Applied Behavior Analysis (ABA) Manual Updates (IB 24-13)

Date: 05/06/24

Louisiana Healthcare Connections is sharing with providers an update to the Applied Behavior Analysis (ABA) Manual issued on May 6, 2024. 

The Louisiana Department of Health (LDH) has expanded the definition of Qualified Health Care Professionals (QHCP) and is now allowing “A Pediatrician under a joint work agreement with an interdisciplinary team of providers who are qualified to diagnose developmental disabilities” to complete Comprehensive Diagnostic Evaluations (CDE).

LDH has also published new guidelines for the number of technicians and Certified Assistant Behavior Analysts (CaBA) a supervising licensed professional should work with per day. The number cannot exceed 24 beneficiaries per day. This language should reduce unnecessary initiations of fraud and abuse inquiries due to the large number of hours billed daily by the licensed provider.

In regard to a large volume of claims being billed under the supervising licensed provider, please note that CPT code 97153 “is used for patients with developmental disabilities or maladaptive behavior that affect their social skills and communication. The treatment is administered by a technician under the direction of a physician or other QHCP, face-to-face with one patient, every 15 minutes,” CPT 2024 p.846.

97153 is defined by the CPT as being performed by a technician under the supervision of the Board Certified Behavior Analyst (BCBA) billing provider or QHCP). Persons reviewing claims should expect to see multiple claims lines for different beneficiaries on the same day billed under one provider.

LDH has also made changes to the telehealth section. References to new and established patients have been removed. To provide ABA via telehealth, there must be an approved Behavior Treatment Plan that indicates telehealth is being used and the same standard of care can be met via telehealth.

All above changes have been updated in the ABA Manual, available online at https://www.lamedicaid.com/provweb1/providermanuals/manuals/ABA/ABA.pdf.
Each managed care organization (MCO) must update their system to reflect the changes above within 60 days of this notification. The updates not requiring a systems change must be implemented effective May 10, 2024.

Questions regarding these changes should be directed to René Huff at rene.huff@la.gov or at 225-892-7532.