Updated State Plan Amendment for Applied Behavioral Analysis therapy services
Updated Feb. 14, 2025
Based on feedback from stakeholders and in working with legislators, the Indiana Family and Social Services Administration has updated its State Plan Amendment regarding Applied Behavioral Analysis therapy. The following limitations will go into effect April 1, pending Centers for Medicare and Medicaid Services approval.
Weekly Limitation on Services
- For individuals diagnosed with ASD Level 1 – Not more than 30 hours per week
- For individuals diagnosed with ASD Level 2 – Not more than 32 hours per week OR the number of hours prescribed by the recipient’s health care provider
- For individuals diagnosed with ASD Level 3 – Not more than 38 hours per week OR the number of hours prescribed by the recipient’s health care provider
- For individuals not diagnosed with ASD, but have a documented disability for which ABA therapy is deemed medically necessary – Not more than 38 hours per week OR the number of hours prescribed by the recipient’s health care provider
Lifetime Limitation on Services
- For all individuals – Not more than 36 months of comprehensive ABA therapy
- For purposes of calculating the length of time in treatment, the time starts on the effective date of the SPA (i.e., regardless of the number of months that an individual has already received ABA therapy, the individual will be able to continue services at least until 4/1/2028)
- Following the 3-year limitation, individuals may still qualify for limited hour, behavior specific, focused ABA based on medical necessity.
We will continue to require prior authorization for services. Prior authorization with peer review may be required for individuals that require services for 2 years or more.