Medicaid Update Effective January 1, 2023 – Coverage of Applied Behavior Analysis Services
11/16/2022
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Posted by Provider Relations
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Provider News
Effective January 1, 2023, Applied Behavior Analysis (ABA) services provided by Licensed Behavior Analyst (LBA), Certified Behavior Analyst Assistant (CBAA) working under the supervision of LBAs, or other individuals specified under Article 167 of NYS education law, will be included in the Fidelis Care benefit package for eligible children/youth under age 21 with a diagnosis of autism spectrum disorder and/or Rett Syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
ABA Services
Definition of ABA
ABA is the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relationship between environment and behavior.
Impacted Members
For eligible children/youth under age 21 with a diagnosis of autism spectrum disorder and/or Rett Syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Type of Providers that can render services.
Applied Behavior Analysis (ABA) services provided by Licensed Behavior Analyst (LBA), Certified Behavior Analyst Assistant (CBAA) working under the supervision of LBAs, or other individuals specified under Article 167 of NYS education law, will be included.
Additional information can be found in the October 2022 Medicaid Update.
If you have any further questions, contact your Fidelis Care Provider Relations Specialist or email the NYS Department of Health at: omcmail@health.ny.gov.