Applied Behavior Analysis

Effective Feb. 1, 2018, the five Healthy Louisiana managed care organizations (MCOs) will be responsible for providing Applied Behavior Analysis (ABA) services to their members. MCOs must follow the Louisiana Department of Health (LDH) ABA manual and the LDH fee schedule. For more details, see Informational Bulletin 17-12.

 

Behavior analysis is based on a scientific study of how people learn.  By doing research, techniques have been developed that increase useful behavior (including communication) and reduce harmful behavior.  Applied behavior analysis (ABA) therapy uses these techniques. ABA is helpful in treating autism spectrum disorders.

HOW TO ACCESS:

Medicaid enrolled ABA provider.

ELIGIBILITY:

  1. Be from birth up to 21 years of age;
  2. exhibit the presence of excesses and/or deficits of behaviors that significantly interfere with home or community activities (examples include, but are not limited to aggression,
  3. self-injury, elopement, etc.);
  4. be medically stable and does not require 24-hour medical/nursing monitoring or procedures provided in a hospital or intermediate care facility for persons with intellectual disabilities (ICF/ID);
  5. be diagnosed by a qualified health care professional with a condition for which ABA-based therapy services are recognized as therapeutically appropriate, including autism spectrum disorder;
  6. have a comprehensive diagnostic evaluation by a qualified health care professional; and have a prescription for ABA-based therapy services ordered by a qualified health care professional.

COVERED SERVICES:

ABA-based therapy services shall be rendered in accordance with the individual's approved treatment plan.

COMMENTS:

All medically necessary services must be prescribed by a physician and Prior Authorization is required.  The provider of services will submit requests for Prior Authorization..

CODES AND RATES:

H2019 $18.00/15-minute unit
H2019 (w/modifier) $12.50/15-minute unit
G9012 $18.00/15-minute unit
H0032 $125.00/hour

RESOURCES:

CONTACT:

Rene Huff

(225) 342-3935, 1(844) 423-4762