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

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

Aug 19, 2023 110 likes •302 views

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

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Applied Behavior Analysis (ABA)

Division of Health Care Financing and Policy

Brian Sandoval Governor

Marta Jensen Administrator Division of Health Care Financing and Policy

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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

  • rganizations.

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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

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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

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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

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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

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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

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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

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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

  • wn 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

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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

  • wn 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

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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

  • wn 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

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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

  • r a printed copy of the email confirmation showing the

provider’s NPI

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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

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Division of Health Care Financing and Policy

Provider Enrollment Data

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30 71 4 5 227 31 72 4 5 282 34 77 4 6 316 37 82 4 6 352 38 85 4 6 382 50 100 150 200 250 300 350 400 450 No Specialty

  • Lic. Board Certified Behavior

Analyst Psychologist

  • Lic. Board Certified Assist

Behavior Analyst Registered Behavior Technician (Rbt) 000 310 311 312 314 Applied Behavior Analysis Prov 085

Chart Title

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

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Division of Health Care Financing and Policy

ABA Recipients

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QTR 1 2017 QTR 2 2017 QTR 3 2017 QTR 4 2017 QTR 1 2018 Claim ID no Void 085 Patients 185 237 187 267 302 185 237 187 267 302

ABA Recipients **data reflects Fee For Service claims only

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Division of Health Care Financing and Policy

Net Payment

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$569,916.50 $792,436.45 $806,245.98 $898,516.80 $1,157,478.28 QTR 1 2017 QTR 2 2017 QTR 3 2017 QTR 4 2017 QTR 1 2018

Net Payment

Claim ID no Void 085 Net Payment Time Period: Incurred With Runoff Quarter

**data reflects Fee For Service claims only

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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/

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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

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