Wednesday, September 25, 2019

IHCP amends the rules for applied behavior analysis therapy services

IHCP amends the rules for applied behavior analysis therapy services

Effective March 1, 2019, the Indiana Health Coverage Programs (IHCP) amended Indiana Administrative Code 405 IAC 5-22-12 Applied Behavior Analysis Therapy Services to implement current best practices, modify the time limits and length of applied behavioral analysis (ABA) therapy services, and amend standards and criteria for ABA therapy services.

The following changes were made:

 405 IAC 5-22-12(a)(3) was amended to include that when completing a diagnostic evaluation, a qualified provider must use the most recent version of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) at the time of the evaluation and include a recommended treatment referral for ABA therapy services.

 405 IAC 5-22-12(e) was amended to clarify that treatment plans must be focused on addressing specific behavioral issues and community integration. All treatment plans must include a projected length of therapy. The rule also clarifies that school attendance includes any homeschooling.

  405 IAC 5-22-12(h) was amended to remove language that limited services to 3 years. Clarification was added that ABA therapy services extending beyond 40 hours per week must be medically necessary and will require additional prior authorization (PA).

 405 IAC 5-22-12(i) was amended to clarify that determinations for hours and duration will not be based upon other therapies that do not address the specific behaviors being targeted, or on any standardized formulas used to deduct hours based upon daily living activities.

 405 IAC 5-22-12(j) was amended to clarify that short-term, adjunctive hours may be requested outside the standard therapy PA if any of the following special conditions occur:
 Sudden increase in self-injurious behaviors
 Sudden increase in aggression or aggressive behaviors
 Increase in elopement behaviors
 Regression in major self-care or language activities
 A shift in family or home dynamic
 Development of a non-mental-health-related comorbidity or health crisis with the patient

 405 IAC 5-22-12(k) was amended to clarify that coverage shall not be available for services that are duplicative in addressing the same behavioral goals using the same techniques as the treatment plan. The restriction on allowing a registered behavior technician (RBT) to provide services in the home or school setting was removed.

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