Changes to Applied Behavioral Analysis Provider Credentialing Requirements
As part of the ongoing effort to improve the quality and delivery of services for infants and toddlers with disabilities and payment process to providers through the Individuals with Disabilities Education Act (IDEA) Part C program, commonly known as “BabyNet,” the South Carolina Department of Health and Human Services (SCDHHS) is integrating IDEA Part C and Healthy Connections Medicaid policies. SCDHHS is informing the provider and beneficiary community about all actions necessary to implement this realignment through a series of alerts and bulletins. This bulletin announces changes to credentialing requirements for IDEA Part C providers who render Applied Behavioral Analysis (ABA) therapy pursuant to an approved Individualized Family Service Plan (IFSP).
Effective Oct. 1, 2019, ABA providers within the IDEA Part C network, including supervisory and direct therapy providers, must meet the provider qualifications specified in the Autism Spectrum Disorder (ASD) Medicaid State Plan, which is available on SCDHHS’ website. Requiring ABA providers to credential with the Behavioral Analyst Certification Board (BACB) aligns IDEA Part C provider qualifications with Healthy Connections Medicaid qualifications and current industry standards. Families electing to receive services from non-credentialed providers may continue to do so; however, SCDHHS will no longer reimburse for them for dates of service after and including Oct. 1, 2019.
If an ABA provider employs non-credentialed staff, they must contact service coordinators to make sure children who are covered by Healthy Connections Medicaid, including IDEA Part C, are receiving services from appropriately credentialed staff. Service coordinators serving children who need to transition to a different provider should contact Gail Shelley at Joyce.Shelley@scdhhs.gov to begin transitioning the child to a provider who meets the credentialing standards.
A link to the state plan may be found here: https://msp.scdhhs.gov/autism/
A link to the ASD provider manual may be found here: https://scdhhs.gov/provider-type/autism-spectrum-disorder-asd-services-manual-070119-edition-posted-070119
Non-credentialed providers can learn more about BACB credentialing on the BACB website. An overview of BACB credentialing levels is also available in the table below.
Provider Qualification Table
| Credential | Provider Qualifications |
|---|---|
| Board Certified Behavior Analyst-Doctorate (BCBA-D) | BCBA-D is the doctoral designation for a Board Certified Behavior Analyst (BCBA) with doctoral training in behavior analysis. BCBAs supervise the work of Board Certified Assistant Behavior Analysts (BCaBA), Registered Behavior Technicians (RBT) and others who implement behavior-analytic interventions. |
| BCBA | A BCBA has a graduate-level certification in behavior analysis. BCBAs supervise the work of BCaBAs, RBTs and others who implement behavior-analytic interventions. |
| BCaBA | A BCaBA has an undergraduate-level certification in behavior analysis. BCaBAs must be supervised by someone certified at the BCBA-D or BCBA level. BCaBAs can supervise the work of RBTs and others who implement behavior-analytic interventions. |
| RBT | A RBT is a paraprofessional who practices under the supervision of a BCBA-D, BCBA or BCaBA. The RBT is primarily responsible for the direct implementation of behavior-analytic services. The individual supervising the RBT is responsible for the work performed by the RBT. An RBT must be 18 years of age or older, possess a minimum of a high school diploma or national equivalent, complete 40 hours of training, pass the RBT Competency Assessment and pass the RBT exam. |
In addition to the changes in the provider qualifications, SCDHHS has also aligned all BabyNet services to ASD services currently covered in Medicaid. Please see the table below for a comparison.
Current Procedural Terminology (CPT) to 2019 Code Comparison Table
| SERVICE NAME | Old CPT Code | Current 2019 Code | Attended By | UNIT FREQ. | FREQ. LIMITS | |
|---|---|---|---|---|---|---|
Screening and Assessment Services | ||||||
Behavior Identification Assessment
| 0359T | 97151 | BCBA-D BCBA BCaBA | 1 unit = 15 minutes | 32 units annually | |
ASD Treatment Services | ||||||
| Adaptive Behavior Treatment by Protocol | 0364T 0365T | 97153 | BCBA-D BCBA BCaBA RBT* *RBTs must bill under a BCBA-D, BCBA or BCaBA. | 1 unit = 15 minutes | 160 units per week | |
| Adaptive Behavior Treatment with Protocol Modification | 0368T 0369T | 97155 | BCBA-D BCBA BCaBA | 1 unit = 15 minutes | To be rendered at the rate of 10% of weekly therapy hours, up to 64 units per month | |
| Family Adaptive Behavior Treatment Guidance | 0370T | 97156 | BCBA-D BCBA BCaBA | 1 unit = 15 minutes | 48 units annually | |
Please contact Gail Shelley at Joyce.Shelley@scdhhs.gov or (803) 360-0643 if you have any questions regarding these changes.
Thank you for your continued support of the BabyNet program.