Arkansas Autism Waiver
The Arkansas Autism Partnership is designed to provide early, intensive intervention for children diagnosed with autism. Children must be between the ages of 18 months and five years old and (must enter the program before their 5th birthday but can continue to receive services up to their 7th birthday). Children must also meet the financial and level of care eligibility requirements. This is a statewide program offering one to one intervention in the home for 20 to 30 hours per week. This program is designed to improve the child’s skills in the areas of communication, socialization, self- care and behavior. Parental participation is necessary.
- We provide one on one, intensive early intervention treatment for individuals diagnosed with Autism Spectrum Disorders ages 18 months to 7 years old. Individuals must enter the program on or before their 5th birthday in order to be eligible. Autism waiver participants must meet the ICF/MR level of care.
- We provide a team of professionals dedicated to providing quality evidence-based programs to children on the Autism spectrum and their families.
- All services are individualized to meet the unique needs of each child. Parent education and involvement is encouraged.
Applied Behavior Analysis (ABA) services:
The Behavior Analyst Certification Board (BACB) defines ABA as “a systematic approach for influencing socially important behavior through the identification of reliably related environmental variables and the production of behavior change techniques that make use of those findings” (bacb.com). If you aren’t familiar with ABA or how it works/who provides this service, you can find more information at the following website: https://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba
Coverage for Applied Behavior Analysis:
Private Health Insurance – Many Arkansas families have private insurance coverage for autism diagnostic/treatment services, including ABA. To find out if your policy covers ABA contact your insurance company or benefits administrator.
Arkansas Medicaid – Currently ABA is not a covered service under Arkansas Medicaid. However, coverage may be granted on a case-by-case basis for individual children through a request for coverage of non-covered treatments under the Medicaid Early and Periodic Screening Diagnosis and Treatment or (EPSDT) program. EPSDT is a federally mandated child health component of Medicaid. It is designed to bring comprehensive health care to individuals eligible for medical assistance from birth until their 21st birthday. Under the Medicaid EPSDT program, when the need for a medically necessary treatment is identified through an EPSDT screening then it may be covered by Medicaid for that individual child. The request must be submitted by the child’s primary care physician (PCP) and must include the following information:
- Statement of need (provide information about symptoms that require treatment using ABA methodology)
- Completed EPSDT screening (more detailed information about required components of an EPSDT screening can be found at https://www.medicaid.state.ar.us/provider/docs/epsdt.aspx)
- Completed DMS-Form 693 for non-covered services — this must be completed by the Medicaid PCP
- Documentation of 3-prong diagnosis – physician, Speech-Language pathologist and Psychologist. Include a CARS or ADOS evaluation as part of the diagnostic documentation of disability
- Patient records indicating other treatment methodology did not ameliorate patient’s condition
- Any other medical records showing a need for services
The completed form and all other information must be sent by the child’s PCP to:
Attn: Kiral Gunter
Division of Medical Services/Utilization Review Unit/ Slot S413
700 Main Street
Little Rock, AR 72203-1437
- Once the application has been submitted to Medicaid, Medicaid will review the application packet to determine if it includes all information necessary for further approval
- If the packet does not include all necessary items, then it will be mailed to the child’s address along with a letter requesting the missing documentation.
- If the packet includes all necessary items, it will be forwarded to the medical necessity review team
- The medical necessity review team will either approve or deny the request
- If the request is approved, the family will be sent a letter stating that the request is approved and authorizing autism-specific Medicaid Services, along with contact information for an autism services intake specialist.
- The autism services intake specialist will schedule a home visit and parent interview with the family. At the home visit the family will be asked to select an approved provider agency to provide the autism services, including ABA.
- The provider agency will be responsible for the delivery of services.
- Families with private insurance coverage for ABA may be required to exhaust all ABA benefits before accessing coverage under EPSDT