Posted 1 week ago Author: 3 Pie Squared Marketing Team

Nebraska Issues New ABA Medicaid Service Definitions Amid Federal Audit Scrutiny

The Nebraska Department of Health and Human Services (DHHS) has released updated Medicaid Service Definitions (MSDs) for Applied Behavior Analysis (ABA), effective February 7, 2025. This move comes as federal audits highlight concerns over improper billing practices in other states, notably Indiana's $56 million in improper Medicaid payments for ABA services.

Key Updates in the New ABA Service Definitions

The revised MSDs aim to clarify service expectations and ensure compliance with federal and state regulations. Developed in consultation with Board Certified Behavior Analysts (BCBA-Ds), psychologists, and physicians, the updates incorporate industry best practices and national trends.

Main areas of clarification include:

Hours of Service: Defined parameters for service hours to prevent overutilization.
Provider Requirements: Updated qualifications for practitioners delivering ABA services.
Schools as a Place of Service: Guidance on providing ABA services within educational settings.
Parent and Caregiver Involvement: Emphasis on active participation in the treatment process.
Treatment Plan Review Frequency: Distinction between plan updates and prior authorization timelines.
Supervision Requirements: Detailed expectations for oversight of ABA services.
Crisis Intervention: Inclusion of protocols for managing behavioral crises.
Scope of Practice: Clarification of roles and responsibilities within ABA service delivery.

Stakeholder Engagement and Feedback

DHHS received over 300 comments from ABA providers and community members during the open review period. The department expressed gratitude for this input, which informed the final revisions.

The collaborative approach underscores Nebraska's commitment to transparency and stakeholder involvement in policy development.

Context: Federal Audits and Increased Scrutiny

The release of Nebraska's updated MSDs coincides with heightened federal oversight of Medicaid-funded ABA services. A recent audit in Indiana uncovered significant improper payments, prompting reviews in other states. In Nebraska, ABA services have seen a 1,200% increase, emphasizing the need for clear guidelines to prevent misuse and ensure appropriate billing.

Implications for ABA Providers

Providers should familiarize themselves with the new MSDs to ensure compliance and maintain service quality. Key actions include:

Reviewing Updated Definitions: Understanding the revised service parameters and documentation requirements.
Training Staff: Ensuring that all team members are informed about the changes and their implications.
Adjusting Practices: Aligning service delivery models with the updated guidelines to meet compliance standards.

Staying informed and adaptable will be crucial as Nebraska implements these changes and as federal scrutiny continues.

Sources:

Disclaimer: This article summarizes publicly available information and reporting from external sources. We encourage readers to review the original reports linked above for complete details and context. This summary does not represent legal advice, nor is it an official statement from any party involved.