6 a.m.Oct. 1, 2014
Applied Behavioral Analysis (ABA) therapy is now available for children on Medi-Cal who have autism spectrum disorder.
As a result, low-income families on Medi-Cal may call their health plan and their childs primary care physician and request an assessment for ABA therapy, which is a system of autism treatment based on theories that behaviors can be taught through a system of rewards and consequences.
To be eligible, children need to have a diagnostic assessment of autism spectrum disorder and a prescription for ABA therapy from either a psychologist or treating physician. The prescribing professional must explain why ABA therapy is medically necessary.
In July, the federal Centers for Medicare & Medicaid Services issued rules stating that state Medicaid programs must cover a full range of autism services, including ABA therapy.
Because the order was issued on July 7, eligible Medi-Cal children whose families have been paying for ABA out-of-pocket between July 1 and Sept. 15 will be eligible for reimbursement.
Californias Department of Health Care Services has been proactive in asking for feedback and taking suggestions from families, advocacy groups, ABA providers and others about how to best implement the new ABA benefit.
At a Sept. 4 stakeholders meeting at the state capitol, several critical issues were raised by attendees.
For instance, several ABA providers raised concerns about the Medi-Cal reimbursement rate, arguing that it had to be sufficient to fund high-quality treatment. Families already receiving ABA therapy for their children through regional centers expressed concerns about having to change providers, given established relationships.
The DHCS agreed to take concerns into consideration as it drafts its final plans for administering the ABA benefit. Anyone interested in submitting questions, comments or concerns may email the DHCS at ABAinfo@dhcs.ca.gov.