Template for Applying to NH Medicaid for ABA Therapy to be covered

It has recently been brought to light that NH Medicaid is actively working towards developing a program to cover “autism services” as directed by the Center for Medicaid and Medicare Services (CMS) of the Federal government in the middle of 2014.  How this program will be shaped and what will be covered is still being determined.  NH ABA and it’s assigned Medicaid Committee are actively participating in this process with the hopes of influencing the resulting State Plan Amendment (SPA) to include ABA Therapy as a specifically covered benefit as well as maintaining a high level of fidelity and quality for all those affected across the entire State of NH.  That said, those affected by autism who have Medicaid coverage have a right to medically necessary ABA therapy NOW. 

Services that are medically necessary but not a specifically covered benefit can be applied for and covered by Medicaid under a regulation titled He-W546.  The application process is detailed but may make the difference between accessing life changing ABA Therapy or not.  To aid families and fellow BCBAs in the process for applying for this coverage NH ABA has developed the linked template.  Please note that this is a template which includes/incorporates a sample of supporting research as well as advice on how to frame responses to each of the required sections.  A detailed description of the process can be found at http://www.gencourt.state.nh.us/rules/state_agencies/he-w500.html.

Additional support in the application process as well as during any potentials appeals can be requested from the NH Disabilities Rights Council at www.drcnh.org.   

Please note that this is not legal advice nor a guarantee of coverage under He-W546 but merely a tool to aid families in the process.  NH ABA nor Constellations Behavioral Services, LLC should not be held liable for the use or misuse of this tool.

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