Applied Behavioral Analysis (ABA)

EPSDT: Applied Behavior Analysis (ABA)

Acentra Health, the QIO-like organization for the Arkansas Department of Human Services (DHS), provides utilization and quality control peer review for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits of Applied Behavior Analysis (ABA) to qualifying Arkansas Medicaid beneficiaries, ages 18 months to 21 years.  These services require a physician’s recommendation of medical necessity.  Minors on ARKids First B are not entitled to all the extended EPSDT benefits. Beneficiaries enrolled in the Autism Waiver are not eligible for ABA therapy services because they receive their autism services through the waiver.  Beneficiaries enrolled in a PASSE must request ABA services through their assigned PASSE care coordinator.

Request for ABA services

1. All reviews require a diagnosis of autism spectrum disorder
2. All assessment and treatment prior authorization reviews are conducted by a Board-Certified Behavior analyst
3. If the Prior Authorization (PA) request does not contain documentation clearly establishing that the requested services are medically necessary, the request will be reviewed by either a BCBA-D or a physician reviewer who will determine whether to enter a determination that some or all of the requested care is not medically necessary (adverse decision)