6 Arkansas Medicaid ABA Therapy Rules Families Need to Know

Key Points:

• Arkansas Medicaid ABA therapy covers qualifying children ages 18 months to 21, provided they meet state eligibility and medical requirements. 
• Families need active coverage, an ASD diagnosis confirmed by at least two qualifying licensed professionals, an evaluation referral, and prior authorization before treatment. 
• Coverage rules vary across ARKids First-A, ARKids First-B, PASSE, TEFRA, and the Autism Waiver. 

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Arkansas Medicaid covers medically necessary ABA therapy for eligible children ages 18 months to 21 who meet state requirements. Coverage requires a qualifying autism diagnosis, an evaluation referral, a BCBA assessment, a treatment prescription, and prior authorization. 

This guide covers six key state rules based on whether your child has ARKids First-A, ARKids First-B, TEFRA, PASSE, or the Autism Waiver. 

1. Arkansas Medicaid ABA Therapy Starts With Age and EPSDT Eligibility

Medicaid-funded ABA therapy in Arkansas falls under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Services are available to qualifying children ages 18 months to 21 who have an autism diagnosis and are enrolled in EPSDT. 

Meeting the age and coverage requirements does not automatically authorize ABA therapy. Your child must also complete the required referral, ABA assessment, treatment prescription, and prior authorization process. 

CDC's 2022 Arkansas autism monitoring data found that about 1 in 34, or 3.0%, of 8-year-old children in the 21-county central Arkansas surveillance area were identified with autism. 

Arkansas Medicaid ABA eligibility begins at 18 months, while Cross River Therapy provides ABA services for children ages 1 to 21 based on eligibility and insurance coverage. Qualifying factors for standard state coverage include:

• Active enrollment in a qualifying state Medicaid plan
• Reaching at least 18 months of age up to 21 years
• Meeting state medical criteria for an autism diagnosis
• Demonstrating medical necessity through the required ABA assessment and authorization process 

2. Arkansas Requires Autism Confirmation From Two Qualified Clinicians

Arkansas Medicaid requires an autism diagnosis confirmed by at least two qualifying licensed professionals before ABA services can move through the approval process. 

State policy requires the ASD diagnosis to be confirmed by at least two of three qualifying licensed professional types: a physician, psychologist, or speech-language pathologist. A single doctor's evaluation or a school classification does not meet state funding guidelines on its own.

Recent CDC surveillance data indicates that 49.9% of 8-year-old children with autism in Arkansas had a developmental evaluation documented by 36 months of age. Early evaluations help families complete these required clinical steps without unnecessary delays. 

If only one qualifying professional has documented the ASD diagnosis, a second qualifying professional must also confirm it. 

Accepted clinical evaluation specialists include:

• Licensed Physicians
• Licensed Psychologists
• Licensed Speech-Language Pathologists

If your child has confirmation from only one qualifying professional, our team can explain what is still needed before you continue the ABA intake process. 

3. Your Child's PCP Usually Starts the Medicaid ABA Referral 

Your child's Arkansas Medicaid-assigned primary care provider (PCP) usually starts the ABA evaluation referral by completing the DMS-641 ER evaluation referral form. Arkansas rules also allow certain substitute or affiliated physicians to complete the referral when applicable. 

The referral connects the ABA evaluation to your child's medical care. The assigned PCP or a permitted substitute or affiliated physician completes the DMS-641 ER and documents the basis for the referral. Once completed, this referral allows an ABA clinic to evaluate your child's specific strengths and needs.

Documents and information families may need during the referral and authorization process include: 

• Documentation showing an ASD diagnosis confirmed by at least two qualifying licensed professionals 
• Active Medicaid member details
• Primary care provider contact information
• Completed DMS-641 ER evaluation referral
• Relevant developmental or medical history files

4. Prior Authorization Happens Before Both Assessment and Treatment

Approval moves through two distinct stages before in-home ABA therapy sessions or clinic-based sessions begin. First, the provider submits diagnostic reports and doctor referrals to receive authorization for an evaluation. 

The Arkansas DHS process for qualifying for ABA therapy services explains the state's required steps from the initial referral through treatment authorization. A Board Certified Behavior Analyst (BCBA) then evaluates your child and builds an individualized plan. 

What Arkansas Medicaid ABA Therapy Prior Authorization Includes

The remaining process includes:

1. The PCP reviews the assessment and proposed treatment plan.
2. The PCP issues the DMS-641 TP treatment prescription when appropriate. 
3. The ABA provider submits the prescription, assessment, treatment plan, and supporting records.
4. ABA begins after the requested services receive authorization.

Arkansas no longer requires the old DDS ABA pre-approval letter, and DMS-693 is no longer required under the current process. 

Review Your Insurance Records Before Authorization

Reviewing insurance documentation can feel confusing when you are starting out. Our intake team can review your insurance information and help you understand which records may be needed before authorization. Families who want help confirming the next step can contact our intake team. 

5. PASSE Members Use Their PASSE for ABA Authorization

Children enrolled in the Arkansas PASSE program receive most Medicaid-covered services through their PASSE organization. Some Arkansas Medicaid beneficiaries with qualifying developmental or behavioral health needs receive their care through a PASSE organization. 

When your child belongs to a PASSE, service approvals move through that organization rather than standard state Medicaid review channels.

Requesting PASSE ABA therapy in Arkansas requires coordinating directly with your child's assigned care coordinator. Families can review Cross River Therapy's accepted insurance plans before intake and confirm network participation for their child's specific PASSE plan. 

Key PASSE details to collect before requesting services include:

• Current PASSE plan organization name
• Child's member identification number
• Name and contact information for your assigned care coordinator
• In-network status of your chosen behavior therapy provider
• Complete diagnostic and primary care records
• Active plan authorization status

6. ARKids First-B and the Autism Waiver Follow Different Rules

Not all Arkansas Medicaid programs cover behavior services in the same manner. 

• ARKids First-A provides full state coverage, including behavioral benefits for qualifying children. 
• ARKids First-B is Arkansas's CHIP coverage option. Cross River Therapy does not accept ARKids First-B for ABA therapy because the plan does not cover ABA services. 
• TEFRA can provide Medicaid coverage to eligible children age 18 or younger with disabilities who meet Arkansas's medical-necessity requirements. ABA therapy still requires the state's separate ABA eligibility and authorization process. 

Parents frequently wonder how the Arkansas Autism Waiver interacts with daily therapy. The Arkansas Autism Waiver serves eligible children from 18 months up to age 8, with eligibility established on or before the fifth birthday and a maximum of three years of waiver services. 

Arkansas rules do not allow a child to receive Autism Waiver services and Medicaid ABA therapy at the same time. Understanding these program distinctions helps you avoid unexpected costs and plan your child's care effectively.

Knowing your coverage program helps clarify which Arkansas Medicaid ABA rules apply and which authorization process your family needs to follow. Our intake team can help you review your coverage information before starting intake. 

FAQs About Arkansas Medicaid Coverage for ABA

Does Arkansas Medicaid cover ABA therapy? 

Yes. Arkansas Medicaid covers medically necessary ABA therapy for qualifying children ages 18 months to 21 who have an autism diagnosis, are enrolled in EPSDT, and complete the required referral, assessment, treatment-prescription, and prior-authorization process. PASSE enrollment or another coverage program can affect how authorization is handled. 

Can Medicaid-approved ABA happen at home or school in Arkansas?

We offer home-based sessions, school-based ABA sessions, and clinic-based sessions in Arkansas based on client needs. Approved locations depend on your child's authorized treatment plan, provider availability, and specific insurance rules. Always verify that your desired setting is listed on your service authorization.

Who works with my child after Medicaid approves ABA?

Board Certified Behavior Analysts design and supervise care plans, while Registered Behavior Technicians provide direct day-to-day support. A parent testimonial from Shonurell Roundtree describes significant progress for her son and highlights the commitment of both his RBT and BCBA. 

How Can Cross River Help With Arkansas Medicaid ABA Coverage? 

Arkansas Medicaid ABA approval depends on eligible coverage, an ASD diagnosis confirmed by two qualifying licensed professionals, an evaluation referral, a comprehensive ABA assessment, a treatment prescription, and prior authorization. 

Cross River Therapy accepts ARKids First-A, TEFRA, and PASSE plans for ABA services in Arkansas. Our intake team can review your insurance information and explain what paperwork may be needed during intake and authorization. Cross River provides home, school, and clinic-based ABA services across Arkansas. 

Families ready to review their coverage information can submit the online enrollment form to begin the intake process.