CurrentLouisiana Department of HealthPolicy N/A

Applied Behavior Analysis

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This Louisiana Department of Health informational bulletin describes Applied Behavior Analysis, identifies Medicaid and LaCHIP children who may be eligible, and outlines diagnostic and evaluation requirements for accessing ABA services.

Policy Summary

PayerLouisiana Department of Health

PolicyApplied Behavior Analysis

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMaintain documentation of Medicaid or LaCHIP eligibility, age under 21, qualifying diagnosis, behavioral impairment, and a comprehensive evaluation recommending ABA services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Under 21Age requirement for ABA eligibility

Medicaid or LaCHIPRequired coverage status

5Eligibility requirements identified

State PlanService classification

ABA Eligibility

Policy Summary

PayerLouisiana Department of Health

PolicyApplied Behavior Analysis

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMaintain documentation of Medicaid or LaCHIP eligibility, age under 21, qualifying diagnosis, behavioral impairment, and a comprehensive evaluation recommending ABA services.

SourceLink

On This Page

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CurrentLouisiana Department of HealthPolicy N/A

Applied Behavior Analysis

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Sign up for all Louisiana Department of Health policy alerts

Know when Louisiana Department of Health releases new policies or updates existing guidance.

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Policy Summary

PayerLouisiana Department of Health

PolicyApplied Behavior Analysis

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMaintain documentation of Medicaid or LaCHIP eligibility, age under 21, qualifying diagnosis, behavioral impairment, and a comprehensive evaluation recommending ABA services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Under 21Age requirement for ABA eligibility

Medicaid or LaCHIPRequired coverage status

5Eligibility requirements identified

State PlanService classification

ABA Eligibility

Policy Summary

PayerLouisiana Department of Health

PolicyApplied Behavior Analysis

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionMaintain documentation of Medicaid or LaCHIP eligibility, age under 21, qualifying diagnosis, behavioral impairment, and a comprehensive evaluation recommending ABA services.

SourceLink

On This Page

ABA eligibility

ABA services may be provided when all eligibility requirements are met.

Coverage and age: Be a Medicaid or LaCHIP recipient and be less than 21 years old.Under age 21
Functional behavioral impairment: Exhibit excesses and/or deficits of behaviors that significantly interfere with home or community activities.Significant interference with home or community activities
Qualifying diagnosis: Be examined and diagnosed by a qualified provider, such as a psychologist, psychiatrist, or a pediatrician who specializes in behavior disorders, as having a condition known to respond to ABA services, including autism spectrum disorder.Diagnosis by a qualified provider
Comprehensive diagnostic evaluation: Have a comprehensive diagnostic evaluation conducted by a qualified health care provider that prescribes and/or recommends ABA services.Comprehensive evaluation prescribing or recommending ABA

Documentation and Eligibility Checks

Documentation Required

Document ABA eligibility and evaluation

Maintain documentation that the recipient is a Medicaid or LaCHIP beneficiary under age 21 and meets all ABA eligibility requirements.

Exhibits excesses and/or deficits of behaviors that significantly interfere with home or community activities.
Was examined and diagnosed by a qualified provider, such as a psychologist, psychiatrist, or a pediatrician who specializes in behavior disorders, as having a condition known to respond to ABA services, including autism spectrum disorder.
Has a comprehensive diagnostics evaluation conducted by a qualified health care provider that prescribes and/or recommends ABA services.

Denial Risk

Failure to meet ABA eligibility requirements

ABA eligibility is not established if any required criterion is unmet, including coverage status, age, behavioral impairment, qualifying diagnosis, or the required comprehensive evaluation recommending or prescribing ABA services.

The individual is not a Medicaid or LaCHIP recipient.
The individual is 21 or older.
The individual does not exhibit behavioral excesses and/or deficits that significantly interfere with home or community activities.
A qualified provider has not diagnosed a condition known to respond to ABA services, including autism spectrum disorder.
A qualified health care provider has not conducted a comprehensive diagnostics evaluation that prescribes and/or recommends ABA services.