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.