Nebraska Blue's Revised ABA Policy Starts Nov. 15: Office or Telehealth, 25 Hours

Blue Cross and Blue Shield of Nebraska revised its ABA medical policy, I.178 Autism Spectrum Disorders, effective November 15, 2026. That's less than three weeks out. Preauthorization stays required. The plan's November medical policy update says only that "several changes have been made," and it doesn't list them. So the useful question is what the policy requires from November 15, not which lines are new.

The line about where

The hour and supervision numbers will draw the attention. The sentence that can change a schedule is about setting: "Services must be delivered in an office setting or through telehealth (CPT codes 97155 97156 are the only services payable as telehealth)." Daycare is out entirely: services there "are an exclusion of the members' contract." The policy doesn't name the home either way. If you deliver 97153 in families' homes, raise it with the plan before November 15, not after the first denial.

What I.178 says from November 15

• Hours: the treatment plan "should include treatment with a certified or licensed ABA provider ... for no more than 25 hours per week." The same wording appears for children 7 and under and for those 8 and over.
• Supervision: when a CBAA or BCaBA delivers services, the LBA or BCBA "must provide and document supervision for a minimum of 25% (6.25 hours per week) of the direct therapy hours provided by the CBAA or BCaBA."
• Diagnosis and referral: a diagnosis by a licensed medical professional or licensed psychologist, and "a current referral (within 3 years)" from the treating or ordering physician. The diagnosis must be supported by structured caregiver interviews, direct behavioral observation, social-communication deficits "in at least 2 different settings," and restricted or repetitive behaviors.
• Gaps in service: "If a patient has been absent from services for more than 60 days, new assessments and goals are required."
• Continuation: reassessment every 6 months. "Significant improvement" means "mastery of a minimum of 50 percent of stated goals and/or objectives," shown with pre- and post-data that include generalization "across people, settings, and environments." Progress toward closing the gap between chronological and developmental age is measured with "psychological tests." A member who keeps missing those marks "may be denied through the peer review process."
• Group ABA: needs documentation that the child's age and developmental level make group therapy beneficial, with goals that support the group hours requested.

The same notice adds a new policy, I.222, that limits physical, occupational and speech therapy to "a maximum of 25 hours per week for each therapy discipline," also from November 15. So from November 15, 25 hours a week appears in both of BCBSNE's therapy policies.

The limits

We couldn't find the prior version of I.178, so we can't tell you which of these requirements are new. The 25-hour figure is written as what a treatment plan "should include," not as a hard claim edit. The policy applies "when a state mandate requires or a benefit plan explicitly provides coverage for ABA," and groups outside Nebraska's mandate get a separate list of services the plan may treat as not medically necessary. It points to New Directions' provider manual for documentation rules. This is BCBSNE's commercial policy. Nebraska Medicaid runs on its own rules.

What you must know or do

• Owners: list every BCBSNE client whose 97153 happens at home or in a daycare. Before November 15, ask the plan in writing whether in-home sessions stay payable under the revised I.178, and keep the answer in the file.
• Clinical directors: pull BCBSNE authorizations above 25 hours a week. Each one needs a documented case for the extra hours at its next reauthorization.
• BCBAs supervising a CBAA or BCaBA: check last month's documented supervision against 25% of that clinician's direct hours. At 25 direct hours, that's 6.25.
• Intake: check the date on each BCBSNE client's physician referral. Anything older than 3 years needs a new one.
• Schedulers: flag any BCBSNE client out of services for more than 60 days. They need new assessments and goals before sessions restart.