Administrative Letter 24-03: OHCA ABA Changes

Dear Providers,

I hope you are having a wonderful holiday season and enjoying much-needed time to relax and make cherished memories with family and friends. I’d like to take a moment to introduce myself as the newest member of the DDS Behavior Support team. As the new Program Manager, I am excited to work alongside you as we continue our important work in supporting the individuals we serve.

I look forward to connecting with you in person soon. However, today I’m reaching out to share some important updates from the Oklahoma Health Care Authority (OHCA). Effective Oct. 25, 2024, OHCA approved emergency changes to their ABA policy that impacts the services available through the DDS waiver. These changes affect individuals under the age of 21 who have a definitive diagnosis of Autism Spectrum Disorder (ASD) and receive behavior support services through the waiver.

Key Update: Extension of ABA Reimbursement for Behavioral Intervention Plans (BIP)
One of the key changes is the extension of Medicaid reimbursement for Behavioral Intervention Plans (BIP). These plans are designed to address targeted maladaptive behaviors that pose risks to the individual or others and include maintenance therapy to manage these challenges. Notably, this service is like the Protective Intervention Plans (PIP) available through the DDS waivers. As you know, DDS has been able to support children with Autism through the waiver by covering PIPs under the service necessity policy (33.1. Criteria to establish service necessity), which states that waiver funds can only be used if other funding sources are unavailable. Since BIPs are now eligible for Medicaid reimbursement, DDS waiver funds can no longer cover PIPs for individuals eligible for ABA services through OHCA.

While we welcome the expanded coverage for ABA services and recognize the increased flexibility it provides to families, we also understand this policy change impact your business and contracts with DDS. Specifically, by Jan. 31, 2025, all behavior support services authorized for individuals under 21 with a diagnosis of autism will be end-dated. This revision will affect a total of 70 individuals. We hope that this advanced notice helps you navigate the process of obtaining the necessary prior authorizations for continued services through OHCA without interruption.

Impact on Non-Autism Waiver Recipients
For clarification, if a DDS waiver recipient under the age of 21 does not have a diagnosis of Autism (ASD), their behavior support services will remain unaffected by this change.

Next Steps for Families and Providers
If you are not currently contracted with OHCA to provide Medicaid funded services, families will need to select a new provider to continue behavioral support services. A similar notice has also been sent directly to the affected families, which will include a link to OHCA’s provider search portal (https://apps.okhca.org:456/OHCAProviderDirectory/).

If you have any questions or need further clarification, please feel free to reach out to our team at DDS.Behavioral.Supports@okdhs.org. We are committed to assisting you in navigating these changes to ensure a smooth transition for all involved.

Thank you for your ongoing support and the exceptional care you provide to the individuals we serve. Your professionalism and expertise are invaluable to our work, and we truly appreciate all that you do.

Warm regards,

Bethany Willige
Program Manager, DDS Behavior Support