Sunflower Health Plan Applied Behavioral Analysis (PDF) Form

Applied Behavior Analysis (ABA) is the application of behavioral principles to everyday situations, intended to increase skills or decrease targeted behaviors. ABA has been used to improve areas such as language, self-help, and play skills, as well as decrease behaviors such as aggression, self-stimulatory behaviors, and self-injury. For those with autism spectrum disorder (ASD), treatment may vary in terms of intensity and duration, complexity, and treatment goals. The extent of treatment provided can be characterized as focused or comprehensive. Focused ABA is direct care provided for a limited number of behavioral targets. Treatment ranges from 10 to 25 hours per week and is most appropriate for those who need treatment for only a limited number of key functional skills or have such acute problem behavior that its treatment should be the priority. Comprehensive ABA is for treatment of multiple affected developmental domains, such as cognitive, communicative, social, emotional, and adaptive functioning. Intensive treatment ranges from 30 to 40 hours per week (plus direct and indirect supervision and caregiver training) to increase the potential for behavior improvement.1 When applied to young children, ABA is also referred to as Early Intensive Behavior Intervention (EIBI) or Intensive Behavior Intervention (IBI).4 Centene will work with providers to implement best practices and standardization of outcome measures into the Applied Behavior Analysis treatment plan. Policy/Criteria I. It is the policy of Centene Advanced Behavioral Health and health plans affiliated with Centene Corporation® that when a covered benefit, Applied Behavior Analysis (ABA) services are medically necessary when meeting all the following (A-C, and service-specific criteria in D): A. The member/enrollee has a confirmed autism spectrum disorder (ASD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria or an appropriate diagnosis as otherwise specified according to state- defined ABA criteria; B. The ASD diagnosis, including severity level, is confirmed by one of the following screening tools: 1. Checklist for Autism in Toddlers (CHAT); 2. Modified Checklist for Autism in Toddlers/Modified Checklist for Autism in Toddlers, Revised with follow-up (M-CHAT/M-CHAT-R/F); 3. Screening Tool for Autism in Toddlers & Young Children (STAT); 4. Social Communication Questionnaire (SCQ); 5. Autism Spectrum Screening Questionnaire (ASSQ); 6. Childhood Autism Spectrum Test, formerly known as the Childhood CLINICAL POLICY Applied Behavior Analysis Asperger’s Syndrome Test (CAST); 7. Krug Asperger's Disorder Index (KADI); 8. Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule 2nd edition (ADOS/ADOS-2); 9. Autism Diagnostic Interview Revised (ADI-R); 10. Childhood Autism Rating Scale/ Childhood Autism Rating Scale 2nd edition (CARS/CARS-2); 11. Gilliam Autism Rating Scale (GARS-3); 12. Other valid form of approved evidence-based assessment result/summary; C. ABA is recommended by a physician, psychologist, social worker, or another appropriately licensed health care practitioner working within their scope of practice and who is qualified to diagnose ASD and recommend ABA; D. Requested service meets one of the following: 1. Behavioral assessment, completed prior to requesting treatment services, include both of the following: a. Documentation includes all the following: i. Past records; ii. Interviews; iii. Rating scales; iv. Direct observation; b. One or both of the following types of assessment is requested, depending on the member/enrollee’s noted areas of deficit: i. For a member/enrollee that exhibits problem behaviors that are disruptive and/or dangerous, one of the following: a) Functional behavioral assessment (FBA); b) Traditional functional analyses; c) Interview-Informed, Synthesized Contingency Analysis (IISCA); ii. Skill acquisition assessment, one of the following: a) Verbal Behavior Milestones and Assessment Placement Program (VB- MAPP); b) Assessment of Basic Language and Learning Skills-Revised (ABLLSR); c) Assessment of Functional Living Skills (AFLS); d) Promoting the Emergence of Advanced Knowledge Generalization (PEAK) Skills Assessment; 2. Initiation of ABA treatment, all the following: a. An ABA assessment was completed and contains all elements described in section I.D; b. A comprehensive treatment plan aligns with the results of the behavioral assessment and includes all of the following: i. Individualized goals with measurable targeted outcomes and timelines, (including transition/discharge planning), that are communicated with providers, the member/enrollee and family members, incorporating the following characteristics: a) Strengths-specific; b) Family-focused; c) Community-based; CLINICAL POLICY Applied Behavior Analysis d) Multi-system; e) Culturally competent; f) Least intrusive; ii. The number of service hours requested meets all the following: a) Is justified by the level of impairment calculated by the behavioral assessment, severity of symptoms, length of treatment history, and response to intervention; b) Incorporates direct and group supervision and care giver training; c) Considers the member/enrollee’s age, school attendance requirements, and other daily activities; d) Outlines hours of therapy per day with the goal of increasing or decreasing the intensity of therapy as the member/enrollee’s ability to tolerate and participate permits; e) Focused ABA treatment plan includes 10 to 25 hours per week or comprehensive ABA treatment plan includes 30 to 40 hours per week; iii. Parent or caregiver training that is performance based and caregiver-driven; iv. Documentation that ABA treatment will be delivered or supervised by an ABA credentialed professional and is consistent with ABA techniques (Note: Two hours of supervision per 10 hours of direct treatment is considered standard of care in most cases; two hours of supervision is required if direct treatment totals less than 10 hours per week); v. Documented coordination of care and communication regarding provider responsibilities with providers, the member/enrollee and family members; vi. Interventions focused on active core symptoms and emphasizing generalization and maintenance of skills in areas of need noted in the assessments, including interventions related to development of spontaneous social communication, adaptive skills, and appropriate behaviors; c. The member/enrollee exhibits behavior that presents as clinically significant to self or others, such as the following: i. Self-injury; ii. Aggression toward others; iii. Destruction of property; iv. Elopement; v. Severe disruptive behavior; vi. Significant interference with daily living in the home or community activities; d. The member/enrollee is medically stable and does not require 24 hour medical/nursing monitoring or procedures provided in a hospital level of care; e. ABA treatment is not requested for services that are otherwise covered under the Individuals with Disabilities Education Act (IDEA). Unless restricted within a state Medicaid benefit, ABA services can occur in coordination with school services and transition plans; f. ABA treatment is not requested to meet treatment goals more appropriately conducted in any of the following disciplines: i. Speech therapy; CLINICAL POLICY Applied Behavior Analysis ii. Occupational therapy; iii. Vocational rehabilitation; iv. Supportive respite care; v. Recreational therapy; vi. Orientation and mobility. 3. Continuation of ABA treatment, all the following: a. Criteria for initiation of services continues to be met; b. Assessments, evaluations, treatment plans, and documentation are current within each profession, licensure, and state standards and completed at a minimum of every six months during ABA treatment; c. There is a reasonable expectation, based on the member’s clinical history, that withdrawal of treatment will result in decompensation/loss of progress made, or recurrence of signs and symptoms; d. Discharge criteria has been reviewed and adjusted according to progress and indicates the point at which services are appropriate for discontinuation and/or transfer to alternative or less intrusive levels of care; e. ABA treatment is not making symptoms worse; f. ABA treatment is not requested for services otherwise covered under the Individuals with Disabilities Education Act (IDEA). Unless restricted within a state Medicaid benefit, ABA services can occur in coordination with school services and transition plans; g. ABA services do not have treatment goals that can more appropriately be conducted in any of these disciplines: i. Speech therapy; ii. Occupational therapy; iii. Vocational rehabilitation; iv. Supportive respite care; v. Recreational therapy; vi. Orientation and mobility; h. There is a reasonable expectation that the member/enrollee will benefit from the continuation of ABA services due to one of the following: i. Documented progress toward goals within six months from the last authorization (or less, as clinically appropriate, or as state mandated), as evident by mastery of skills defined in the initial treatment plan commensurate with level of care provided, and both of the following: a) New goals have been formulated based on targeted symptoms and behaviors; b) A transition plan contains less intensive interventions; ii. Documented limited progress toward goals within six months from the last authorization (or less as clinically appropriate, or as state mandated), both of the following: a) An updated assessment identifies determining factors that may be contributing to inadequate progress; b) Changes from the treatment plan in the prior authorization period include all the following: 1) Reevaluation of each treatment plan goal; CLINICAL POLICY Applied Behavior Analysis 2) Increased time and/or frequency working on targets; 3) Increased parent/caregiver training; 4) Identification and resolution of barriers to treatment effectiveness; 5) Any newly identified co-existing conditions; 6) Consideration of alternative treatment settings; 7) Evaluation for other services that may be helpful for added support: i) Speech therapy; ii) Occupational therapy; iii) Psychiatric evaluation; iv) Psychotherapy; v) Case management; vi) Family therapy; vii) Feeding therapy; viii) School based supports; i. Treatment plan includes the following: i. Interventions consistent with ABA techniques that align with the updated assessment; ii. Requested treatment hours meet all the following: a) Based on response to treatment and current needs; b) Necessary to effectively address the member’s skill deficits and behavior reduction goals; c) Consider the member’s age, school attendance requirements, and other daily activities when determining the number of hours for direct service, group and supervision hours; j. Qualitative and quantitative data are provided and meet the following: i. Gathered from ABA providers as well as from parents/guardians, teachers and other caregivers(such as speech therapists, occupational therapists; ii. Collected from multiple settings as applicable, such as in clinic, home and school; iii. Includes a description of the change over time on all behaviors and skills that are the focus of treatment; iv. Clearly documented and easily interpretable; k. Care coordination is occurring with applicable services, such as but not limited to: i. Speech therapy; ii. Occupational therapy; iii. Medication management; iv. School system supports; v. Inpatient admissions; vi. Other behavioral or physical health occurrences that may impact treatment. II. It is the policy of Centene Advanced Behavioral Health and affiliated health plans with Centene Corporation that when a covered benefit, Applied Behavior Analysis (ABA) CLINICAL POLICY Applied Behavior Analysis services may be appropriate for discontinuation and/or transfer to alternative or less intrusive levels of care when meeting all the following: a. Transition planning and discharge considerations are made with input from the entire care team; b. Discharge criteria is clearly defined and measurable; c. Services may be appropriate for discontinuation and/or transfer to alternative or less intrusive levels of care when any of the following are present: i. Member/ Enrollee no longer meets continued stay criteria and/or meets criteria for another level of care; ii. The individual treatment plan goals have been met; iii. The parent/guardian/caregiver can continue the behavioral interventions independently; iv. The parent/guardian withdraws consent for treatment; v. There is expected transition to the utilization of community resources for alternative treatment, specifically that of a school setting; vi. Documentation that there has been no clinically significant progress or measurable improvement towards treatment plan goals for a period of at least 6 months, and there is not a reasonable expectation that a revised treatment plan could lead to clinically significant progress. Background Applied Behavior Analysis (ABA) is the application of behavioral principles to everyday situations to increase skills or decrease targeted behaviors. Based in the science of behavior modification, ABA is the careful application of teaching strategies to promote learning. ABA targets socially significant behaviors, increases social skills, decreases behavioral excesses, and has been documented to be effective in many environments and circumstances. The goal of tailored treatment plans for those utilizing ABA services is to help increase socially adaptive skills and decrease challenging behaviors. Despite the value of ABA treatment, there is a significant gap in terms of measurement of success and fidelity to the model of care. Through standardization of criteria for initiation of treatment, continuation, and titration of services, and application of ABA therapies, better outcomes can be achieved. To help individuals reach their maximum potential, an improved, more robust industry standard should be implemented for the appropriate dosage, and intensity of treatment that goes beyond the current restrictive model tied to units of time. Industry adoption of evidence-based standards of care is essential. Quality and clinical progress for members/enrollees should be monitored regularly, and quantitative analyses of outcomes should be conducted. Further research needs to be done to determine the effectiveness of ABA at improving IQ, language skills, social skills, and adaptive behaviors, especially compared to other interventions. In addition, rigorous studies should examine which subgroups of children or adolescents with autism spectrum disorder (ASD) benefit the most from ABA. Numerous scientific studies have been conducted evaluating the effectiveness of ABA. The original and long-term follow-up study conducted by O. Ivar Lovaas reported improvements in cognitive function and behavior that were sustained for at least 5 years. Almost half of the ABA group passed normal first grade and had an intelligence quotient CLINICAL POLICY Applied Behavior Analysis (IQ) score that was at least average. The flaws in this study included: small sample size, non-randomization of patients to treatment groups, potential selection bias, and endpoints that may not meet current standards.4 More recent studies have reported effectiveness of ABA interventions in children with autism. A 2010 early intensive behavior intervention study utilized data from over 400 children with autism. For the study, “children were divided into one of three groups: those that had received behavioral intervention, those that had received another intervention of similar intensity, or to a control group where no specific intervention was provided.”24 The outcomes for the behavioral intervention group were significantly better showing gains in both IQ and ABC scores.24 Similarly, a smaller study examined the content of ABA therapy on skill acquisition and intelligence test scores of twenty-eight children with autism and related disabilities. The study examined three groups: a traditional ABA group utilizing verbal behavior techniques developed by Skinner , a comprehensive ABA which incorporated additional behavior techniques, and a control group not receiving ABA therapy. The results indicated that skill acquisition improved equally across both ABA intervention groups, with the comprehensive ABA group showing higher gains in intelligence scores.25 Multiple systematic reviews with meta-analyses have been conducted on ABA studies for ASD, with conflicting results. In 2008, Ospina and colleagues, systematically reviewed studies comparing behavioral and developmental interventions for ASD. The four randomized control trials (RCTs) reviewed that compared ABA to Developmental Individual-difference relationship- based intervention (DIR) or Integrative/Discrete trial combined with Treatment and Education of Autistic and related Communication Handicapped Children (TEACCH) found no significant difference in outcomes.9 Seven out of eight studies that reported significant improvements were not RCTs and have significant methodological limitations.9 Five other systematic reviews found that ABA was an effective intervention for ASD, but still noted the substantial limitations of included studies, which could affect meta- analysis results and the expected efficacy of ABA.3,20,7,15,18 Furthermore, Reichow et, al, conducted a systematic review of the RCTs, quasi- RCTs, and controlled clinical trials in the ABA literature, commenting that these were not of optimal design. The systematic review concluded that the evidence suggests ABA can lead to improvements in IQ, adaptive behavior, socialization, communication and daily living skills. However, they strongly caution that given the limited amount of reliable evidence, decisions about using ABA as an intervention for ASD should be made on a case-by-case basis.11 In contrast, Spreckley and Boyd state in their systematic review that children receiving high intensity ABA did not show significant improvement in cognitive functioning (IQ), receptive and expressive language, and adaptive behavior compared to lesser interventions including parenting training, parent- applied behavior intervention supervised weekly by a therapist, or interventions in the kindergarten.14 Screening Recommendations for Autism Spectrum Disorder (ASD) ASD screening is generally the first step in the diagnostic process. Screenings are typically performed by a general pediatrician but may also be performed by a child developmental- behavioral or neurodevelopmental pediatrician, child psychologist, or neurologist. The American CLINICAL POLICY Applied Behavior Analysis Academy of Pediatrics recommends routine developmental and ASD screenings in toddlers, noting ASD can be diagnosed in children as young as 18 months. Standardized autism specific screening test should occur in primary care setting at 18 and 24 months with ongoing developmental surveillance.27 ASD specific assessments can be used to identify core symptoms and signs of autism in a child presenting with symptoms of ASD. Some examples include: • Clinician-administered screening tests such as: o Modified Checklist for Autism in Toddlers (M-CHAT); o Screening Tool for Autism in Toddlers and Young Children (STAT); • Parent-completed questionnaires such as: Infant and Toddler Checklist,; o o Communication and Symbolic Behavior Scales Development Profile; o The Infant and Toddler Checklist. A comprehensive diagnostic evaluation is recommended for children who have been identified as at risk for ASD or who are presenting with key symptoms of ASD to identify diagnoses and recommendations more accurately for treatment including any other ancillary services. Best practice recommends updating testing every three years. Evaluations should be performed by a child developmental-behavioral or neurodevelopmental neurologist, child psychologist, or general neurologist. A standardized psychological assessment should include: • Interviews with the child, parent/guardian, and teachers/daycare workers to obtain a detailed history of the individual including but not limited to past and current: o Educational information o Behavioral interventions o Family history o Relevant psychosocial concerns • Observation of core symptoms of ASD including social interaction and repetitive, restrictive behaviors. Recommended diagnostic assessment tools: • Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) • Childhood Autism Rating Scale, Second Edition (CARS-2) • Autism Diagnostic Inventory-Revised (ADI-R) • Gilliam Autism Rating Scale (GARS-3) Recommended assessments and standardized test that provide a more in-depth probe into developmental challenges and assist in identifying strengths and weaknesses for the purpose of guiding treatment planning: • Cognitive ability/IQ (SB-5 Standford-Binet, WISC-V Wechsler Intelligence Scale for Children-5th edition, and Wechsler Preschool & Primary Scale of Intelligence 4th edition) • Adaptive skills (Vineland Adaptive Behavior Scales and the Adaptive Behavior Assessment System) CLINICAL POLICY Applied Behavior Analysis • Language/Communication to identify receptive and expressive abilities (Peabody Picture Vocabulary Test 4th edition and Expressive Vocabulary Test 2nd edition) Sensory Processing (Short Sensory Profile) • Differential Diagnosis: The comprehensive evaluation should help differentiate ASD from other conditions. All resulting diagnoses should be included in the diagnostic formulation and addressed as part of treatment recommendations. When a diagnosis of ASD is made, the diagnosis should include: • • • • • • Medical conditions; • Known genetic or environmental etiological factors. Severity rating; Course specifiers; Intellectual impairment; Language impairment; Catatonia; Coding Implications This clinical policy references Current Procedural Terminology (CPT®). CPT® is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2019, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from the current manuals and those included herein are not intended to be all-inclusive and are included for informational purposes only. Codes referenced in this clinical policy are for informational purposes only. Inclusion or exclusion of any codes does not guarantee coverage. Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services. CPT®* Codes 97151 97152 97153 97154 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician's or other qualified health care professional's time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non- face-to-face analyzing past data, scoring/ interpreting the assessment, and preparing the report/treatment plan Behavior identification-supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes CLINICAL POLICY Applied Behavior Analysis CPT®* Codes 97155 97156 97157 97158 0362T 0373T Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes Behavior identification supporting assessment, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior Adaptive behavior treatment with protocol modification, each 15 minutes of technicians' time face-to-face with a patient, requiring the following components: administration by the physician or other qualified health care professional who is on site; with the assistance of two or more technicians; for a patient who exhibits destructive behavior; completion in an environment that is customized to the patient's behavior ICD-10-CM Diagnosis Codes that Support Coverage Criteria - ICD 10 - CM Code F84.0 F84.2 F84.3 F84.5 F84.8 F84.9 Autistic disorder Rett’s syndrome Other childhood disintegrative disorder Asperger’s syndrome Other pervasive developmental disorders Pervasive developmental disorder, unspecified CLINICAL POLICY Applied Behavior Analysis Reviews, Revisions, and Approvals Initial approval Updated policy to “Applied Behavioral Analysis” and description Split criteria into initial and continuation and removed authorization protocols Combined diagnostic specific screening tools into one section and removed Confirmation of diagnosis by specialist type in II.B Add DSM-5 to list in II.D Added length of failure for less intensive treatments Changed treatment provided by requirements to a credentialed provider In continuation criteria, added reasonable expectations of therapy points Updated template. Updated background with recent studies. Changed policy reference number from CP.BH.02 to CP.MP.103. Specialist reviewed Revision Date 12/14 Approval Date 08/09 01/15 01/16 01/16 Reviewed and updated references. Added ICD-10 codes. 12/16 01/17 01/18 01/18 05/18 05/18 01/19 02/19 Added language to further define ABA therapy to the section- . Revised I. C.2 to state that lead poisoning rather than heavy metal poisoning has been ruled out per American Academy of Neurology recommendation. Specified which DSM-IV and DSM-5 diagnoses apply and broke these into separate criteria points. Added pediatric psychiatrist, neurologist, or developmental pediatrician as clinicians that can validate the ASD diagnosis. Updated description to include definition of focused and comprehensive ABA treatment. Moved providers qualified to make diagnosis of ASD to I.A. and added PCP to this group. Added updated versions of various screening/diagnostic tests noted in in I.B and #12, “A valid form of approved evidenced based assessment result/summary” per recommendation of specialist. Removed requirement that neurological disorder, lead poisonings and primary speech or hearing disorder has been ruled out as this is implied. Added I.C., description of categories that justify ABA treatment; Added I.D treatment plan criteria for focused and comprehensive ABA. Under continuation of services, section II, removed requirement that treatment plan be reviewed on a monthly basis, revised review from 12 to 6 months in D & E. Added additional criteria I.F-H. Removed statement that an appropriate diagnostician has ruled out intellectual disability or global developmental delay as a sole explanation for symptoms of ASD as this implied in I.A. References reviewed and updated. Specialist reviewed. Revision Date 03/19 Approval Date 6/20 6/20 5/21 5/21 11/21 11/21 CLINICAL POLICY Applied Behavior Analysis Reviews, Revisions, and Approvals Removed examples of physician types under I.A and added “qualified licensed professional”. Removed four-year-old requirement from I.A.4. Removed section specifying which individual therapies ABA is not for the sole purpose of providing in I.H. Changed policy number to CP.BH.104. Replaced “Applied Behavioral Analysis” with “Applied Behavior Analysis.” Replaced “Lovaas therapy” with Early Intensive Behavior Intervention (EIBI). Updated Section I. A. to include “ABA recommended by a qualified licensed professional” and added definition of “qualified licensed professional.” Removed DSM-5 Criteria from Section I.B, as this was duplicative. Replaced “plan of care” with “treatment plan” in Section I.D. and added “the number of service hours necessary to effectively address the skill deficits and behavioral excesses is listed in the treatment plan and considers the member/ enrollee’s age, school attendance requirements, and other daily activities when determining the number of hours of medically necessary direct service, group and supervision hours” to Section I. E. Replaced “challenging behaviors” with “skill deficits and behavioral excesses” in Section II.E. Added “and align with the identified areas of need in the assessments” to Sections I.I. and II. C. Added “Assessments, evaluations, treatment plans, and documentation is expected to be current within each profession, licensure, and state standards.” to Section II. J. Annual review. Reference list reviewed and updated. Changed “Review Date” in the header to “date of last revision” and “date” in the revision log header to “Revision date.” Addition of treatment range for focused ABA and literature review in introduction. Addition of Medical necessity criteria for behavioral assessment. Addition of Intensity of Services for ABA. Addition of “or appropriate diagnosis as otherwise specified according to state defined ABA criteria” and removal of “clinical professional counselor, marriage and family therapist, addiction counselor”, addition of “strengths‐specific, family‐focused, community‐based, multi‐system, culturally‐competent, and least intrusive. And where specific target behaviors are clearly defined; frequency, rate, symptom intensity or duration” in criteria. Section III.D. updated definition. Addition of H, K, L, M in initiation of services criteria. Addition of K, L, M, N in continuation of ABA services criteria. Addition of transition planning section. Updated introduction and research studies including citations to section entitled “Background.” Addition of section Screening Recommendations for ASD. Changed “Last Review Date” in the policy header to “Date of Last Revision,” and “Date” in the revision log header to “Revision Date.” Revision Date 1/12/22 Approval Date 1/22 06/22 11/22 6/22 12/22 CLINICAL POLICY Applied Behavior Analysis Reviews, Revisions, and Approvals Edit of verbiage for caregiver training goals changed “Caregiver Training is performance based. Identifies measurable outcomes for every goal and objective including parent training” to “Caregiver training is performance based and parent driven. Identifies measurable outcomes for every goal and objective”; and formatted for to standard Clinical Policy format. Added revision log entry form 5/21 which was previously omitted in error. Annual Review. Policy restructured and reformatted. Reordered and reorganized criteria for clarity. Minor wording changes made for clarity. Removed redundant language. Removed all instances of dashes and replaced with the word “to”. Updated the description section to incorporate changes to the level of intensity hours for Comprehensive ABA from “25- 40 hours” hour to “30-40 hours”. Replaced all instances of the statement: “It is the policy of Centene Advanced Behavioral Health and affiliated health plans” with “It is the policy of Centene Advanced Behavioral Health and health plans affiliated with Centene Corporation”. Replaced all instances of “member” to “member/enrollee.” Changed all instances of “dashes (-) in page numbers to the word “to”. Grammatical changes made to the background with no impact to the policy. References added, reviewed, updated, and reformatted.