AUTISM SPECTRUM DISORDER (ASD) / APPLIED BEHAVIOR ANALYSIS (ABA)
Autism Spectrum Disorder (ASD) is a life-long neurological disability that is characterized by significant social-communication and behavioral deficits. The severity of this disorder can vary greatly from one individual to another. The term "spectrum" refers to this range of social-communication and behavioral deficits. The intent of the Autism Benefit package is to optimize the social, emotion, and communication skills (verbally or non-verbally) and appropriate behavior in a variety of settings. Applied Behavior Analysis (ABA) is the approved Autism Benefit Medicaid service. Children enrolled in the Autism Benefit are also eligible for any medically necessary services provided by the Managed Specialty Supports and Services Plan under the authority of Section 1915(b) of the Social Security Act (the b-Waiver, b-3x, or b-3 services).
The Autism Benefit provides children and individuals under 21 years of age, who have a medical diagnosis of ASD with ABA services. ABA is the science of analyzing and improving socially significant human behavior. ABA focuses on increasing: language skills, social skills, communication skills, following instructions, peer interactions, academic/cognitive skills, following typical daycare/classroom routines, and self-help and daily living skills.
Step 1: Screen for ASD:
- Modified Checklist for Autism in Toddlers Revised (M-CHAT-R)
- Social Communication Questionnaire (SCQ)
Step 2: Diagnostic Evaluations to verify the child has ASD.
- Autism Diagnostic Observation Schedule-2 (ADOS-2)
- An adaptive measure, the Vineland Adaptive Scales of Behavior – II (VABS-II)
- A cognitive measure, the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV) or the Mullen Scales of Early Learning (MSEL)
- Autism Diagnostic Observation Schedule-2 (ADOS-2)
- A developmental family history interview like the Autism Diagnostic Interview-Revised (ADI-R) or other similar tool
- Clinical Global Impression Severity Scale
- Wechler Intelligence Scale for Children (WISC-V)
- Wechler Intelligence Scale for Children –IV (WISC-IV)
- Differential Ability Scales – II (DAS-II)
- Adaptive Behavior Assessment System – III (ABAS-III)
- Diagnostic Adaptive Behavior Scale (DABS)
Assess the strengths of the child and develop IPOS and goals the child will focus on during the ABA services with the family and team.
- ABA Treatment Plan developed annually; reviewed quarterly
- Skills Assessments (Assessment of Basic Language and Learning or VB-MAPP); updated semi-annually
- An Annual re-evaluation by a qualified licensed practitioner to assess eligibility criteria and/or to assess appropriateness for continuation in the program must be conducted through direction observation utilizing the ADOS-2 and symptoms rated using the Clinical Global Impression Severity Scale. Other tools may include cognitive/developmental tests, adaptive behavior tests, and/or symptom monitoring.
Begin ABA services with ABA behavior technicians work 1:1 with the child in a variety of settings – home, daycare center, or community to work on goals outlined in the child’s plan.
- Services are supervised by a Behavioral Analyst who is either a Board Certified Behavior Analysts (BCBA) QBHP, or BCaBA
- Behavior Technicians are trained in ABA principles and on the IPOS and ABA Treatment Plan
By qualifying for the Autism Benefit, the child may also be eligible for additional services such as: Speech Therapy, Occupational Therapy, Respite, Family Training, Community Living Supports, and Physical Therapy.
Comprehensive Behavioral Intervention services typically involve an average of 16-25 hours per week (actual hours as determined by a behavior intervention plan and interventions required and family choice of schedule).
Focused Behavioral Intervention services typically involve an average of 5-15 hours (actual hours as determined by a behavior intervention plan and interventions required and family choice of schedule).
Exit Criteria (will need to meet at least one of the following criteria):
- The child has achieved treatment goals and less intensive modes of services are medically necessary and appropriate.
- The child is either no longer eligible for Medicaid or is no longer a State of Michigan resident.
- The child no longer meets the eligibility criteria as evidenced by use of valid evaluation tools administered by a qualified licensed practitioner.
- The child has not demonstrated measurable improvement and progress toward goals, and the predicted outcomes as evidenced by lack of generalization of adaptive behaviors across different settings where the benefits of the BHT interventions are not able to be maintained or they are not replicable beyond the BHT treatment sessions through a period of six months. The child and/or parent/guardian is not able to meaningfully participate in BHT services, and does not follow through with treatment recommendations to a degree that compromises the potential effectiveness and outcome of the BHT services.
- Targeted behaviors and symptoms are becoming persistently worse with BHT treatment over time or with successive authorizations.
- The child and/or parent/guardian is not able to meaningfully participate in BHT services, and does not follow through with treatment recommendations to a degree that compromises the potential effectiveness and outcome of the BHT services.
- Child or Individual reaches the age of 21.
An exit administration of the ADOS-II is completed whenever possible to children aging out of the program or terminating Autism services. The exit ADOS-II is completed prior to the child’s 21st birthday.
The Behavior Analyst will complete a Closing Report for each child who participated in the Autism Services program. The report will summarize the child’s progress and will include a transition plan with recommendations for any services needed going forward.