Social Skills Groups and Medi-Cal/Health Plan of San Joaquin
Did you know Medi-Cal/Health Plan of San Joaquin (HPSJ) does not require an Autism diagnosis for ABA and Social Skills Groups?
In most situations, HPSJ requires a letter from a physician recommending ABA along with what behavioral and/or social challenges would be best addressed by ABA.
ABA may be approved for conditions other than autism, where it is shown to address specific behaviors and improve functioning. Behavioral Therapy and Social Skills Groups for ADHD, I/DD, and Speech Delays can be approved by Medi-Cal/HPSJ. Examples include:
Intellectual or developmental disabilities (I/DD)
ADHD
Speech and language delays/deficits
Other behavioral or developmental challenges
How to get a referral: A healthcare professional must recommend ABA as medically necessary for the individual.
Burgos Behavior has a referral form available on our website (linked: Referral Form) for medical providers to recommend ABA.
After HPSJ approves the referral, an ABA provider must complete a treatment plan documenting the need for ABA and submit it to HPSJ for approval.
The typical assessment at Burgos Behavior looks like this:
1-hour meeting on Zoom or in person to gather background information and complete several assessment questionnaires.
Two (2), two-hour observations with peers at the Burgos Behavior office
One (1), 1 hour meeting on Zoom or in person to discuss goals and services.
Two (2) hours for the clinician to finalize the report. The family and client are not present when the clinician is writing the report.
Burgos Behavior submits the report to HPSJ and keeps the family updated on the status of the authorization.
Services can begin when Burgos Behavior receives the authorization.
The team reassesses goals together every 6 months in a similar process as the initial assessment.
Burgos Behavior has a form that families can use to help determine if we are a good fit for their child or teen’s needs.
Find Your Quirky Crew https://www.burgosbehavior.com/quirky-activities
