Managed Health Services Insurance Coverage for ABA Therapy

Applied behavior analysis (ABA) therapy is a widely recognized treatment for children with autism spectrum disorder (ASD). Families often need to understand their insurance coverage for this essential therapy. Managed Health Services (MHS), a provider offering various health plans, does cover ABA therapy under specific conditions. Here’s what you need to know.

Understanding Managed Health Services (MHS)

Managed Health Services (MHS) is a health insurance provider in Indiana that offers a range of health plans, including Medicaid services. MHS is dedicated to providing comprehensive health coverage to its members, with a strong focus on quality care and access to necessary medical services. MHS operates in several states, with extensive services in Indiana, among others.

Coverage for ABA Therapy 

Eligibility Requirements

To qualify for ABA therapy coverage under MHS, the following criteria must be met:

  • Diagnosis: A formal diagnosis of ASD from a qualified healthcare professional, such as a psychologist or psychiatrist, is required.
  • Treatment Plan: The diagnosis must be accompanied by a detailed treatment plan outlining the necessity of ABA therapy. This plan must be approved by MHS.

Coverage Limits

MHS covers ABA therapy, but there are specific limits to the coverage:

  • Session Limits: There may be a cap on the number of therapy sessions or hours covered per week or month. For example, some plans might limit coverage to a specific number of hours annually.

Approval Process

Obtaining coverage for ABA therapy involves several steps:

  1. Prior Authorization: Before starting ABA therapy, prior authorization from MHS is required. This involves submitting a comprehensive treatment plan, including diagnosis, treatment goals, and justification for the therapy’s medical necessity.
  2. Continued Authorization: Ongoing therapy requires periodic reviews to maintain authorization. These reviews ensure the therapy is effective and track the child's progress.

Tips for Maximizing Your Coverage

Navigating insurance coverage can be complex, but these tips can help you make the most of your MHS benefits:

Understand Your Policy

Familiarize yourself with the terms of your insurance policy, including deductibles, copayments, and coverage limits. Knowing these details will help you manage your financial responsibilities.

Stay In-Network

Using in-network providers can reduce out-of-pocket costs. Ensure your ABA therapy provider is contracted with MHS.

Keep Detailed Records

Maintain comprehensive documentation of your child’s diagnosis, treatment plans, and progress reports. This information is crucial for obtaining and maintaining coverage.

Utilize the Appeals Process 

If your coverage request is denied, use the appeals process provided by MHS. Gather additional supporting documentation and follow the instructions for submitting an appeal.

Conclusion

Navigating the insurance landscape for ABA therapy can be complex, but understanding Managed Health Services (MHS) coverage options ensures your child receives the necessary support. Being informed about eligibility requirements, coverage limits, and the approval process helps you effectively manage your child's ABA therapy needs.

At Step Ahead ABA, we prioritize fostering a positive and supportive environment where your child can learn, grow, and reach their full potential. Reach out to our representative today.

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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.