Frequently Asked Questions
What is Applied Behavior Analysis (ABA)?
ABA is a treatment approach based on scientific principles of behavior developed over the past 50 years. ABA is considered to be the most effective, evidence-based treatment for children diagnosed with autism spectrum disorder and other developmental disorders. There are many different techniques used under the ABA umbrella including, Verbal Behavior (VB), Discrete Trial Teaching (DTT), and Natural Environment Teaching (NET).
Is ABA the right choice for my child?
Determining appropriate services for your child can be difficult for any family. With the variety of programs, services, and approaches available for children with special needs, it can be confusing and frustrating to identify the right program for your child. NSLTC is here to help. To determine if ABA is an appropriate therapy for your child you should start with a recommendation for ABA from your physician or a psychologist. Decisions about level and intensity of services that are appropriate depend on the unique characteristics of your child.
Who is responsible for my child's ABA program?
Each Treatment Program is written and closely monitored by a designated Program Manager (BCBA) who oversees each clients’ program and supervises the technicians responsible for implementing the program. The program manager is responsible for the ongoing success of the ABA program which is measured through daily data collection and analysis. The program manager is responsible for the development and review of progress reports with parents/guardians and providing assistance with IFSP and IEP meetings/review. The Program Manager will provide parent/caregiver training throughout the service period and will be the point of contact for all issues specific to a client’s case.
After the program has been created a team of RBTs work directly with the client implementing the program, taking data, providing parent/guardian instruction/assistance as needed, and maintaining parent/guardian and Program Manager communication.
Additionally, parents/caregivers are important parts of a successful ABA program and will be expected to observe, participate, and help monitor their child’s therapy.
How often is an assessment required?
There is no required frequency at which an assessment must take place. At a minimum, most treatment reviews are required every 4-6 months depending on the account/state law.
What are examples of standardized functional assessments?
Examples include: Verbal Behavior Milestone Assessment and Placement Program (VB- MAPP), Assessment of Basic Learning and Language Skills (ABLLS), and Vineland Adaptive Behavior Scale.
For our daily session notes do we need to have a hard copy or is a computerized version acceptable?
The requirement is that there is a daily session note that includes the following information: place of service, start and stop time, who rendered the service, the specific service (e.g., parenting training, supervision, direct service), who attended the session, interventions that occurred during the session, barriers to progress, and response to interventions.
Are provider signature and parent/guardian signatures required on progress notes?
Provider signature is required on progress notes. Parent/guardian signatures are not required on progress notes.
How many hours of supervision are allowed? Is there a minimum requirement?
A minimum of 1 hour of supervision per month is required for each case. The maximum number of hours approved is based on the direct number of hours the member is receiving: P 1 hour for every 10 hours of direct paraprofessional hours being provided, ordinarily not to exceed 8 hours per month If you request more hours than the 1:10 ratio, please be prepared to provide a clinical rationale when you call in to request treatment.
Is it possible to bill for supervision and the paraprofessionals time at the same time?
No. When supervision is provided, you are reimbursed for the service provided not the people present.
Is it possible to bill for team meeting’s
Team meetings are covered only as supervision if the member, the supervisor and the paraprofessional are present. When supervision is provided, you are reimbursed for the service provided, not for the people present, so the entire team would not be covered individually in the billing. Only the supervision code would be billed for the entire time spent instead of the number of people in the meeting.
Can any services be delivered in a school?
School-based services are reviewed for medical necessity; however, school-based ABA services or services that are otherwise covered under the Individuals with Disabilities Education Act (IDEA) are not covered. Typical school services we would expect to see include coordination of care, attending IEP meetings, working to train teachers or school staff in the behavior plans or skill management, or assessing the member’s behaviors across environments.
Is parent training covered?
Parent training is required. Bill H2012 or H2019 depending on who is providing the service.
What if only one caregiver is participating in treatment?
If both of the member’s parents have custodial rights it is expected that both parents have some involvement in treatment. If that is not occurring, it is expected that barriers to parent training are removed, such as time of day, location, etc. If, after multiple documented attempts, one parent is not engaged in parent training, documentation should include why, potential impacts, and how potential impacts are being mitigated.
What is the difference between parent training and supervision?
Supervision is billed for the supervision of paraprofessionals. A paraprofessional is anyone who is not a BCBA® or a licensed mental health clinician such as a Psychologist or Social Worker. The exception to this is a BSL/BSC for certain cases in the state of Pennsylvania. To determine which cases, please talk to the Autism Care Advocate/Navigator. Caregiver training is billed when providing direct services to the parents.
Is Skype or other tele-supervision services allowed?
In order to be eligible to provide ABA remote supervision via videoconferencing technology you must do the following: P Complete the Autism/ABA Remote Supervision Compliance Attestation form and fax it to your Regional ABA Network Manager. (See ABA Remote Supervision process for commercial member’s link on Autism Corner.) P Ensure that your videoconferencing technology is HIPAA compliant* and meets current American Telemedicine Association minimum standards. P After you receive approval from your Regional ABA Network Manager, youmust indicate on each applicable treatment plan that ABA remote supervision will be utilized. P The code to utilize when billing remote supervision isH0032. ∗ Please Note: Skype is not an acceptable HIPAA technology.
What if more services are needed during a current approval period?
If you need additional approvals, please call the ABA/Autism team and provide clinical rationale during that discussion as to why you need more services than were previously approved.
Insurance Providers We accept
- BCBS NV
- Health Plan of Nevada
- Sierra Health and Life
- United Health Care
- Teacher’s Health Trust