Just a reminder that OHPs coverage of Applied Behavior Analysis (ABA) starts January 1st. There will be NO specific hour, duration, visit or age limits due to mental health parity. The only limit is whats medically appropriate, as determined by doctors and providers who are experienced in autism, not insurance bean counters. Here are the steps for accessing ABA treatment: 1. Doctor or psychologist *experienced in diagnosis or treatment of autism*: a. Makes diagnosis of autism (OK if already have diagnosis): b. Makes determination that ABA treatment is medically appropriate - and - c. States that less intensive treatments have been considered (not necessarily tried). d. Makes referral to ABA provider 2. ABA provider completes an assessment and treatment plan 3. Treatment begins 4. Treatment reviewed every 6 months for reasonable progress towards stated goals. I cant stress enough the following: 1. OHP is clearly serious about providing this coverage. They arent looking for ways not to provide coverage. Its a refreshing change. But, this is a new program so expect that it will not go smoothly. Stay calm, keep good notes, remain polite and be persistent! If you need help, please contact ASO and well do our best. 2. There are nowhere near enough ABA providers in the state for the expected numbers of people who will want ABA therapy. Its a huge concern, but there are groups coming into Oregon (primarily Portland but were encouraging them to branch out) and training programs. Demand will drive supply, but its going to take time. 3. ABA therapy is not appropriate for everyone on the autism spectrum, and everyone on the autism spectrum is unique. Do the research about ABA, talk to your doctor and other providers, and determine if this might be useful in your specific case. With those caveats, this is an exciting development in Oregon! Between this and the K Plan, Oregon has made tremendous strides in autism services in just two years (after years and years of effort).
Posted on: Thu, 01 Jan 2015 00:18:01 +0000
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