ABA Therapy Centers in Utah

Utah Medicaid autism services and ABA prior authorization

Utah Medicaid covers ABA for eligible members with an ASD diagnosis, regardless of age. A clinician licensed to diagnose autism writes the diagnosis, a licensed clinician writes the ABA order, and the ABA provider sends both to the Medicaid agency with a treatment plan. Ongoing services need a new order every year. Behavior technicians must hold an accredited certification before they work with a Medicaid member.

• Providers get a 10-business-day grace period to submit the first prior authorization request.
• Accountable Care Organization plans: Health Choice Utah, Healthy U, Molina Healthcare and SelectHealth Community Care.
• To find an enrolled provider, call a Health Program Representative at 1-866-608-9422.
• To apply for Medicaid, call the Department of Workforce Services at 1-866-435-7414.

Utah Code 31A-22-642 and private insurance

Utah Code 31A-22-642 requires individual and large-group health benefit plans to cover autism diagnosis and treatment, including ABA. For plans entered into or renewed on or after January 1, 2020, behavioral health treatment cannot carry a limit on covered hours, and the statute itself sets no age cap. The plan network must include board certified behavior analysts, and your provider files a treatment plan within 14 business days of starting. Self-funded employer plans follow federal ERISA rules instead, so ask HR whether your plan is fully insured in Utah.

DSPD waivers and the closed Autism Waiver

The Medicaid Autism Waiver no longer accepts new applications. The Division of Services for People with Disabilities (DSPD) runs the Community Supports Waiver for people of all ages with an intellectual disability or a related condition such as autism. DSPD rarely offers services right after eligibility, because the Legislature sets funding each year and thousands of eligible Utahns wait. Apply early by calling 1-844-275-3773 or starting intake through MySteps, and ask your intake worker to re-score your needs when circumstances change.

Baby Watch Early Intervention for infants and toddlers

Baby Watch is Utah's Part C program for infants and toddlers with developmental delays or disabilities. Any parent, guardian or professional can refer a child, and the evaluation is free. A child can qualify through a medical diagnosis, test scores or clinical opinion, and the family builds an Individualized Family Service Plan with the team. Services take place in the child's natural environment, such as home or child care, and planning for special education preschool starts as the third birthday approaches.

Who can deliver ABA in Utah

Utah requires a license or registration to practice behavior analysis. The Behavior Analyst Licensing Act creates licenses for behavior analysts and assistant behavior analysts, and registrations for behavior specialists and assistant behavior specialists. Medicaid adds its own rule: a psychologist or behavior analyst directs the ABA program, and technicians are certified before they treat members. Ask any provider for the supervising analyst's Utah license number.

Utah Fits All and the Carson Smith Scholarship

Utah Fits All is a state scholarship for school-age Utah residents who have not turned 19 by September 1. The statute caps a private school award at $8,000 a year, subject to appropriations, and lists behavioral, occupational and speech-language therapy for students with disabilities among covered expenses. Families apply every school year, and a preference order, then a lottery, decides awards when applications exceed funds. The Carson Smith Scholarship is the IEP-based private school option, and a student can hold only one of these scholarships at a time.