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ABA Update

Effective April 04/01/2022, All requests for the initial pre approval of Applied Behavior Analysis (ABA) Therapy Services “must” be submitted to Kepro through your eQSuite account. Providers who are not in active in our portal may submit a manual request by faxing the required documentation and a Manual case request form to 855-997-3707.

Requests for pre-approval of Applied Behavioral Analysis (ABA) Therapy generally originate from the child’s Primary Care Physician (PCP) or the child’s parent/guardian but may also come from other sources such as therapists and counselors.

The required information includes:

  • DMS-693 prescription specifying ABA therapy, signed, and dated by the Medicaid-assigned PCP
  • Most recent EPSDT screen notes and/or well-child visit (no older than one year)
  • Documentation of “2-prong ASD diagnosis” including

    A physician reports

    A psychological evaluation

    A speech-language evaluation

Upon receipt of this information, if approved, DDS will mail an ABA Therapy Pre-Approval Information Packet to the child’s parent/guardian. The packet contains a list of ABA Providers enrolled with Medicaid that shows the therapists’ coverage area. Parents/guardians are instructed to select an ABA provider and furnish them with a copy of the letter contained in the packet as well as any documentation they have on their child’s diagnosis of ASD.

User guide for submitting ABA requests to the eQSuite Portal can be found here.

EPSDT: Applied Behavior Analysis (ABA)

eQ Health Solutions, the QIO-like organization for the Arkansas Department of Human Services (DHS), provides utilization and quality control over per review for both Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefits of Applied Behavior Analysis (ABA) and Day Habilitation to qualifying Arkansas Medicaid beneficiaries.  These are services require a physician’s recommendation of medical necessity.  Kids on ARKids First B are not entitled to all the extended EPSDT benefits.

 

Request for ABA services

  1. All reviews require preapproval of the diagnosis of autism spectrum disorder
  2. All assessment and treatment prior authorization reviews are conducted by a Board-Certified Behavior analyst
  3. All requests are for 6 months duration
  4. If the PA request does not contain documentation clearly establishing that the requested services are medically necessary, the request will be reviewed either BCBA-D or a physician reviewer who will determine whether to enter a determination that some or all of the requested care is not medically necessary (adverse decision)
ABA Training Resources