Applied Behavior Analysis (ABA) – What you need to know about this member benefit
July 22, 2024
Parkland Community Health Plan offers Applied Behavior Analysis (ABA) services to HEALTHfirst (STAR Medicaid) members diagnosed with Autism Spectrum Disorder (ASD). This benefit is available through the Texas Health Steps-Comprehensive Care Program. See below for some common questions about these services.
What is Applied Behavior Analysis (ABA)?
ABA is a treatment that can improve social, communication, and self-regulation skills in patients with Autism Spectrum Disorder (ASD).
What is Autism Spectrum Disorder (ASD)?
ASD is a condition that includes limited, repeated patterns of behavior, along with gaps in communication and social interaction. Symptoms usually start in early childhood.
Who can diagnose ASD?
Per HHSC policy, the following provider types are approved to diagnose ASD:
- a developmental pediatrician
- a neurologist
- a psychiatrist
- a licensed psychologist
Who can qualify for ABA?
Children ages 0-20 who have been diagnosed with ASD may qualify for ABA.
- They must have been diagnosed with ASD in the last three years or have the ASD diagnosis re-confirmed within the last three years.
- They must meet other medical criteria to qualify for ABA as described in the HHSC policy.
What services are included?
ABA services include
- ABA evaluation
- individual or group treatment
- training for parents and caregivers
- meetings with your care team
Can my main doctor provide ABA services?
You cannot get ABA services through your primary care physician (PCP). However, your PCP may assist in referring to ABA services. Only qualified providers called Licensed Behavior Analysts (LBAs) can offer these services.
Do you need help finding an LBA? Call our Member Services department at 1-888-672-2277.
What are Licensed Behavior Analysts (LBA)?
Providers called Licensed Behavior Analysts (LBAs) offer ABA services for members who qualify. LBAs can also supervise Licensed Assistant Behavior Analysts (LaBAs) and/or Behavior Technicians (BTs) in providing certain ABA services.
How do I know if I need these services?
Please speak to your main doctor for more details or to see if you qualify.
How can this therapy help kids with ASD?
It can improve their social, communication, and learning skills. The therapy involves treating behavior difficulties and teaching and enforcing new patterns of behavior. With this treatment, your child can learn the skills they need to function in daily life.
Is there any cost for using these services?
ABA services are available to Medicaid members at no extra cost.
Is this benefit covered under CHIP?
Right now, this benefit is available for HEALTHfirst (STAR Medicaid) members only.
Can my child get other medically necessary treatments for ASD while receiving ABA treatment?
Yes, they can continue to get other medically necessary treatments.
What is my role as a parent or caregiver during ABA treatment?
Parents and caregivers are an important part of ABA treatment. You can help kids use what they’ve learned in therapy to function at home and in public.
I still have questions about ABA coverage. How can I learn more?
- HEALTHfirst STAR Medicaid: 1-888-672-2277
