Family and Social Services Administration Insurance Coverage for ABA Therapy

Raising a child with autism spectrum disorder (ASD) can be both challenging and rewarding. Finding effective therapies, like applied behavior analysis (ABA), is crucial for their development. 

The Indiana Family and Social Services Administration (FSSA) offers coverage for ABA therapy, but navigating the system can be confusing. This guide simplifies the process, explaining eligibility requirements, coverage details, and steps to secure approval.

What is the Family and Social Services Administration (FSSA)?

FSSA oversees various programs designed to support the health and well-being of Indiana residents. This includes Medicaid services, which provide healthcare coverage for low-income individuals and families. FSSA's Medicaid programs are instrumental in ensuring access to essential healthcare services, including ABA therapy for children with autism.

Coverage for ABA Therapy

ABA therapy is a well-established method for improving social, communication, and learning skills in children with ASD. Here’s how FSSA supports ABA therapy:

Eligibility Requirements:

  • Diagnosis: A formal diagnosis of ASD from a qualified healthcare provider is required to access ABA therapy.
  • Age Limit: Coverage is generally available for individuals under 21 years old, ensuring early and continuous intervention​.

Coverage Limits:

  • The extent of coverage varies based on the specific Medicaid plan. Typically, plans include a set number of therapy hours per week. The rate for services by a Registered Behavioral Technician (RBT) has been set at $68.24 per hour, and for a Board Certified Behavior Analyst (BCBA) at $110.52 per hour​.

Approval Process:

Prior Authorization: Obtaining prior authorization is essential before starting ABA therapy. This involves submitting a comprehensive treatment plan, including the diagnosis, treatment goals, and justification for the therapy’s medical necessity.

Continued Authorization: Ongoing therapy requires periodic reviews to maintain authorization, ensuring the therapy's effectiveness and tracking the child's progress​.

Provider Requirements:

Families must use state-approved providers, typically BCBAs or professionals with specialized ABA training, ensuring high-quality, standardized care​.

Additional Services Covered

FSSA's comprehensive coverage includes various other services beneficial for children with special healthcare needs, such as:

Behavioral Health Services

Counseling and psychiatric care to support mental and emotional well-being.

Speech and Occupational Therapy

These therapies help improve communication and motor skills.

Medical Equipment

Necessary devices like communication aids and other assistive technologies are covered​​.

How to Verify Coverage

To confirm your coverage for ABA therapy under FSSA, follow these steps:

Contact Member Services

Reach out to FSSA's member services for detailed information about your specific plan.

Review Policy Documents

Carefully review your insurance policy documents to understand the extent of coverage and any limitations.

Consult with Providers

Speak with approved ABA therapy providers to ensure they accept FSSA coverage and understand the coverage process.

Navigating the Approval Process

Securing prior authorization for ABA therapy involves several steps:

Consultation

Schedule a consultation with a qualified healthcare provider to diagnose ASD and recommend ABA therapy.

Documentation

Gather all necessary documentation, including the diagnosis, treatment plan, and medical necessity justification.

Submission 

Submit the required documents to FSSA for prior authorization.

Follow-Up

Stay in contact with your provider and FSSA to ensure all paperwork is processed and approved.

Tips for Navigating FSSA

Maximizing the benefits provided by FSSA can be straightforward with the right approach. Here are some tips to help you:

Stay Informed

Regularly check the FSSA website and consult with healthcare providers for updates on coverage and benefits. Staying informed helps you make the best decisions for your child’s care.

Maintain Detailed Records

Keep comprehensive documentation of your child’s diagnosis, treatment plans, and communications with healthcare providers. This can streamline the authorization process and ensure continuity of care.

Advocate for Your Child

Proactively seek necessary services and reach out to healthcare professionals or autism support organizations if you face challenges with coverage. Effective advocacy can help you secure necessary services for your child.

Conclusion

Understanding FSSA's coverage for ABA therapy equips you to advocate for your child's needs and unlock their potential. With this knowledge, you can navigate the system with confidence and secure vital support that can make a world of difference in their development. Remember, you are not alone on this journey. 

Reach out Step Ahead ABA today to schedule a consultation and embark on this transformative journey with your child.

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ABA impact: Real life success stories

Get a glimpse at the impact of ABA on our client’s lives, with
these genuine success stories shared by our proud team.

*All names have been changed to ensure client confidentiality.

"All year, Sophia* has been working towards integrating into the gen-ed class at school and the hard work has paid off! Next week, after spring break, she will be fully integrating all day!
But that’s not all. Sophia’s school goes on regular trips to the swimming pool and we have been working hard on swimming independently in a community pool (as opposed to at water parks, where Sophie is more confident). Yesterday she swam in the pool independently for the first time while telling herself she could do it and earned a strawberry ice cream afterward to celebrate!"

RBT - Indiana

“I’ve been working with Mia* for a year and a half. Mia had a good start to many skills but her challenging behaviors were getting in the way of her ability to be successful in a daycare environment. She often became upset and refused to follow instructions, even for activities she enjoyed. She would spend a lot of her day having tantrums and resist doing things she was asked, which made it difficult for her to interact with other children or make progress academically. After eighteen months of hard work from her whole team at Step Ahead, she was able to decrease challenging behaviors to near zero levels, successfully transition into a Kindergarten setting and make friends without requiring prompting. Mia did so well that we were able to completely transition her out of our services and she is now an independently successful Kindergartener!”

Regional Director - Indiana

“Liam* has made so much progress in his communication! When I first started he was only using physical gestures to express his needs. He is now independently using 2+ word requests in every session! His parents have also reported that he is using verbal requests independently, outside of session as well. I am so proud of Liam and how much progress he has made!”

RBT - North Carolina

“I’ve been working on eating a wider variety of foods with my kiddo, Logan, tolerating new foods and being okay with alternatives if a preferred food is not available. In the past, his caregivers dealt with tantrums that were hours long and Logan would refuse to eat if a preferred food wasn't available. The other day, when Logan asked for fries, his caregiver did an AMAZING job confidently offering alternatives- "You can have salad or rice". Logan chose rice and ate all of what was served to him!
Recently, he’ll even prepare non-preferred food items that we’ve been working on, so when I arrive he can show them to me. He points to it and says "Eat! Good!" while giving me a thumbs up.”

Lead RBT - Nebraska

“We’ve been working with Ava* for 3 months now and at my parent meeting last week, Mom and Dad stated that they are so happy with our services and the progress Ava has made. When we first started, she had little functional communication skills and she now asks to be played with, requests to stop an activity, and asks for more time! Ava’s parents are so happy with her progress that they want her sibling to receive in-home therapy too.”

BCBA - Oklahoma

Put your child on the path to progress.