Utilization Management

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.

• Emailing requests and documentation cannot be accepted.
• EDMS (cover sheet) is required.
• EDMS LINK  https://sharedsystems.dhsoha.state.or.us/DHSForms/Served/me3971.pdf
  OHP reviews and approves amends or denies ABA requests.

4. OHP generates an adjudication letter to the ABA provider.
5. 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.