Applied Behavior Analysis (ABA) Division of Health Care Financing - PowerPoint PPT Presentation

Brian Sandoval Marta Jensen Governor Administrator Division of Health Care Financing and Policy Applied Behavior Analysis (ABA) Division of Health Care Financing and Policy

The Division of Health Care Financing and Policy works in partnership with the Centers for Medicare and Medicaid Services (CMS) to assist in providing quality medical care for eligible individuals and families with low income and limited resources. Services are provided through a combination of traditional fee-for-service provider networks and managed care organizations. 2 Division of Health Care Financing and Policy

ABA Medicaid Policy • Medicaid Services Manual (MSM) Chapter 1500 Health Kids Program Attachment B – Coverages and Limitations – Prior Authorization Requirements – Provider Responsibility – Parent/Guardian Responsibility 3 of [total slides] Division of Health Care Financing and Policy

ABA Coverage and Limitations • Children under the age of 21 • Eligible for Medicaid FFS or MCO • Diagnosis of Autism Spectrum Disorder (ASD) • Focused Delivery Model – directly provided to the individual for a limited number of specific behavioral targets • Comprehensive Delivery Model – provided to the individual for a multiple number of targets across domains of functioning including cognitive, communicative, social and emotional 4 Division of Health Care Financing and Policy

Coverage and Limitations (cont.) • Covered Services – Behavioral Screening – Comprehensive Diagnostic Evaluations – Behavioral Assessment – Adaptive Behavioral Treatment Intervention • Prior Authorization Required – Adaptive Behavioral Family Treatment • Prior Authorization Required 5 Division of Health Care Financing and Policy

Prior Authorization • Must have ASD diagnosis – IEP/School Based diagnoses are not accepted per federal regulations • Forms FA-11E and FA-11F submitted by ABA provider • Fee for Service PAs processed by DXC, fiscal agent – 5 business days from date of receipt – 2 additional days if needed for physician review – May pend to provider for additional information Note: Assessments and evaluations do not require auth but are subject to limitations, i.e. once every 180 days 6 Division of Health Care Financing and Policy

Provider Responsibility • Services must be provided under a treatment plan • Submit and monitor prior authorization requests • Submit and monitor claims submissions • Alert DXC and DHCFP of any inconsistencies 7 Division of Health Care Financing and Policy

Parent/Guardian Responsibility • Must be present during all home-based services • Participate in trainings • Sign the treatment plan • Participate in treatment hours when applicable 8 Division of Health Care Financing and Policy

Provider Enrollment BCBA (Provider Type 85 Specialty 310) • – SS-4, CP575 or W-9 form showing Taxpayer Identification Number (this may be the employer’s tax ID; individual providers do not need their own tax ID if they are an employee of an entity/agency/group with a tax ID) – Masters or Doctorate degree in social science/special education from an accredited educational institution – Certification by the Behavior Analyst Certification Board (BACB) – Proof of Licensure or provisional licensure as a Behavior Analyst under Nevada Revised Statute (NRS) 641.170 from the Nevada Board of Psychological Examiners – Provider Enrollment Application and Contract (original document/signatures required) – National Provider Identifier (NPI) validation: Printed page from the NPPES NPI Registry displaying the provider’s NPI or a printed copy of the email confirmation showing the provider’s NPI 9 Division of Health Care Financing and Policy

Provider Enrollment Psychologist (Provider Type 85 Specialty 311) • – SS-4, CP575 or W-9 form showing Taxpayer Identification Number (this may be the employer’s tax ID; individual providers do not need their own tax ID if they are an employee of an entity/agency/group with a tax ID) – Doctorate in psychology from an educational institution accredited by the American Psychological Association (APA) (NRS 641.170) – Proof of Licensure or provisional licensure as a Psychologist under Nevada Revised Statute (NRS) 641.170 from the Nevada Board of Psychological Examiners – Provider Enrollment Application and Contract (original document/signatures required) – National Provider Identifier (NPI) validation: Printed page from the NPPES NPI Registry displaying the provider’s NPI or a printed copy of the email confirmation showing the provider’s NPI 10 Division of Health Care Financing and Policy

Provider Enrollment BCaBA (Provider Type 85 Specialty 312) • – SS-4, CP575 or W-9 form showing Taxpayer Identification Number (this may be the employer’s tax ID; individual providers do not need their own tax ID if they are an employee of an entity/agency/group with a tax ID) – A minimum of a Bachelors degree in social science/special education from an accredited educational institution – Certification by the Behavior Analyst Certification Board (BACB) – Proof of Licensure as an Assistant Behavior Analyst under Nevada Revised Statute (NRS) 641.170 from the Nevada Board of Psychological Examiners – Provider Enrollment Application and Contract (original document/signatures required) – National Provider Identifier (NPI) validation: Printed page from the NPPES NPI Registry displaying the provider’s NPI or a printed copy of the email confirmation showing the provider’s NPI 11 Division of Health Care Financing and Policy

Provider Enrollment • RBT (Provider Type 85 Specialty 314) – SS-4, CP575 or W-9 form showing Taxpayer Identification Number (this may be the employer’s tax ID; individual providers do not need their own tax ID if they are an employee of an entity/agency/group with a tax ID) – Proof of Credentialing from Behavior Analyst Certification Board – Provider Enrollment Application and Contract (original document/signatures required) – National Provider Identifier (NPI) validation: Printed page from the NPPES NPI Registry displaying the provider’s NPI or a printed copy of the email confirmation showing the provider’s NPI 12 Division of Health Care Financing and Policy

Provider Enrollment • Entity/Agency/ Group – SS-4, CP575 or W-9 form showing Taxpayer Identification Number – Business license – Clinical supervisor’s professional license as a Behavior Analyst (BCBA) or Psychologist under Nevada Revised Statute (NRS) 641.170 from the Nevada Board of Psychological Examiners – Provider enrollment application and contract (original document/signatures required) – National Provider Identifier (NPI) validation: Printed page from the NPPES NPI Registry displaying the provider’s NPI or a printed copy of the email confirmation showing the provider’s NPI 13 Division of Health Care Financing and Policy

Provider Enrollment Data Chart Title 450 382 400 352 350 316 282 300 250 227 200 150 85 82 100 77 71 72 38 37 34 31 30 50 6 6 6 4 4 4 4 4 5 5 0 No Specialty Lic. Board Certified Behavior Psychologist Lic. Board Certified Assist Registered Behavior Technician Analyst Behavior Analyst (Rbt) 000 310 311 312 314 Applied Behavior Analysis Prov 085 Providers Enrolled QTR 1 2017 Providers Enrolled QTR 2 2017 Providers Enrolled QTR 3 2017 Providers Enrolled QTR 4 2017 Providers Enrolled QTR 1 2018 **data reflects Fee For Service claims only 14 Division of Health Care Financing and Policy

ABA Recipients ABA Recipients 302 267 237 187 185 QTR 1 2017 QTR 2 2017 QTR 3 2017 QTR 4 2017 QTR 1 2018 Claim ID no Void 085 Patients 185 237 187 267 302 **data reflects Fee For Service claims only 15 Division of Health Care Financing and Policy

Net Payment Net Payment $1,157,478.28 $898,516.80 $806,245.98 $792,436.45 $569,916.50 QTR 1 2017 QTR 2 2017 QTR 3 2017 QTR 4 2017 QTR 1 2018 Claim ID no Void 085 Net Payment Time Period: Incurred With Runoff Quarter **data reflects Fee For Service claims only 16 Division of Health Care Financing and Policy

Resources ABA Nevada Medicaid Program information http://dhcfp.nv.gov/Pgms/CPT/ABA/ ABA Billing guide https://www.medicaid.nv.gov/Downloads/provider/NV_BillingG uidelines_PT85.pdf ABA Medicaid Services Manual Policy http://dhcfp.nv.gov/Resources/AdminSupport/Manuals/MSM/C 1500/Chapter1500/ 17 Division of Health Care Financing and Policy

Contacts Jaime Hutchison, Program Specialist (775) 684-3782 Jaime.Hutchison@dhcfp.nv.gov Jodi Patton, Social Services Program Specialist III (775) 684-3778 jpatton@dhcfp.nv.gov 18 Division of Health Care Financing and Policy