The North Dakota Department of Human Services announced Friday the Centers for Medicare and Medicaid Services (CMS) has approved its Medicaid State Plan to provide coverage for Applied Behavior Analysis (ABA) services to qualifying individuals from infancy to age 21 diagnosed with an autism spectrum disorder (ASD).

ABA approved services include program oversight and skills training for individuals with an ASD and their caregivers. Originally, these services were covered under the state’s Autism Spectrum Disorder Medicaid Waiver and were available only to children age seven and younger. Individuals receiving these services will now have their coverage transition to Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

Families eligible for Medicaid seeking ABA therapy for their children will need proof of an ASD diagnosis, a current EPSDT screening, and a recommendation from a primary care provider for ABA therapy. More information about the EPSDT program is online at www.nd.gov/dhs/services/medicalserv/health-tracks/.

Agencies interested in becoming a provider of Medicaid ABA services can apply to be a provider at www.nd.gov/dhs/info/mmis/materials.html.

In addition, the department expects final approval from CMS on an amendment to the Autism Spectrum Disorder Medicaid Waiver that will add 12 slots and increase the qualifying age. Currently, children can be served through age seven. When that waiver amendment is approved, children through age nine can be served. This will increase the total number of children who can be served from 47 to 59.

The 2017 North Dakota Legislature authorized other enhancements to the state’s Autism Spectrum Disorder Medicaid Waiver. They added 37 slots, for a total of 96 slots, and increased the qualifying age through 11 years old.

The department must submit another waiver amendment to meet legislative intent. The amendment will be open for public comment, and then will be submitted to CMS for review and approval. CMS approval is required in order to pay for services through Medicaid.

North Dakota’s autism waiver was first approved in November 2010. Children qualify for the waiver based on need and diagnosis, and the child’s income. Families can apply by completing an application at www.nd.gov/eforms/Doc/sfn60618.pdf or by contacting the Department of Human Services at 701-328-8912, toll-free 800-755-2604, or by email at dhsautism@nd.gov.

The Medicaid State Plan is an agreement between the state and the federal government that outlines how North Dakota administers its Medicaid program.