Nebraska Cut ABA to 20 Hours a Week on July 1 and Stopped Paying for It in Schools

Nebraska Medicaid's revised ABA service definition took effect July 1, 2026. Provider Bulletin 26-06, issued June 1, announced it. The headline change is hours: “Direct ABA service hours provided to the individual may not exceed 6 hours in a single day or a total of 20 hours per week.”

WOWT reported the previous threshold before prior authorization was 30 hours a week. In a piece on August 29 we described Nebraska's weekly cap as 30. That was already out of date when it ran. It's 20.

The turn: 20 is a ceiling with a door

The definition doesn't make 20 absolute. “Additional daily or weekly treatment hours may be requested in certain clinical circumstances for which clinical justification must be submitted for prior authorization and be approved.” So the practical effect is paperwork on every case above 20, not an automatic cut. A clinic owner told WOWT that 54 percent of the children they serve need more than 20 hours.

Schools

“Independent providers may not bill Medicaid directly for services provided at a school.” ABA in a school is part of the school-based services program and is the school's responsibility under 471 NAC 25. School isn't among the allowable settings: community, home, and office or clinic.

In person, every month

• The supervisor must observe the technician or LaBA in person for at least one hour a month.
• The treating LBA or psychologist must provide at least one hour of in-person direct services to the individual monthly.
• Direct supervision by observation must be no less than 10% of direct service hours (97153, 97154, 97155) each week, and any shortfall needs a documented reason and corrective action plan.
• An LBA may not supervise more than 24 technicians.

Families and teachers

• Family participation: 1 hour a month for individuals receiving 10 hours or less a month, 2–4 hours for everyone else.
• Teacher training can't exceed 25% of required caregiver training hours, and IEP meetings aren't billable.
• Services continued longer than 6 months without demonstrated progress, or without plan changes to address barriers, are a discharge criterion.

One expansion: members on Developmental Disabilities waivers can now receive 97151 and 97152 assessments regardless of age.

The limits

The definition PDF carries no date of its own, so the effective date rests on the bulletin. DHHS told WOWT Medicaid ABA spending rose more than 2,000% since 2020. That's the agency's figure, and it didn't publish the underlying data.

What you must know or do

• Pull every authorization above 20 hours a week or 6 hours a day and confirm a clinical justification was submitted and approved for dates after July 1.
• Search claims since July 1 for a school place of service. An independent provider billing those is billing a service the definition says belongs to the school.
• Add two monthly checks to each chart: one hour of in-person supervisor observation per technician, and one hour of in-person direct service by the treating LBA or psychologist.
• Count teacher training against caregiver hours for each client. Anything above 25% doesn't count toward the requirement.