Providers and families are advocating for health insurers and school districts allow medically necessary services be provided in the school setting. HB22-1260 would allow children reasonable accommodations to access third-party-funded healthcare to get the care they need in schools and Ensure healthcare insurers, including Medicaid, cover costs of ameliorating medical symptomatology rather than schools.
Illinois is the last state where Medicaid coverage for ABA is not available. House Bill 4769 (HB4769) creates a license for BCBA’s that would allow ABA to be provided to Medicaid beneficiaries. The bill passed the House and will now move to the Senate to be heard in committee before going to the Senate floor for a vote.
The Oregon Health Authority (OHA) will submit a State Plan Amendment (SPA) to the
Centers for Medicare & Medicaid Services (CMS) to increase reimbursement for Applied Behavioral Analysis (ABA) procedure codes based on the OHA Legislatively Approved Budget (LAB) for the 2021-2023 biennium.
The 2021-2023 LAB approved increasing reimbursement for ABA CPT codes 97153 and 97155 to $55 per hour, or $13.75 per 15-minute unit.
The New Jersey Department of Medicaid has increased the RBT rate for 97153 to $15.00 a unit, effective January 1, 2022.
HB412 which creates a licensure for BCBAs in Georgia passed the House and is moving to the Senate. The bill has faced scrutiny from other licensed professionals that would like RBTs to be included in the bill. This would create significant delays to access for families that have just recently been able to access ABA through Medicaid in the state.
SB103 was signed into law by the Governor in May 2021. The licensure board appointees have been made. The NC Behavior Analyst Licensure Board is currently working on developing the rules, regulations, and processes for licensure. BCBAs must continue to follow the existing laws under the practice act until they can obtain their own license. There is no update on the timeline for when BCBAs can apply.
Questions and Additional Information
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