OREGON HEALTH PLAN CARE COORDINATION

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    Prior Authorization Resources

    Checklist for Applied Behavioral Analysis (ABA) Requests:

    The Following Six Items are Required:

    1. The child is evaluated by a specialist experienced in diagnosing and treating autism spectrum disorder or stereotypy with self-harming behavior and recommends ABA.
    2. PCP receives the evaluation results from the specialist and can refer, or the specialist can refer to an ABA provider.
    3. ABA provider submits prior auth request to OHP by faxing to 503-378-5814 or can load request into MMIS themselves.
    1. OHP reviews and approves amends or denies ABA requests.
    2. OHP generates an adjudication letter to the ABA provider.
    3. The physician does not submit the prior auth request to OHP.

    Please note an assessment that refers to a doctor that gave a child a diagnosis of autism is not enough. There must be a documented diagnosis and order from the physician.

    Please use the resources down below:

    OAR LINK: https://secure.sos.state.or.us/oard/displayChapterRules.action?selectedChapter=87

    • 410-172-0610 Provider Enrollment
    • 410-172-0620 Documentation Standards
    • 410-172-0650 Prior Authorization
    • 410-172-0760 Applied Behavior Analysis
    • 410-172-0770 Individual Eligibility for Applied Behavioral Analysis Treatment

    Please visit HERC (Health Evidence Review Commission) Evidence-based guidelines on Prioritized List for additional information.

    HERC LINK: https://www.oregon.gov/oha/HPA/DSI-HERC/Pages/Prioritized-List.aspx

    • Guideline Note 75 is for APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER
    • Guideline Note 126 is for APPLIED BEHAVIOR ANALYSIS INTERVENTIONS FOR SELF-INJURIOUS BEHAVIOR

    For more help, please email us at ORCM@kepro.com
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