Information About Applied Behavioral Analysis (ABA)
What to do if your child is enrolled in Medical Assistance and you have concerns about Applied Behavioral Analysis.
If you are having a problem getting Applied Behavioral Analysis (ABA) for your child that you have not been able to resolve with your Behavioral Health Managed Care Organization or the county, you may contact OMHSAS at (717) 772-7646 or RA-PWIBHS@pa.gov
Applied Behavioral Analysis Using Behavioral Analysis Using Behavioral Specialist Consultant-Autism Spectrum Disorder and Therapeutic Staff Support Services
On January 13, 2017 a bulletin was issued to inform the Behavioral Health Managed Care Organizations and providers of the procedures for requesting Applied Behavioral Analysis (ABA) using Behavioral Specialist Consultant-Autism Spectrum Disorder (BSC-ASD) and Therapeutic Staff Support (TSS) services, and the procedure code and modifier combinations that can be used to bill for services when BSC-ASD and TSS services are used by appropriately qualified individuals to provide ABA. This bulletin includes a confirmation of skills and knowledge to provide ABA and an attestation for behavioral health rehabilitation services providers that provide ABA using BSC-ASD and TSS services.
Medical Necessity Guidelines for Applied Behavioral Analysis
In August 2015, OMHSAS convened a small, time-limited clinical workgroup to assist in the development of new Medical Necessity Guidelines (MNG) for children and adolescents with ASD. The workgroup gathered input from BH-MCOs, county contacts, providers, advocates and family members of children with ASD between November 23, 2015, and January 8, 2016. The Guidelines are specific to Applied Behavioral Analysis within the home and community-based services level of care.
The Department utilized the workgroup’s recommendations to develop medical necessity guidelines that apply to both the Fee For Service and managed care delivery systems. On July 1, 2016 the Department issued the guidelines in OMHSAS-16-09. The guidelines specify what must be considered when a request for prior authorization of ABA using BSC-ASD services or BSC-ASD and TSS services for children and adolescents under age 21 with ASD is reviewed. The Department has further revised the guidelines in response to comments and questions it received after the issuance of the guidelines.