Medicaid has an Autism Service benefit that includes coverage of medically necessary ABA services for individuals with Autism Spectrum Disorder (ASD) and provides for coordination of the service array in interdisciplinary team meetings.
The draft of the Medicaid Autism Services benefit includes the following topics:
- Applied Behavior Analysis (ABA) as a new benefit
- Requirements for prior authorization for ABA evaluation and treatment
- Clinical documentation requirements
- Licensed Behavior Analyst (LBA) as a new provider type and descriptions of Licensed assistant Behavior Analysts (LaBAs) and Behavior Technicians (BTs) who may work under supervision of an LBA. Note: LaBAs and BTs may not enroll in Medicaid.
- Requirements for interdisciplinary team meetings
- Prior authorization, billing, and reimbursement for procedure codes 97151, 97153, 97154, 97155, 97156, 97158, and 99366
- Medicaid Autism Services will be delivered in managed care as well as in fee-for-service.
CLASS Behavioral Support
Effective September 1, 2008, the service type previously labeled “Psychological Services” will change to “Behavioral Support.”DADS Information Letter No. 08-127: Behavioral Support Services
7231 Behavioral Support Services
Revision 17-1; Effective November 1, 2017
Behavioral support services are specialized interventions that assist an individual in increasing adaptive behaviors and replacing or modifying challenging or socially unacceptable behaviors that prevent or interfere with the individual’s inclusion in the community.
A program provider must ensure the behavioral support services provider is a:
- licensed psychologist;
- provisionally licensed psychologist;
- licensed psychological associate;
- licensed clinical social worker;
- licensed professional counselor; or
- behavior analyst certified by the Behavior Analyst Certification Board, Inc.
The behavioral support services provider must have received training in behavioral support or have experience in providing behavioral support. The DSA may document a behavioral support provider’s compliance with this requirement by listing any training related to behavioral support the provider states has been completed. The DSA program director or RN may also document observation of positive outcomes for any individual receiving behavioral support services. The DSA may also document observation of the behavioral support provider by successfully completing the billable tasks listed below.
The following activities may be billed under the CLASS program if included in the individual’s authorized IPC:
- conducting a functional behavior assessment;
- developing an individualized behavior support plan;
- training and consulting with an individual, family member, or other persons involved in the individual’s care regarding the implementation of the behavior support plan;
- monitoring and evaluating the effectiveness of the behavior support plan;
- modifying, as necessary, the behavior support plan based on monitoring and evaluating the plan’s effectiveness; and
- counseling and educating an individual, family members, or other persons involved in the individual’s care about the techniques to use in assisting the individual to control challenging or socially unacceptable behaviors.
The behavioral support provider must provide justification for time required to develop an individualized behavior support plan. The justification should include time necessary to conduct the functional assessment, any review of individual records, and time spent developing an individualized behavior support plan.