ABA FAQs

Applied Behavior Analysis (ABA) is an evidence-based treatment for individuals with Autism Spectrum Disorder (ASD) that includes many different techniques to increase useful or desired behaviors such as communication and social skills, and to reduce behaviors that may interfere with learning or behaviors that may be harmful.

Effective January 1, 2017, the Department of Health and Mental Hygiene will cover medically necessary Applied Behavior Analysis (ABA) therapy services for Maryland Medical Assistance enrolled members under the age of 21.

Children and adolescents who are:

• Under 21 years of age;
• Enrolled in the Maryland Medical Assistance Program;
• Living in the community;
• Diagnosed with an Autism Spectrum Disorder (ASD) through a comprehensive diagnostic evaluation; and
• Referred to the Administrative Services Organization (ASO) for ABA therapy services.

The following qualified health care professionals, with appropriate training and experience, are able to diagnose ASD:

• Pediatricians;
• Developmental pediatricians;
• Nurse Practitioners;
• Pediatric Neurologists;
• Child Psychiatrists;
• Clinical Psychologists; and
• Neuropsychologists.

The following providers are able to render ABA services:

• Psychologists – licensed by the Board of Examiners of Psychologists and acting within the scope of their practice;
• Board Certified Behavior Analysts-Doctorate (BCBA-Ds) – certified by the Behavior Analyst Certification Board (BACB) and licensed by the Maryland Board of Professional Counselors and Therapists;
• Board Certified Behavior Analysts (BCBAs) – certified by the Behavior Analyst Certification Board (BACB) and licensed by the Maryland Board of Professional Counselors and Therapists;
• Board Certified Assistant Behavior Analysts (BCaBAs) – certified by the Behavior Analyst Certification Board (BACB) and works under the supervision of a Maryland licensed psychologist, BCBA-D or BCBA;
• Registered Behavior Technicians (RBTs) – registered by the Behavior Analyst Certification Board (BACB) and works under the supervision of a Maryland licensed psychologist, BCBA-D or BCBA; and
• Behavior Technicians (BTs) – may provide ABA services under the supervision of a Maryland licensed psychologist, BCBA-D or BCBA thru December 31, 2018. Effective January 1, 2019 Behavior Technicians (BTs) must be registered by the Behavior Analyst Certification Board (BACB) as Registered Behavior Technicians (RBTs) in order to continue providing ABA services.

All qualified providers must complete the following steps in order to provide ABA services:

• Complete a Maryland Medicaid provider application for provider type AB and obtain a Medicaid provider number; and
• Register with Beacon Health Options ASO.

ABA therapy services include a variety of interventions identified as evidence-based by nationally recognized research reviews. The following ABA services are available to eligible children/adolescents:

• ABA assessment and reassessment administered by a psychologist, BCBA-D or BCBA;
• Individual therapy administered face-to-face to a child/adolescent by any ABA provider;
• Group therapy administered to multiple children/adolescents by any ABA provider;
• Social skills group therapy administered to multiple children/adolescents by a psychologist, BCBA-D or BCBA;
• Individual parent training administered by a psychologist, BCBA-D, BCBA or BCaBA; and
• Multiple-family group training administered by a psychologist, BCBA-D or BCBA.

All ABA services require prior authorization from the behavioral health ASO contracted by DHMH, Beacon Health Options. The ASO will only authorize services that are medically necessary to eligible participants.

The following steps must be taken for a child/adolescent to receive ABA services:

• The qualified health care professional conducts a comprehensive diagnostic evaluation of the child/adolescent and if the diagnosis of ASD is confirmed, refers the child/adolescent for ABA services;
• The ASO preauthorizes child/adolescent for ABA services if medically necessary; and
• The psychologist, BCBA-D or BCBA completes an assessment for ABA services and develops a detailed treatment plan.

Preauthorization for services from the ASO are valid for a maximum of 180 days. The psychologist, BCBA-D or BCBA must complete a reassessment of the child/adolescent to determine if ABA services continue to be medically necessary prior to the end of the initial authorization period.

ABA services will continue to be preauthorized for additional 180 day periods as long as it is determined that they are medically necessary.

ABA services must be provided in home and community settings, including clinics where there is a plan for generalization to the home environment.

ABA services will be discontinued if no longer medically necessary because:

• Long-term treatment goals and objectives are achieved; or
• The participant is no longer demonstrating progress towards treatment goals, and objectives and measurable functional improvement is no longer expected.

For additional information, please click on the following link:
https://mmcp.dhmh.maryland.gov/epsdt/ABA/Pages/Home.aspx.

For questions about provider enrollment, please e-mail
dhmh.aba@maryland.gov.

For questions about registering with the ASO, please visit Beacon Health Options at https://www.beaconhealthoptions.com/providers/.