Standards of care

 

What to expect from my Applied Behavior Analysis (ABA) provider

Good ABA practices:

  • Initial assessments and reassessments
  • Development of a treatment plan
  • One-on-one ABA services
  • Training of immediate family members on ABA
  • Modifications based on the progress of treatment plan goals, outcome measures and parent engagement

Red flags:

  • Using punishment (such as yelling at or hitting your child)
  • Offering general treatment recommendations without a personalized assessment
  • Lack of data showing progress
  • Lack of maintenance and generalization

If you are concerned that your Board Certified Behavior Analyst (BCBA) may have violated one or more of the Behavior Analyst Certification Board's (BACB) ethics requirements, you can report your issue of concern to the BACB's Ethics Department.

Exclusions

  • ABA services for any other diagnoses other than Autism Spectrum Disorder (ASD)
  • ABA services are not covered for symptoms and/or behaviors that are not part of the core symptoms of ASD (i.e., impulsivity due to Attention-Deficit/Hyperactivity Disorder (ADHD), reading difficulties due to learning disability, excessive worry due to anxiety disorder, etc.)
  • Educational/academic and vocational goals
  • ABA services are not authorized in the school setting as a shadow, aid or support to the beneficiary
    • ABA services in the school setting are limited to the role of the BCBA who is targeting a specific behavior excess or deficit and is for a limited duration
    • Any ABA services requested for the school setting must be specifically pre-authorized in the treatment plan for use in the school setting
  • Billing for school tuition
  • Rendering or billing for any two ABA providers at the same time
  • Rendering or billing for custodial care, personal care and/or child care
  • Billing for ABA services while the beneficiary is at another medical appointment to include another family member’s appointment
  • ABA goals targeting Activities of Daily Living (ADL) (principles of ABA such as chaining, schedules of reinforcement, task analysis may be taught during parent training sessions)
  • Billing of direct and indirect supervision of staff
  • Rendering or billing of any interventions considered psychotherapy to include cognitive behavior therapy, acceptance and commitment therapy, prolonged exposure, group psychotherapy
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Contact Humana Military's dedicated Autism Care Demonstration (ACD) team

Available Monday through Friday, 8 AM - 7 PM (ET)
Call
(866) 323-7155
Fax
(877) 378-2316 (Referrals)
(877) 200-0401 (ECHO support)