Applied Behavior Analysis (ABA) is an evidence-based treatment for individuals with Autism Spectrum Disorder (ASD) that includes many different techniques to increase useful or desired behaviors such as communication and social skills, and to reduce behaviors that may interfere with learning or behaviors that may be harmful.
Effective January 1, 2017, the Maryland Department of Health covers medically necessary Applied Behavior Analysis (ABA) therapy services for Maryland Medical Assistance enrolled members under the age of 21.
Children and adolescents who are:
- Under 21 years of age;
- Enrolled in the Maryland Medical Assistance Program;
- Living in the community;
- Diagnosed with an Autism Spectrum Disorder (ASD) through a comprehensive diagnostic evaluation; and
- Referred to the Administrative Services Organization (ASO) for ABA therapy services.
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The following qualified health care professionals, with appropriate training and experience, are able to diagnose ASD:
- Developmental pediatricians;
- Nurse Practitioners;
- Pediatric Neurologists;
- Child Psychiatrists;
- Clinical Psychologists; and
The following providers are able to render ABA services:
- Psychologists - licensed by the Board of Examiners of Psychologists and acting within the scope of their practice;
- Board Certified Behavior Analysts-Doctorate (BCBA-Ds) - certified by the Behavior Analyst Certification Board (BACB) and licensed by the Maryland Board of Professional Counselors and Therapists;
- Board Certified Behavior Analysts (BCBAs) - certified by the Behavior Analyst Certification Board (BACB) and licensed by the Maryland Board of Professional Counselors and Therapists;
- Board Certified Assistant Behavior Analysts (BCaBAs) - certified by the Behavior Analyst Certification Board (BACB) and works under the supervision of a Maryland licensed BCBA-D or BCBA;
- Registered Behavior Technicians (RBTs) - registered by the Behavior Analyst Certification Board (BACB) and works under the supervision of a Maryland licensed, BCBA-D or BCBA; and
- Behavior Technicians (BTs) - Prior to January 1, 2019, Behavior Technicians (BTs) provided ABA services under the supervision of a Maryland licensed BCBA-D OR BCBA. Effective January 1, 2019 Behavior Technicians (BTs) must be registered by the Behavior Analyst Certification Board (BACB) as Registered Behavior Technicians (RBTs) in order to continue to providing ABA services.
All qualified providers must complete the following steps in order to provide ABA services:
- Enroll with Maryland Medicaid program: and
- Register with Optum Maryland.
: All providers must enroll in Maryland Medicaid, whether they are a group practice, solo practice or members of a group. This includes all licensed and unlicensed individuals (psychologists, BCBA-Ds, BCBAs, BCaBAs, and RBTs). Licensed Psychologists already enrolled with Maryland Medicaid must attest that they have the necessary training and experience to provide ABA services by completing an Attestation Form
. To enroll with the Maryland Medical Assistance Program, all ABA group practices and individual providers must register with the Maryland Medicaid's electronic Provider Revalidation and Enrollment Portal (ePREP) at-https://eprep.health.maryland.gov/sso/login.do
. The ePREP is the one-stop for provider enrollment, re-enrollments, revalidation, information updates, and demogrpahic changes.
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Yes, all ABA providers must have a unique NPI number for ABA services prior to completing the Maryland Medicaid ABA application.
ABA therapy services include a variety of interventions identified as evidence-based by nationally recognized research reviews. The following ABA services are available to eligible children/adolescents:
- ABA assessment and reassessment administered by a psychologist, BCBA-D or BCBA;
- Individual therapy administered face-to-face to a child/adolescent by any ABA provider;
- Group therapy administered to multiple children/adolescents by any ABA provider;
- Social skills group therapy administered to multiple children/adolescents by a psychologist, BCBA-D or BCBA;
- Individual parent training administered by a psychologist, BCBA-D, BCBA or BCaBA; and
- Multiple-family group training administered by a psychologist, BCBA-D or BCBA.
All ABA services require prior authorization from the behavioral health ASO contracted by MDH, Optum Maryland. The ASO will only authorize services that are medically necessary to eligible participants.
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The following steps must be taken for a child/adolescent to receive ABA services:
- The qualified health care professional conducts a comprehensive diagnostic evaluation of the child/adolescent and if the diagnosis of ASD is confirmed, refers the child/adolescent for ABA services;
- The ASO preauthorizes child/adolescent for ABA services if medically necessary; and
- The psychologist, BCBA-D or BCBA completes an assessment for ABA services and develops a detailed treatment plan.
Preauthorization for services from the ASO are valid for a maximum of 180 days. The psychologist, BCBA-D or BCBA must complete a reassessment of the child/adolescent to determine if ABA services continue to be medically necessary prior to the end of the initial authorization period.
ABA services will continue to be preauthorized for additional 180 day periods as long as it is determined that they are medically necessary.
Is a remote direction allowed?
ABA direction of a BCaBA or RBT performed by a BCBA-D or BCBA is a covered ABA service. The direction must be performed in person at least 25 percent of the time. Please note that the provider must obtain approval from Optum Maryland prior to providing remote services.
Can a provider bill for treatment planning?
ABA treatment planning performed by a psychologist, BCBA-D, or BCBA, which includes the development and revision of treatment plan and goals, data analysis, and real-time, direct communication with the participant's other service providers is a covered ABA service. Treatment planning may only be billed for a maximum of four hours per month.
ABA services must be provided in home and community settings, including clinics where there is a plan for generalization to the home environment.
ABA services will be discontinued if no longer medically necessary because:
- Long-term treatment goals and objectives are achieved; or
- The participant is no longer demonstrating progress towards treatment goals, and objectives and measurable functional improvement is no longer expected.
For questions about registering with the ASO, please call Optum Maryland at 1-800-888-1965.
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