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
- All reviews require a diagnosis of autism spectrum disorder
- All assessment and treatment prior authorization reviews are conducted by a Board-Certified Behavior analyst
- 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)
ABA Update
December 31, 2024
We are pleased to announce the publication of the Applied Behavior Analysis (ABA) Arkansas Medicaid Provider Manual effective January 1, 2025. This new manual establishes eligibility, clinician qualifications, supervision, service delivery, service delivery documentation, billing, and extension of benefit requirements in connection with the performance of ABA therapy services.
Please review the ABA Provider Manual and Acentra Health documentation to see how this program and the required Prior Authorization process is changing, and what will be required of you, as the provider.
Click HERE to be redirected to the Arkansas Medicaid Manuals page. The new manual can soon be found by clicking on Applied Behavior Analysis (ABA). Assistive Acentra Health documentation can be found below.
Please note that pursuant to these updates a BCBA credential is required to perform behavior identification and assessment services. In addition, group ABA therapy services are no longer permitted. As a result, procedure codes 97152, 97154, and 97158 will no longer be available starting January 1, 2025.
DMS-693 forms may be accepted until April 1, 2025, after which date all PA submissions must include the new DMS-641 forms.
As always, if you have any questions, email us at arkansaspr@acentra.com.