Applied Behavioral Analysis (ABA) Services for Autism Spectrum Disorders

If you or one of your dependents requires ABA Services for an Autism Spectrum Disorder, Tufts Health Plan will cover medically necessary ABA Services if:

  • The member is covered under a plan subject to the MA or RI autism mandate (or that has chosen to include such coverage despite not being subject to the mandate)* 
  • The member meets the criteria outlined in the applicable Tufts Health Plan medical necessity guidelines, including the following:
    • The member has a definitive diagnosis of an Autism Spectrum Disorder 
    • Services are rendered by a BCBA (Board Certified Behavior Analyst) or a paraprofessional supervised by a BCBA 
    • Please note: Services related to Autism Spectrum Disorders that are provided by school personnel as part of an individualized education program are not covered. Please click here for more information regarding IEPs. 
    • Services are rendered or supervised by a BCBA in the Tufts Health Plan network (unless your coverage includes out of network benefits) 
    • The parent or guardian is involved in the training of behavioral techniques 

Prior Authorization for all services is required:

  • The BCBA rendering the services must submit the initial Applied Behavioral Analysis Autism Service Request Form
  • The form must be mailed or faxed to the Tufts Health Plan Mental Health Department
    Tufts Health Plan Mental Health Department
     705 Mount Auburn Street Watertown, MA 02474
     Fax: 617-673-0314
  • Once the form is received, it will be reviewed by an Authorized Reviewer from Tufts Health Plan for a determination regarding authorization of services 

Questions

If you have questions about your benefits or coverage or need help finding a BCBA provider in the Tufts Health Plan network, please call our Mental Health Department at 800.208.9565.

Coverage for physical, occupational, or speech therapy as related to an Autism Spectrum Disorder require separate authorization. If you have any questions about these services, please contact Member Services at the number on your Member ID card.


*Certain self-funded groups may not qualify for ABA/ASD coverage

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