requested services are not medically necessary for the treatment of the patient's medical condition. Therefore, the Health Plan's denial should be upheld. Credentials/Qualifications: The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is an expert in the treatment of the patient's medical condition and knowledgeable about the proposed treatment through recent or current actual clinical experience treating those with the same or a similar medical condition.

    Case MN25-45624

12. Upheld 2025 · Medical necessity · age 0–10 Occupational therapy · Autism The physician reviewer found that Nature of Statutory Criteria/Case Summary:The parent of an enrollee has requested authorization and coverage for occupational therapy (OT). The patient underwent a formal OT evaluation, which determined that the patient was…

    The physician reviewer found that Nature of Statutory Criteria/Case Summary:The parent of an enrollee has requested authorization and coverage for occupational therapy (OT). The patient underwent a formal OT evaluation, which determined that the patient was not able to participate in or benefit from medical OT services due to behavioral limitations. While there are concerns regarding functional skills, the evaluating provider did not recommend medical OT services at this time. Recommendations from non-OT providers or educational staff are not sufficient to establish medical necessity without a formal recommendation from an OT provider. Additionally, alternative therapies were suggested to better address the patient’s current needs. Given the absence of a recommendation for OT services from the evaluating provider and the patient’s limited ability to participate, the requested OT services are not medically necessary for the treatment of this patient. Final Result:The reviewer determined that the requested services are not medically necessary for the treatment of the patient’s medical condition. Therefore, the Health Plan’s denial is upheld. Credentials/Qualifications:The reviewer is board-certified in neurology with special qualification in child neurology and is actively practicing. The reviewer is knowledgeable about the proposed treatment through recent or current clinical experience treating those with the same or a similar medical condition.

    Case MN25-45499