UM Guidelines

Evaluation / Assessment for Applied Behavior Analysis - For BlueCare Use Only

Line of Business Specific Guidelines - Behavioral Health

BCBST last reviewed June 10, 2021*

Added Clinical Indications for Procedure:
   
 
  • Evaluation for Applied Behavioral Analysis (ABA) therapy is appropriate if ALL of the following are met[A]:
    • Diagnosis of Autism Spectrum Disorder, diagnoses associated with Traumatic Brain Injury, and/or Intellectual disability disorder using one or more validated assessment tools.
    • There are symptoms or behaviors that are preventing the individual from adequately participating in age appropriate home, school or community activities or there are symptoms or behaviors that are presenting a safety risk to self, others or property.
    • Severity assessment of symptoms has been performed within the last 6 months.
    • Evaluation for services will be done on a 1:1 basis between the qualified practitioner and the individual member and/or caregiver.
    • Less intensive behavior therapy or medical treatment has not been sufficient to reduce interfering behavior, to increase pro-social behavior or to maintain desired behaviors.

 

Footnotes

[A] The assessment is required prior to receiving ABA Therapy.

References

  1. American Academy of Child and Adolescent Psychiatry. Committee on Quality Issues. (2014, February). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53 (2), 237-257.
  2. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). (February, 2014). Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. Retrieved April 20, 2016 from the National Guideline Clearinghouse (NGC: 010489).

 

 

 

 

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