NYS Medicaid: Updates in Provider Manual for Applied Behavioral Analyst (ABA) Providers 

ABA services provided by enrolled Licensed Behavior Analysts (LBAs) and/or Certified Behavior Analyst Assistants (CBAAs) will be covered for NYS Medicaid fee-for-service (FFS), and Medicaid Managed Care (MMC) members under 21 years of age with a diagnosis of Autism Spectrum Disorder (ASD) as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and/or Rett Syndrome. For ABA services by a NYS-licensed and NYS Medicaid-enrolled physician, psychologist, psychiatric nurse practitioner, pediatric nurse practitioner, or physician assistant, the NYS Medicaid member must have a medical referral.  

These referrals are valid for two years and should include such a data:  

• The age of age;  
• ASD or Rett Syndrome diagnosis;   
• Date when the initial diagnosis was made; 
• Co-morbid diagnosis (if applicable);  
• Symptom severity level/level of support (if a referral is from an ASD-diagnosing provider);  
• Statement the patient needs ABA;   
• DSM-5 Diagnostic Checklist for ASD diagnoses. 

Qualifications 

If LBAs and CBAAs want to enroll and participate in the NYS Medicaid FFS program, the former must be licensed, and the latter must be certified by the NYS Department of Education (NYSED).  

To be certified and licensed, you must meet the following criteria: 

• Be of good moral character 
• Be at least 21 years of age 
• Meet education, examination, and experience requirements 

Provider Enrollment 

For reimbursement for ABA services provided to a NYS Medicaid FFS or MMC member, an LBA must be enrolled with the NYS Medicaid FFS program.