Noblesville Schools Medical Plan 48 Section 1: Covered Health Care Services • Intensive Outpatient Programs. • Outpatient treatment. Inpatient treatment and Residential Treatment includes room and board in a Semi-private Room (a room with two or more beds). Services include the following: • Diagnostic evaluations, assessment and treatment, and/or procedures. • Medication management. • Individual, family, and group therapy. • Crisis intervention. • Mental Health Care Services for Autism Spectrum Disorder (including Intensive Behavioral Therapies such as Applied Behavior Analysis (ABA)) that are the following: ▪ Focused on the treatment of core deficits of Autism Spectrum Disorder. ▪ Provided by a Board Certified Behavior Analyst (BCBA) or other qualified provider under the appropriate supervision. ▪ Focused on treating maladaptive/stereotypic behaviors that are posing danger to self, others and property, and impairment in daily functioning. This section describes only the behavioral component of treatment for Autism Spectrum Disorder. Medical treatment of Autism Spectrum Disorder is a Covered Health Care Service for which Benefits are available under the applicable medical Covered Health Care Services categories in this SPD. Virtual Behavioral Health Therapy and Coaching Specialized virtual behavioral health care provided by AbleTo, Inc. ("AbleTo Therapy360 Program") for Covered Persons with certain co-occurring behavioral and medical conditions. AbleTo Therapy360 Program provides behavioral Covered Health Care Services through virtual therapy and coaching services that are individualized and tailored to your specific health needs. Virtual therapy is provided by licensed therapists. Coaching services are provided by coaches who are supervised by licensed professionals. If you would like information regarding these services, you may contact the Claims Administrator at the telephone number on your ID Card. Non-Preventive Nutritional Counseling Non-preventive nutritional counseling services for mental health and substance-related and addictive disorders and medical diagnosis that are provided as part of treatment for a disease by appropriately licensed or registered health care professionals. When nutritional counseling services are billed as a preventive care service, these services will be paid as described under Preventive Care Services in this section. Ostomy Supplies Benefits for ostomy supplies are limited to the following: • Pouches, face plates and belts. • Irrigation sleeves, bags and ostomy irrigation catheters. • Skin barriers.