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Applied Behavioral Analysis for Children with Autism Spectrum Disorder?????Nancy E. Wright, Esq. Newright.law@GAL Video Training 20151. What is ABA?Applied Behavior Analysis is therapy using consistent interventions based on principals of learning theory to bring about meaningful and positive change in behavior. ABA can address both problematic behaviors, as well as life skills, like communication, sociability, self-care and school-readiness.Requires behavioral assessment, behavioral intervention plan, training and implementation, data collection and analysis for impact and need for modification2. Who provides ABA?DD Waiver Provider:Certified Behavior Analyst (CBA)Certified Assistant Behavior Analyst (CaBA) if supervised by a CBAPersons licensed under Ch 490 (psychologists) or 491 (social work, LMHC, marriage & family therapy)Behavioral AssistantCBA Infant Toddler Development Specialist enrolled as an Early Intervention Services provider orCBA or behavioral health technician employed or under contract with a Community Behavioral Health Services provider to provide Therapeutic Behavioral On-Site services3. How much ABA can be provided?A total of 160 quarter-hour units (40 hours) per week of combined services (CBA and Behavioral Assistant)Usually a combination of CBA, providing assessment, plan development, training and supervision andBehavior Assistant working in the home to implement the program and train caregivers and other providers4. Who Qualifies for ABA?Pre-DSM-V: Autistic Disorder, PDD-NOS, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s SyndromeDSM-V: Autism Spectrum DisorderICD-9 Codes: 299, 299.0, 299.00, 299.01, 299.1, 299.10, 299.11, 299.8, 299.80, 299.81, 299.9, 299.90 or 299.915. Garrido v Dudek?731 F. 3d 1152 (11th Cir. 2013)The lower court rejected AHCA’s argument that ABA was experimental and Enjoined AHCA from enforcing the Community Behavioral Health Handbook provision that stated Medicaid does not pay for CBH services for treatment of autism or PDD.Ordered AHCA to provide, fund and authorize ABA for all Medicaid recipients under 21 with ASD11th Circuit clarified that medical necessity still required6. How to RequestPrior authorization through local Medicaid OfficeSubmit following information:Recipient’s name, DOB, Medicaid ID, current mailing addressProvider’s name, national provider ID, address, phone and faxDiagnosis and codeIF already assessed, expected scope and durationPrimary focus of ABA treatmentSigned medical records documenting ASD diagnosisPhysician FormProvider ListAHCA Area Medicaid Phone #sArea 1: (850) 595-2300Fax: (850) 595-5718Area 2a: (850) 767-3400(850) 747-5456Area 2b: (850) 412-4002(850) 921-0394Area 3a: (386) 462-6200(386) 418-5370Area 3b: (352) 840-5720(352) 620-3076Area 4: (904) 798-4200(904) 353-2198Area 5: (727) 552-1900(727) 552-1216Area 6: (813) 350-4800(813) 673-4592Area 7: (407) 420-2500Area 8: (239) 335-1300(239) 338-2642Area 9: (561) 712-4400(561) 616-1545Area 10: (954) 958-6500(954) 202-3220Area 11: (305) 593-3000(305) 499-2022 ................
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