CurrentLouisiana Department of HealthPolicy N/A

Applied Behavior Analysis-Based Therapy Services — Place of Service Limitations

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This policy governs where Louisiana Medicaid-covered applied behavior analysis (ABA)-based therapy services may be delivered and identifies services that do not meet medical necessity or coverage requirements.

Policy Summary

PayerLouisiana Department of Health

PolicyApplied Behavior Analysis-Based Therapy Services — Place of Service Limitations

Policy CodePolicy N/A

Change TypeMaterial policy revision

Effective DateJul 15, 2022

Next Review DateN/A

Key ActionDeliver ABA-based therapy services in a natural setting, including home and community-based settings, schools, and clinics.

SourceLink

POLICY UPDATE CHANGES

The policy removes the prior limitation excluding ABA services delivered in non-conventional settings.

ABA therapy services may be delivered in a community setting and must be delivered in a natural setting, including home and community-based settings, schools, and clinics.

Natural settingsRequired service-delivery setting

Home, community, schools, clinics

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CurrentLouisiana Department of HealthPolicy N/A

Applied Behavior Analysis-Based Therapy Services — Place of Service Limitations

Customize your policy alerts

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-Based Therapy Services — Place of Service Limitations

Policy CodePolicy N/A

Change TypeMaterial policy revision

Effective DateJul 15, 2022

Next Review DateN/A

Key ActionDeliver ABA-based therapy services in a natural setting, including home and community-based settings, schools, and clinics.

SourceLink

POLICY UPDATE CHANGES

The policy removes the prior limitation excluding ABA services delivered in non-conventional settings.

ABA therapy services may be delivered in a community setting and must be delivered in a natural setting, including home and community-based settings, schools, and clinics.

Natural settingsRequired service-delivery setting

Home, community, schools, clinics

Covered Service Requirements and Exclusions

Natural-setting and school-based service criteria

Covered service delivery requirements: all of the following must be met.

Natural-setting delivery

School-setting safeguard: When services are delivered in a school setting, they must not duplicate services rendered under an Individualized Education Program (IEP) as required under the Individuals with Disabilities Education Act (IDEA).
Applies to school-based services.

Treatment whose purpose is vocational or recreational is excluded from Medicaid-covered ABA-based therapy services and does not meet medical necessity criteria.

Services that could be provided by persons without professional skills or training are excluded from Medicaid-covered ABA-based therapy services and do not meet medical necessity criteria.

The following services are not medically necessary and do not qualify as Medicaid-covered ABA-based therapy: treatment with a vocational or recreational purpose and services that could be provided by persons without professional skills or training.

Provider Requirements and Denial Risks

Denial Risk

Vocational or Recreational Purpose

Treatment whose purpose is vocationally or recreationally based does not meet medical necessity criteria and does not qualify as a Medicaid-covered ABA-based therapy service.

Denial Risk

Services Not Requiring Professional Skills

Services that could be provided by persons without professional skills or training do not meet medical necessity criteria and are excluded from Medicaid coverage as ABA-based therapy.

Denial Risk

Duplicate IEP Services Not Permitted

When ABA services are delivered in a school setting, they must not duplicate services rendered under a student's Individualized Education Program (IEP) as required by the federal Individuals with Disabilities Education Act (IDEA).

Policy Scope and Context

This policy addresses the place of service for applied behavior analysis (ABA)-based therapy provided through the Louisiana Medicaid Medical Assistance Program. Covered services must be delivered in a natural setting, including home and community-based settings, schools, and clinics.

Natural Setting

Natural setting

DefinitionA setting in which ABA-based therapy services may be delivered.

HomeHome settings are permitted.

Community-based settingsCommunity-based settings are permitted.

Schools and clinicsSchools and clinics are permitted natural settings.

ABA Service-Location Criteria

ABA service-location criteria

ABA-based therapy services must satisfy all of the following service-location and school-coordination requirements.

ABA service-location requirements

No duplicate IEP services: If services are delivered in a school setting, the ABA services must not duplicate services rendered under an Individualized Education Program (IEP) as required under the Individuals with Disabilities Education Act (IDEA).
School setting only.