Applied Behavior Analysis (ABA) therapy

Applied Behavior Analysis (ABA) therapy

Applied Behavior Analysis (ABA) is covered under Apple Health for clients with Autism Spectrum Disorder (ASD) or other developmental and intellectual disabilities. ABA therapy seeks to change inappropriate behaviors when other less intensive treatment has been unsuccessful.

Eligibility

In order for a client age 20 or under to be eligible for ABA therapy through Apple Health, a recognized Centers of Excellence (COE) provider must conduct a comprehensive evaluation, and write an order for ABA therapy.

COE providers must be a neurologist, psychiatrist, or psychologist when a client is diagnosed with autism as an adult and initiates ABA therapy at age 21 and over.

If the COE determines that the client meets medical necessity for ABA services, they will provide the client, caregiver, or family with a copy of their comprehensive evaluation and order for ABA treatment. The client, caregiver, or family is encouraged to contact all of the Medicaid-enrolled ABA providers in their area. The ABA provider selected by the client, caregiver, or family will need a copy of the COE evaluation and order. The ABA provider will then complete their own evaluation of the client and develop an ABA treatment plan. ABA intensive day treatment and ongoing one-on-one ABA therapy require prior authorization before the client receives services.

Clients receiving ABA therapy are eligible for other treatments based on their individualized needs, including speech therapy, occupational therapy, and physical therapy.

Clients enrolled in a managed care plan will have ABA therapy covered through their plan. Clients should contact their managed care plan for help finding an in-network provider.

Resources

• ABA day program capacity attestation form (13-0007)
• ABA attestation form (13-0008)
• Centers of Excellence (COE) attestation form (13-0009)
• ABA level of support requirement form (12-411)
• ABA Assessment and Behavior Change Plan (13-400)
• Autism Spectrum Disorder (ASD) (CDC)
• ABA Provider Directory for Apple Health clients without a managed care plan