You must have a diagnosis of Autism (299.00) from a physician. This diagnosis includes Aspergers Disorder, Pervasive Developmental Disability (PDD) or Autistic Disorder.
Call your insurance company and ask if ABA (Applied Behavior Analysis) behavior services are covered under your plan.
NOTE: If your plan covers state and federal mandates then it should cover ABA Applied Behavior Analysis) behavioral services. However, if you have an ERISA policy, they are not required to follow state and federal mandates. On many occasions, if you ask your human resources department and show them your need for these services, they can add this service to your policy.
Once you determine that you have the coverage, please be sure to download this form where you will provide patient information. Also, follow up with a call to Autism Spectrum Mandate Services (ASMS) at 609.953.5793.
Within 48 hours, you will receive a call from Autism Spectrum Mandate Services (ASMS) in order to schedule a two-hour consultation/intake with a Board Certified Behavior Analyst (BCBA). Prior to this call, ASMS will call your insurance company in order to get authorization to do the intake and initial assessment. We also ask that you complete this Insurance Information form.
The initial assessment can be four to eight hours, (2-3 visits) depending on the insurance company. During this initial assessment, a Board Certified Behavior Analyst (BCBA) conducts the Vineland Adaptive Behavior Scales, Second addition (Vineland-II) assessment (an oral questionnaire with caregiver), the Autism Treatment Evaluation Checklist (ATEC) (checklist completed by caregiver) and an Functional Behavior Assessment (FBA) caregiver interview. Following these assessments, a treatment plan is developed and sent to the insurance company for approval.
During the first one to three months (based on the frequency of services), an ABA therapist comes out to “pair” with the child and also to collect behavior data for the FBA. A BCBA also comes out to the home to supervise the therapist and to administer portions of the Assessment of Basic Language and Learning Skills (ABLLS), Verbal Behavior Milestone Assessment and Placement Program (VB-MAPP) and/or Assessment of Functional Living Skills (AFLS) assessment.
Once the FBA and curricular assessments are completed, a Natural Environment Training (NET) program and Intensive Teaching at the Table (ITT) program along with a behavior intervention plan (BIP) is developed for the child or adolescent. As the individual masters programs, training is provided to the caregivers and new goals are developed.
The continuation of these services is determined by the child’s needs, progress and insurance plan.