Autism Spectrum Disorder
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 ABA services to individuals under age 21 who have a medical diagnosis of ASD. Applied Behavior Analysis is an evidence-based practice to increase positive behaviors and replace challenging behaviors with functional skills. ABA interventions include:
- Reinforcement and adapting environments to increase communication
- Building motivation and imitation to participate and follow directions
- Encouraging social skills, self-management, and independent daily living skills
- Practice tolerating changes, “no,” waiting, sharing, and other rigid behaviors
Step 1: Screen for ASD:
- Modified Checklist for Autism in Toddlers Revised (M-CHAT-R)
- Social Communication Questionnaire (SCQ)
Step 2: Some Diagnostic Evaluations to verify the child has ASD include:
- 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)
- A developmental family history interview like the Autism Diagnostic Interview-Revised (ADI-R) or other similar tool
- Developmental Disabilities-Children’s Global Assessment Scale (DD-CGAS)
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.
ABA services may begin with family training provided by behavior analysts to teach caregivers tools to increase language, set up the environment for success, use requests and responses in ways that lead to desired behavior, and encourage independent use of daily living skills. Behavior technicians trained in ABA principles and on the individual IPOS and ABA Treatment Plan work directly with the individual in a center, home, or other community settings to implement the ABA interventions. Behavioral Analysts regularly supervise behavior techs, continually collect and analyze data to watch for progress or barriers, assess functions of behaviors and complete safety/crisis plans as needed.
- 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
The recommended service intensity, setting(s), and duration, based on clinical recommendations and medical necessity vary with each individual and reflect the goals of treatment, specific needs of the individual, and response to treatment. ABA interventions may reinforce and generalize skills taught in school, therapy, or other settings, but do not replace education-based services.
Service hours, determined by the team based on the planned interventions and family choice, is typically an average of 16-25 hours per week (Comprehensive Behavioral Intervention) or 5-15 hours per week (Focused Behavioral Intervention).
Exit Criteria (will need to meet at least one of the following criteria):
- The individual has achieved treatment goals and less intensive modes of services are medically necessary and/or appropriate.
- The individual is either no longer eligible for Medicaid or is no longer a State of Michigan resident.
- The individual, family, or authorized representative(s) is interested in discontinuing services.
- The individual has not demonstrated measureable improvement and progress toward goals, and the predicted outcomes as evidenced by a 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 the successive authorization periods.
- Targeted behaviors and symptoms are becoming persistently worse with BHT treatment over time or with successive authorizations.
- The services are no longer medically necessary, as evidenced by use of valid evaluation tools administered by a qualified licensed practitioner.
- The provider and/or individual/family/authorized representative(s) are unable to reconcile important issues in treatment planning and service delivery to a degree that compromises the potential effectiveness and outcome of the BHT service.
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.