in-20260225-IR-405260060ONA: Notice of Change in Applied Behavioral Analysis Coverage

OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES Notice of Change in Applied Behavioral Analysis Coverage In accordance with public notice requirements established at 42 CFR 447.204 and 42 CFR 447.205, the Indiana Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) publishes this notice of proposed changes to methods and standards governing Applied Behavior Analysis (ABA) coverage and policies. The public notice period is from February 25, 2026, through March 27, 2026. The FSSA - OMPP proposes to submit a State Plan Amendment (SPA) to modify the coverage policy for ABA services. The proposed SPA would revise ABA service coverage to only be available through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Eligible individuals may receive up to 4,000 hours of comprehensive ABA therapy based on medical necessity, with up to 15 hours of medically necessary targeted ABA therapy weekly following the utilization of 4,000 hours. If further comprehensive or targeted ABA therapy beyond these limits is found to be medically necessary, as determined by FSSA or a delegated entity of FSSA, it will be covered under EPSDT. Caregiver coaching will require up to 18 hours within a 6-month prior authorization period, with exceptions for youth in Department of Child Services or foster care. If this requirement is not met, it may result in denials or reductions in future authorizations. For every eight hours of care provided by a Registered Behavior Technician, there will be a requirement of one face-to-face supervision hour by a Board-Certified Behavior Analyst, including both individual and group sessions. All ABA therapy providers must obtain accreditation from the Autism Commission on Quality or another recognized body to be Indiana Health Coverage Program enrolled. OMPP will implement a phased adjustment to reimbursement rates for individual ABA services. Effective April 1, 2026, reimbursement rates for individual ABA services will be reduced by 6%. Effective April 1, 2027, OMPP will apply an additional 4% reduction. There will also be the creation of a range of rates for Group Adaptive Behavior Treatment, varying by group size, to encourage the use of more group services. These adjustments aim to improve accessibility and to ensure the quality of ABA services provided to eligible individuals. It is estimated that there will be a decrease in annual expenditures. This change will be effective April 1, 2026. A copy of this notice is now on file at the Indiana Government Center South, 402 West Washington Street, Room W451, Indianapolis, Indiana and is open for public inspection. Also, a copy of this notice is now available and may be inspected by contacting the local county Division of Family Resources office, except in Marion County, where public inspection may be made at 402 West Washington Street, Room W374, Indianapolis, Indiana. There will be no public hearing. Written comments will be accepted until 5 p.m. on March 27, 2026, and may be directed to FSSA, Office of Medicaid Policy and Planning, Attention: Conner Ortman, 402 West Washington Street, Room W374, Indianapolis, IN 46204 or by email to spacomment@fssa.in.gov. Correspondence should be identified in the following manner: COMMENT RE: APPLIED BEHAVIORAL ANALYSIS COVERAGE. Written comments will be made available for public inspection at the address herein of the OMPP.