Insurance
Understanding the Intake Process
Requirements
In order for a child to be eligible for ABA therapy, they will need a prior authorization from their insurance provider. In order to obtain the prior authorization from insurance, the caregiver will need to ensure that all required documentation has been completed and submitted on their child's behalf. This documentation will include:
- A copy of the child's formal diagnostic report
- A physician referral
- An Insurance Card
- A copy of the child's current IEP (if applicable)
- A complete intake packet (Get Your Packet Today)
Please note that a prior authorization for ABA services will only be submitted once LUMA Autism and the caregiver have both agreed to move forward with services and agreed on a start date. If LUMA Autism currently has a waitlist, a prior authorization will not be submitted for insurance until the child has come off of the waitlist.
Katie Beckett Medicaid Program
The Katie Beckett Program may provide Medicaid coverage for children with significant developmental, behavioral, or medical needs, regardless of household income.
Benefits May Include:
- Access to Medicaid coverage
- Therapy and behavioral health services
- Medical equipment and support services
- Reduced out-of-pocket healthcare costs
- Additional resources that help children thrive at home and in their community
Eligibility is based on your child's needs rather than family income.
If you think your child may qualify, LUMA can connect you with a Katie Beckett specialist and will cover the application fee on your behalf.
Process
Understanding the intake process can be rather gruesome. We're here to help parents and caregivers navigate it as easily and efficiently as possible with these six steps.
Documentation
Caregivers interested in receiving ABA services at LUMA Autism must complete and submit the required documents and intake paperwork. You will be able to submit these after filling out a Contact Form on our website and receiving feedback from our Client Care Team.
Consultation
Upon receiving the completed intake paperwork, a BCBA will contact you to set up an initial consultation. This consultation will allow the BCBA to learn more about both your child, and your family as a whole, to determine any primary areas of need and any concerns you may have. All information provided in the initial consultation will help the BCBA and the caregivers to determine if moving forward with services is the correct plan of action. If so, a prior authorization will be submitted for through insurance and the BCBA will begin to prepare for the child's initial assessment.
Assessment
The BCBA will decide which assessment(s) will be the most appropriate for the child. Common assessments administered during this phase may include FBAs, VB-MAPP, ABLLS-R, and AFLS. A combination of 1:1 direct assessment, observations, data collection, and interview-based assessments will be administered during this time to ensure that the BCBA is able to understand the child's strengths and needs as fully as possible.
Once the initial assessment is completed, the BCBA will develop a comprehensive Treatment Plan based on the findings. The Treatment Plan will include the assessment results, treatment goals, a recommended schedule for therapy, and detailed information about the child.
Following the completion of the treatment plan, the BCBA will set up a meeting with the child's caregivers to review the Treatment Plan in its entirety. If the caregivers approve the direction of therapy, they will sign the Treatment Plan and prepare to begin receiving ABA therapy services at LUMA Autism.
Therapy Services
Once insurance has approved the child's Treatment Plan and recommendation for hours of service, the child will be ready to start receiving ABA therapy at LUMA Autism. The child's ABA team of clinicians will consist of the BCBA, who will oversee the child's treatment in its entirety, and a team of RBTs, who will be thoroughly trained and regularly supervised on implementing the child's Treatment Plan. The RBTs are solely responsible for providing direct therapy to the child on a 1:1 basis while the BCBA monitors all ongoing treatment, updates programs and interventions, and observes the child's progress throughout the direct process.
Caregiver Education
The BCBA is also responsible for training caregivers on all aspects of the child's Treatment Plan as well as the principles and procedures used in ABA. The caregivers will be responsible for attending and participating in monthly meetings with the BCBA, as required by insurance. These meetings may include the child, RBT, and any other stakeholders deemed appropriate.
Meetings may include the BCBA modeling new techniques and procedures, observing and providing feedback on techniques used with the child, training on new strategies or reviewing previous strategies, and/or conducting an overall check-in to review all progress and discussion of upcoming goals.
Application
The goal of LUMA Autism is to generalize and maintain all behaviors targeted in the child's Treatment Plan in order to ultimately transition the child out of therapy and to equip the child with the tools and skills needed to be independent and successful in their natural environment.
At the end of the child's authorization period, the BCBA will reassess the child to identify areas of progress and ongoing need. The BCBA will then update the child's Treatment Plan accordingly for the following authorization period.
Insurance Provider Partners
Plus CareSource, Peach State, Amerigroup, and Kaiser Permanente