Medicaid Rules for ABA in Indiana

Governor Pence has signed the  Final Rules relating to Applied Behavioral Analysis (ABA) therapy services through Medicaid.The rules pertain to Title 405 of Indiana Code (405 IAC 5-22-1 and 405 IAC 5-22-12). These rules will be effective onFebruary 7, 2016.

 

Basically, the rules state the following:

1.  ABA will be available to an individual who has received an ASD diagnosis and a referral for ABA therapy that includes the projected length of treatment.  Services are available until the individual turns 20 years old.  ABA services will be covered for no more than 40 hours/week and available for a 3-year period.

2.  These providers may provide ABA services:  health services provider in psychology (HSPP), licensed or board certified behavior analyst (BCBA, BCBA-D, BCaBA), and credentialed registered behavior technician (RBT).  These providers shall develop a treatment plan  based on the individual's needs, age, school attendance, and other daily activities as documented in the treatment plan (except for services that focus solely on recreational or educational outcomes, that are duplicative like services received through an IEP, or provided by an RBT in home or school setting).

3.  All covered ABA services require prior authorization, which should include the treatment plan and supporting documentation, requested number of therapy hours and supporting documentation, and any other information requested.  Prior authorization (PA) may be approved for up to 6 months, and it is the provider's responsibility to submit a new PA with updated documentation to continue services.  (PA requests for longer than 6 months at a time will not be approved).

If you are interested in reading the final rule, click here.

from Autism Society of Indiana