Guidelines for Availing Treatment by ECHS Beneficiaries for Occupational Therapy, Speech Therapy and Applied Behavior Analysis (ABA)

Guidelines for Availing Treatment by ECHS Beneficiaries for Occupational Therapy, Speech Therapy and Applied Behavior Analysis (ABA) Based Behavioral Therapy in individuals with Autism Spectrum Disorder (ASP)/ Non-Autistic Person/ Children With ADHD and Specific Learning Disabilities

1. The guidelines for availing treatment under ECHS for Occupational Therapy, Speech. Therapy and Applied Behaviour Analysis (ABA) Based Behavioural Therapy in individuals with Autism Spectrum Disorder(ASD)/non-autistic persons/children with ADHD and specific learning disabilities are laid down as follows.
2. Aim of Occupational Therapy/Speech therapy/Applied behaviour analysis-based behavioural therapy (ABA)/ Special education in individuals with Autism Spectrum Disorder:- The therapies aim towards minimizing the sensory issues, motor & praxix related problems, challenging behaviours, decreased social communication and difficulties in the activities of daily living (ADL) experienced in home, school and community. This in turn improves the levels of independence in ADL, acquisition of significant life skills, and promotes community integration and mainstreaming of individuals with Autism Spectrum Disorders.
3. Who can diagnose ASD for the purpose of reimbursement? Reimbursement for therapies after diagnosis of Autism Spectrum Disorder will be done if prescribed by a Pediatrician/Development Pediatrician/Pediatric Neurologist/ Psychiatrist/ Child and Adolescent Psychiatrist in Service Hospital or ECHS-empanelled Hosp/Govt Hosp.
4. Ceiling rates for the therapy session. The ceiling rates for Occupational Therapy, ABA-based therapy, speech therapy and special education for individuals with autism spectrum disorder under ECHS shall be Rs 400/- per session irrespective of the type of session.
5. Eligible Centers. Any Centre (Empanelled or Non-Empanelled) providing therapy services administered by qualified personnel having minimum qualifications (Table-1) as summarized as under:

6. Eligibility to obtain reimbursement for Occupational Therapy/Speech Therapy/ Applied behaviour analysis based behavioural therapy (ABA) /Special Education Services:

(a) Beneficiaries shall be eligible to receive the proposed therapy if:

• They have been evaluated and diagnosed with Autism Spectrum Disorder as per the standard protocol outlined by the committee.
• The said therapy has been recommended as a necessary component in the management of the affected individual with Autism Spectrum Disorder.

(b) The therapies can be taken at empanelled or non-empanelled centers but reimbursement would be done as per the ceiling rate or as per actual whichever is less subject to the condition that

• Provision of therapy session notes as per the format (Basic minimum standard guidelines for recording and therapy report) published in the gazette by the central mental health authority as per provisions of the Mental Healthcare Act, 2017 (Appx).
• The Therapists are recognized by the competent authorities in their respective fields as documented in Table 1 (Para 6 above).

(c) The beneficiary has undergone a detailed assessment by the therapist including sensory profile/sensory checklist, level of communication, social interaction, stereotypic and repetitive behaviour, impact on the school environment/home, impact on motor/ sensory function, activities of daily living, behavioural issues that need to be addressed, parental perception of problems, family coping, strategies, expected family support/involvement, motivation and expected compliance for the therapy.

(d) As autism requires multidisciplinary management it was proposed that reimbursement should include at least two or more types of therapy including any ABA-based behavioural therapy occupational therapy, speech and language therapy, or special education, unless only one type of therapy is available within the reach of the beneficiary.

(e) Individualized therapy plan — The therapist has to provide a written individualized therapy plan (ITP) customized for therapy that specifies the following:

• Short term goals: those that are expected to be achieved in three months.
• Long-term goals: those that are expected to be achieved within a year.
• Home-based plan.
• The schedule and frequency of sessions required to achieve the short-term and long-term goals. This will depend upon the severity of the behavioural issues, the phase of therapy, and the compliance of the caregivers to therapy.
• Therapy record for each session: a specific written plan that details home assignments given to parents/caregivers – the details of activities, how to administer them, the frequency, the duration etc.
• A structured operational system to monitor the compliance of caregivers with the home assignments.
• A structured operational system for regular evaluation of the impact of the therapy on the functioning of the affected individual.

7. Frequency of therapy sessions.

(a) The duration of each session should be at least 40 minutes.

(b) It should be based upon the severity of Autism as diagnosed by the referring clinician and as recommended below:

8. Follow-up to be done every 6 months:

(a) By referring the clinician with the treatment plan and severity rating (Any of CARS2/CARS/ISAA and preferably ATEC).

(b) Number of sessions per week to be decided based upon the inputs and recommendations from the treating therapist and referring clinicians as per the upper ceiling of recommended sessions in initial phase.

(c) Parental compliance to therapy is to be ensured by a compliance sheet of the home-based program, a template to be given by the treating therapist and produced at the time of review.

9. Screening, Diagnosis and Follow-up of Individuals with Autism Spectrum Disorders.

(a) Moderate to High risk for autism may be determined by the Modified Checklist for Autism in Toddlers (M-CHAT-R/F) from 16-30 months of age.

(b) Modified Checklist for Autism in Toddlers (M-CHAT-R/F) for SCORES.

(i) Total Score 0-2: The score is LOW risk. No Follow-Up is needed.

(ii) Total Score 3-7: The score is MODERATE risk.

(iii) Total Score 8-20: The score is HIGH risk.

(c) Severity grading of ASD: Severity scores are assessed by using CARS2/CAR/ISAA scales

10. The instructions will be implemented from the date of issue of this letter.

APPX

1. Basic Minimum Standard Guidelines for Recording of Therapy Report (facilities where persons with ASD are provided with therapy)

2. Minimum Basic Standard Guidelines for Recording of Therapy (Name of the Institute / Hospital/Centre with address)

Clinic record no. ______________

THERAPIST SESSION NOTES

Patient Name:

Age:

• Short Term Goals.
• Long Term Goals.
• Progress

Therapist observations and reflections:

Plan for next session:                                                      Date for next session: