​Effective January 1, 2025, Independence Blue Cross (IBX) will expand the coverage of applied behavior analysis (ABA) therapy for the treatment of autism spectrum disorders (ASD) to include Pennsylvania individual Affordable Care Act consumers.

ABA (for the treatment of individuals with ASD) is covered when a state mandate requires coverage, or when an individual consumer has elected coverage and the following criteria are met:

• The individual has an established and current (within 24 months), documented diagnosis of ASD consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR) criteria, using validated autism assessment tools (e.g., Autism Diagnostic Observation Schedule [ADOS]; Autism Diagnostic Interview [ADI-R]; Parent Evaluation Developmental Stages [PEDS], or Brigance Diagnostic Inventory of Early Development II). 
• Functional behavioral assessment (FBA) using validated tools has been completed by a qualified behavior analyst certified by the Behavior Analyst Certification Board (BACB).
• The FBA includes baseline information on the individual's adaptive functioning within the last six months, or longer time frame if mandated by state law or member benefit contract.

Please note: ABA services require prior authorization. More information will be shared when the updated policy is published on January 1, 2025.

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