Does Partners Health Management Cover ABA Therapy?

Yes. When it comes to accessing necessary treatments for Autism Spectrum Disorder (ASD), understanding the coverage provided by your health plan is essential. Partners Health Management, as a key player in health care services, offers coverage policies that include services for ASD, such as Applied Behavior Analysis (ABA) therapy.

Partners Health Management’s Coverage Approach

Partners Health Management is dedicated to the care of its members, using clinical coverage policies as the primary criteria for administering health plan benefits. These policies encompass a range of services, including those related to evolving medical technologies and procedures, as well as pharmacy policies.

Research-Based Behavioral Health Treatment

• RB-BHT for ASD: Partners Health Management includes Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder within its coverage policies. This inclusion is pivotal for families seeking ABA therapy for ASD.
• Policy Transition: As of October 1, 2023, Partners Health Management has streamlined the authorization process for RB-BHT services by moving to ALL codes. This transition simplifies the billing process for providers and covers a range of service codes and modifiers, including Telehealth and Non-Clinical combinations​​​​.

How to Access ABA Therapy Through Partners Health Management

Accessing ABA therapy covered by Partners Health Management involves understanding the specific policies of your plan. It's essential to work with healthcare providers to ensure that the services are in line with the clinical coverage policies and to navigate the new authorization process effectively.

Conclusion

Partners Health Management's approach to covering ABA therapy under its RB-BHT services provides essential support for families dealing with ASD. The recent changes to their authorization process further simplify access to necessary treatments.

FAQ

Q: What exactly is RB-BHT in the context of Partners Health Management's coverage?

A: Research-Based Behavioral Health Treatment (RB-BHT) is a term used by Partners Health Management to encompass treatments like ABA therapy for Autism Spectrum Disorder. This coverage is part of their commitment to provide effective treatments for ASD​​.

Q: How has the authorization process for ABA therapy changed recently with Partners Health Management?

A: Partners Health Management has transitioned to using ALL codes for new authorizations for RB-BHT services, including ABA therapy, effective from October 1, 2023. This change aims to simplify the authorization process by reducing the number of modifier codes needed, which also includes Telehealth and Non-Clinical services​​​​.

Q: Does the new ALL code system for RB-BHT services affect existing authorizations?

A: The new ALL code system applies to new authorizations. Current authorizations, as of the transition date, do not require updates but will follow the new system when they are extended or renewed​​.

Q: If I am a new member of Partners Health Management, how should I proceed to get ABA therapy for my child?

A: For new members seeking ABA therapy, it’s important to start by consulting with a healthcare provider to confirm the ASD diagnosis and discuss the necessary treatment. Then, you should work with the provider to navigate Partners Health Management’s authorization process under the new ALL code system for RB-BHT services​​​​.