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2018-01: ABA Authorization Form

Date: 01/04/18

Louisiana Healthcare Connections is committed to engaging your patients – our members – in the best, most appropriate treatment, in the right amounts, and at the right time, to achieve the highest functional outcomes. As part of that commitment, effective February 1, 2018, providers requesting Applied Behavioral Analysis (ABA) services for their patients – our members – will be required to complete and submit an ABA Authorization Form.

Louisiana Healthcare Connections will authorize medically necessary ABA services provided in a focused or comprehensive manner. Optimal treatment duration will vary, but generally, total interventions (focused and comprehensive) should be 2-3 years or less of care.

The ABA Authorization Form is located on the Louisiana Healthcare Connections website: www.lahealth.cc/abaauthorization

The ABA Authorization Form must be signed by the rendering provider and submitted via fax to Louisiana Healthcare Connections’ Behavioral Health Utilization Management Department at 1-844-466-1277.

Eligibility requirements for ABA services are as follows:

  • The time period may not exceed 180 days.
  • The minimum medical necessity criteria must be met.

Minimum medical necessity criteria are as follows:

  1. Member under 21 years of age
  2. Member exhibits and or deficits of behaviors that significantly interfere with home or community activities (e.g., aggression, self-injury, elopement, etc.)
  3. Member is diagnosed with a condition for which ABA-based therapy services are therapeutically appropriate
  4. Member has a CDE by a qualified healthcare professional
  5. Member has been prescribed ABA-based therapy services by a qualified healthcare professional whose recommendations for ABA services are included in the CDE
  6. There is a reasonable expectation that ABA services will result in measurable improvement
  7. Caregivers are able to participate and commit, if needed
  8. Member’s positive response to ABA services is evidenced by quantitative data assessed at least every 3 months

Please Note: When submitting the ABA Authorization Form, providers must include assessment and treatment information no older than 30 days. Information older than 30 days will be considered outdated and will not be accepted for review.

Please Note: Authorizations for service are issued for a provider group, but Louisiana Healthcare Connections requires one BCBA within the group to be responsible for the overall implementation of the member’s treatment plan.

Please Note: Louisiana Healthcare Connections will honor Molina Prior Authorizations (PAs) that are approved by Molina prior to February 1, 2018. Molina PAs in existence prior to Feb. 1, 2018, will be honored until they expire. PA information will be provided by Molina to Louisiana Healthcare Connections.

Please Note: In the event that a new Louisiana Healthcare Connections member is receiving medically necessary covered services at the time of enrollment, Louisiana Healthcare Connections will honor a transition period for continuation/coordination of those services for up to 90 days, or until the member may be reasonably transferred without disruption, whichever is less. PA may be required for continuation of select services as noted on the PA list beyond 30 days. Louisiana Healthcare Connections will allow continuation of such medically necessary services without any form of prior approval and without regard for whether such services are being provided by contract or non-contract providers during the transition period.