Article archive / March 1, 2014
Originally published: . Volume 5, No. 7. Source pages: 8.
The regular issue of the Louisiana Register posted an Emergency Rule regarding Applied Behavioral Analysis- Based Therapy Services in the Medicaid program, effective on February 1, 2014.
Also, another Emergency Rule, having to do with the topic was posted on the Register’s website, which is to be published in the next Register. The second Rule was effective February 22. Both are available in full at the Louisiana Register at http://www.doa.louisiana.gov/ osr/reg/register.htm
In the February 1 Rule, the Department of Health and Hospitals, Bureau of Health Services Financing and the Office for Citizens with Developmental Disabilities amends the provisions of the children’s choice waiver in order to provide for the allocation of waiver opportunities to Medicaid- eligible children identified in the Melanie Chisholm, et al vs. Kathy Kliebert class action litigation, referred to as Chisholm class members.
The Rule also notes that the action was taken as a temporary measure to ensure Chisholm class members would have access to ABA therapy services as soon as possible.
According to the Rule, those qualifying for ABA-based therapy services must meet several criteria. Among these, the individual must exhibit the excesses and/or deficits of behavior that interfere with home or community activities; be medically stable; be diagnosed by a qualified health care professional with a condition for which ABA- based therapy services are recognized as therapeutically appropriate; have a comprehensive diagnostic evaluation and a prescription for ABA-based therapy services.
Under a section on Covered Services and Limitations, the Rule notes that services must be provided directly or billed by behavior analysts licensed by the Louisiana Behavior Analyst Board.
Also the statement notes that services shall be based upon the individual needs of the child, and must give consideration to the child’s age, school attendance requirements, and other daily activities as documented in the treatment plan. The Rule notes that any services delivered by direct line staff must be under the supervision of a lead behavior therapist who is a Louisiana licensed behavior analyst.
Also, ABA-based therapy services shall be rendered in accordance with the individual’s treatment plan. The treatment plan shall identify long, intermediate, and short-term goals and objectives that are behaviorally defined and identify the criteria that will be used to measure achievement of behavior objectives, for example.
Also mentioned was that Licensed behavior analysts who render ABA-based therapy services shall meet the be licensed by the Louisiana Behavior Analyst Board, and Certified assistant behavior analyst that render ABA- based therapy services shall meet certain provider qualifications.
Reimbursement for ABA-based therapy services shall be based upon a percentage of the commercial rates for ABA- based therapy services in the state of Louisiana. The rates are based upon 15-minute units of service, with the exception of mental health services plan which shall be reimbursed at an hourly fee rate, noted the statement.
The more recent Rule is published online at the Register. The Emergency Rule is to amend provisions for children’s choice waiver and to allow Medicaid participants to coordinate services through a direct support professional rather than a licensed enrolled provider agency, according to the announcement.
The Rule relates to the Medicaid eligible children identified in the Melanie Chisholm, et al vs. Kathy Kliebert class action litigation, and notes that this is an action being taken to comply the judgment.
The Rule adopts criteria for the provision of ABA services to Chisholm class members. Among other things, the statement defines who is qualified to receive services and how the children’s choice waiver is to work. It sets a cap on yearly services of $16,410 but notes that the capped amount shall not apply to ABA services provided to persons entering the waiver under the reserved slots for Chisholm class members.
The Rule also outlines provider qualifications and enrollment. In this more recent Rule, providers who may qualify include board- certified behavior analysts, licensed psychologists, licensed clinical social worker, licensed professional counselor, licensed marriage and family therapist, licensed addiction counselor, or advanced practice registered nurse, with coursework that includes, at a minimum, 40 hours of coursework in behavior analysis, behavior management theory, techniques, interventions and ethics, and autism spectrum disorders.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.