Applied Behavior Analysis Guidelines
For Treatment of Autism Spectrum Disorders
Autism Spectrum Disorder (ASD) is a medical, neurobiological, and developmental disorder characterized by problems in social communication and social interaction, and restrictive, repetitive patterns of behavior, interests, and activities.
Applied Behavior Analysis (ABA) is the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including use of direct observation, measurement, and functional analysis of the relationship between environment and behavior. Involvement by parents is considered essential to long-term treatment success.
ConnectCare may authorize ABA when the following criteria have been met:
1. The member is under the age of 19.
2. A diagnosis of ASD has been made by a licensed medical professional or other qualified health care professional, such as a developmental pediatrician, pediatric neurologist, psychiatrist, or psychologist.
3. The ASD is adversely impacting the member’s development, communication, social interactions, or behavior such that the member is unable to adequately participate in age-appropriate home, school, or community activities, or the member is a safety risk to self, others, or property.
4. Parent(s) (or guardians) must be involved in the training of interventions and behavioral techniques with a plan for transferring interventions with member to parents.
5. The Board Certified Behavior Analyst (BCBA) has completed a behavior identification assessment using a standardized assessment, such as the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) or the Assessment of Basic Language and Learning Skills (ABLLS).
6. The BCBA has developed an individualized treatment plan that includes the following:
· Identification and detailed description of targeted symptoms and behaviors.
· Objective baseline measurements of each targeted symptom and behavior
· Detailed description of treatment modality and intervention of each targeted symptom and behavior.
· Treatment goals and measures of progress for each targeted symptom and behavior, with estimated timeframes for achieving the goals.
· Communication and coordination with other providers and agencies as appropriate, including day care, school, and other health care providers.
· Total number of hours of planned services per week should be 40 hours or less, including direct services to the client(s).
· Supervision of line therapists by the BCBA should occur at a minimum of 1 hour of supervision for every 10 hours of treatment with the client (s).
· Measurable criteria for completing treatment, with projected plan for continued care after discharge from ABA.
7. Collaboration and involvement of community resources to include the school district if the child is 3 or older, or early intervention if appropriate.
8. ABA services are provided directly by individuals licensed by the state or certified by the Behavior Analyst Certification Board (BACB). The BACB requires that Board Certified Assistant Behavior Analysts (BCaBA) work under the supervision of a BCBA. Registered Behavior Technicians (RBT) must work under the supervision of a BCBA-D, BCBA or BCaBA.
Medical Necessity Criteria for Continued Care:
1. The member continues to meet the criteria above for initiation of ABA.
2. The person-centered treatment plan will be updated and submitted every 6 months.
3. Progress is assessed and documented for each targeted symptom and behavior, including progress towards the defined goals, and including the same modes of measurement that were utilized for baseline measurements of specific symptoms and behaviors.
4. When goals have been achieved, either new goals should be identified, or the treatment plan should be revised to include a transition to less intensive interventions. Goals should be based on targeted symptoms and behaviors which are preventing the member from adequately participating in age-appropriate home, school, or community activities, or that are presenting a safety risk to self, other, or property.
