Applied Behavioral Analysis for Children with
Autism Spectrum Disorder
Nancy E. Wright, Esq. Newright.law@gmail.com
GAL Video Training 2015
1. What is ABA?
Applied Behavior Analysis is therapy using consistent interventions based
on principals of learning theory to bring about meaningful and positive
change in behavior.
ABA can address both problematic behaviors, as well as life skills, like
communication, sociability, self-care and school-readiness.
Requires behavioral assessment, behavioral intervention plan, training and
implementation, data collection and analysis for impact and need for
modification
2. Who provides ABA?
DD Waiver Provider:
Certified Behavior Analyst (CBA)
Certified Assistant Behavior Analyst (CaBA) if supervised by a CBA
Persons licensed under Ch 490 (psychologists) or 491 (social work,
LMHC, marriage & family therapy)
Behavioral Assistant
CBA Infant Toddler Development Specialist enrolled as an Early Intervention
Services provider or
CBA or behavioral health technician employed or under contract with a
Community Behavioral Health Services provider to provide Therapeutic
Behavioral On-Site services
3. How much ABA can be provided?
A total of 160 quarter-hour units (40 hours) per week of combined services
(CBA and Behavioral Assistant)
Usually a combination of CBA, providing assessment, plan
development, training and supervision and
Behavior Assistant working in the home to implement the program and
train caregivers and other providers
4. Who Qualifies for ABA?
Pre-DSM-V: Autistic Disorder, PDD-NOS, Rett’s Disorder, Childhood
Disintegrative Disorder, Asperger’s Syndrome
DSM-V: Autism Spectrum Disorder
ICD-9 Codes: 299, 299.0, 299.00, 299.01, 299.1, 299.10, 299.11, 299.8,
299.80, 299.81, 299.9, 299.90 or 299.91
5. Garrido v Dudek
731 F. 3d 1152 (11th Cir. 2013)
The lower court rejected AHCA’s argument that ABA was experimental and
Enjoined AHCA from enforcing the Community Behavioral Health Handbook
provision that stated Medicaid does not pay for CBH services for
treatment of autism or PDD.
Ordered AHCA to provide, fund and authorize ABA for all Medicaid
recipients under 21 with ASD
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11th Circuit clarified that medical necessity still required
6. How to Request
Prior authorization through local Medicaid Office
Submit following information:
Recipient’s name, DOB, Medicaid ID, current mailing address
Provider’s name, national provider ID, address, phone and fax
Diagnosis and code
IF already assessed, expected scope and duration
Primary focus of ABA treatment
Signed medical records documenting ASD diagnosis
Physician Form
Provider List
AHCA Area Medicaid Phone #s
Area 1: (850) 595-2300
Fax:
Area 2a: (850) 767-3400
Area 2b: (850) 412-4002
Area 3a: (386) 462-6200
Area 3b: (352) 840-5720
Area 4: (904) 798-4200
Area 5: (727) 552-1900
Area 6: (813) 350-4800
Area 7: (407) 420-2500
Area 8: (239) 335-1300
Area 9: (561) 712-4400
Area 10: (954) 958-6500
Area 11: (305) 593-3000
(850) 595-5718
(850) 747-5456
(850) 921-0394
(386) 418-5370
(352) 620-3076
(904) 353-2198
(727) 552-1216
(813) 673-4592
(239) 338-2642
(561) 616-1545
(954) 202-3220
(305) 499-2022
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