Applied Behavior Analysis

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:

Age from birth up to 21 years of age; and

(1) 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, self-injury, elopement, etc.);

(2) 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;

(3) have a comprehensive diagnostic evaluation by a qualified health care professional; and

(4) 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..

RESOURCES:

• Applied Behavior Analysis-Based Therapy Services - Place of Service Limitations LAC 50:XV.301
• How MCOs will Handle 2019 Codes
• Fee Schedule
• Secondary PA Requirements
• Notice To Providers
• Applied Behavior Analysis Provider Manual
• ABA MCO Transition FAQs
• Quick Reference Guide Claims Processing
• Quick Reference Guide Prior Authorization
• Prior Authorization Conversion Bulletin
• ABA Implementation Bulletin

CONTACT:

Rene Huff

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