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Issue 4 |
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👋 Hey there!
California's legislature passed AB 2233 without a single no vote. The idea is simple: a child's authorized ABA hours shouldn't disappear because the family had to cancel that week. It's on Governor Newsom's desk until September 30, and unless he vetoes it, it takes effect January 1. It covers commercial plans, not Medi-Cal, and protects only make-up hours the treatment plan documents. Elsewhere, other states asked the same question in other units of time. Missouri counts billable minutes by the day. Pennsylvania's Community Care now authorizes six months at a time, not twelve. Oklahoma's Medicaid plans require twice the state's supervision. West Virginia won't cover a child diagnosed after turning eight. Act on Washington first: comments on barring relatives from supervising a CBT or LABA close this Tuesday, September 22. None of this changes what good treatment looks like. It changes how much of it a child gets.
⭐ Featured This Week
California's Ban on Forfeited ABA Hours Is on Newsom's Desk Until September 30 California LegislatureAB 2233 bars California commercial plans from weekly caps that forfeit unused authorized ABA hours within the six-month authorization. It passed 38-0 and 76-0. Newsom has until September 30; Medi-Cal plans are excluded. Read Full Article → 🎧 Listen
📚 Research Digest
A Five-Item Screener Caught 91% of Autistic Toddlers in 10 Minutes. Hung YRThe STAT-Brief Form uses turn-taking, bubbles, snack, balloon and a bag of toys, with a cutoff of 3. Administration drops to five to ten minutes. The authors call it a Level 2 tool for toddlers already referred for developmental concerns, not a population screen. Read more → 🎧 Listen5,279 Americans Were Asked What to Call Autism. There Was No Consensus. Dwyer PAlmost half of participants sat in an Open Cluster, comfortable with most terms. The rest split between identity-first and person-first camps, with autistic participants overrepresented in the first and non-autistic parents in the second. Read more → 🎧 Listen
⚖ Legislation Tracker
Tennessee Schools Must Let Your RBT In. Bring an MOU and Proof of Insurance. Tennessee Public Chapter 1112Tennessee districts can no longer charge a fee or place barriers in front of privately paid ABA in the classroom. In exchange the provider owes an executed MOU, a Section 49-5-413 background investigation, and insurance naming the school as an additional insured. Read more → 🎧 ListenLouisiana Registers Your Line Technicians Itself. A BACB Credential Isn't Enough. Louisiana Medicaid Services ManualA BACB credential does not make a technician billable in Louisiana — the state keeps its own register, and the supervisory relationship has to be documented in writing. Supervision is not payable when the licensed professional delivered the therapy. Read more → 🎧 ListenWest Virginia Won't Cover ABA If the Diagnosis Came After the Eighth Birthday. West Virginia BMS Provider ManualA West Virginia child diagnosed at nine is not eligible for Medicaid ABA at any age. Combined codes are capped at 40 hours a week and eight in any 24 hours, back-dating authorizations is barred, and denied services cannot be balance-billed to the family. Read more → 🎧 ListenEvery SSI Child Gets Redetermined at 18. SSA's New Rule Applies October 1. Social Security Ruling SSR 26-2pSSA published SSR 26-2p on September 1 and applies it October 1. It governs age-18 redeterminations, continuing disability reviews, and title II child claims for disability beginning before age 22 — and it names autism spectrum disorder listing 12.10. Read more → 🎧 ListenWashington May Bar Relatives From Supervising a CBT. Comments Close September 22. Washington State RegisterWashington's Department of Health proposes that a CBT or LABA supervisor can't be related to, subordinate to, or employed by the supervisee. Hearing and written comments both close September 22; intended adoption is September 29. Read more → 🎧 Listen
💼 Industry News
Missouri Gives a Behavior Technician 90 Days. Day 91 Is a Full Recoupment. MO HealthNet Division hot tipMissouri lets a behavior technician bill for 90 calendar days from the date they pass the RBT initial competency assessment. Miss the credential by day 90 and every paid claim is subject to immediate, full recoupment, not a denial going forward. Read more → 🎧 ListenThe Six New ABA Codes Have Numbers. 97155's Old Job Now Spans Two Codes. ABA Coding CoalitionThe 2027 ABA codes are 97148/97149 (harmful behavior assessment), 97159/97160 (harmful behavior treatment), 97173 (treatment with analysis by the QHP) and 97180 (non-face-to-face). 97155 narrows to directing a technician. Effective January 1. Read more → 🎧 ListenOklahoma's Three Medicaid Plans Doubled ABA Supervision. Fee-for-Service Didn't. Oklahoma Health Care AuthorityAll three SoonerSelect plans now require ABA case supervision at 10% of direct treatment hours and cap initial 97151 assessments at 24 units. Oklahoma Complete Health requires the TS modifier on reassessments from September 16. Read more → 🎧 ListenOklahoma's ABA Quality Reviews Start This Month. The Trial Round Found 13 Problems. Oklahoma Health Care AuthorityOHCA began full ABA Service Quality Reviews in September. Its educational round flagged uncontracted RBTs, billed naps, unclear start and stop times, and 20 hours billed against 10 documented. Deficiencies can mean full or partial recoupment. Read more → 🎧 ListenOne Payer Authorizes ABA for Down Syndrome. Another Excludes It by Name. Carelon Behavioral HealthCarelon Massachusetts requires two direct observations with at least one in the home, and formal assessment data from three separate categories — including a caregiver-impact measure — before an initial treatment plan is authorized. Read more → 🎧 ListenMissouri: Add Up the Day's ABA Minutes, Then Convert. One Claim Line per Code. MO HealthNet Division hot tipMO HealthNet's September 9 ABA tip: note exact start and stop times, subtract naps and meals, total each code's minutes for the day before converting to units, and bill one line per code. Rounding sessions separately overbills. Read more → 🎧 ListenPennsylvania's Community Care Now Authorizes IBHS Six Months at a Time Community Care Behavioral HealthSince September 17, Community Care Behavioral Health approves IBHS, ABA included, for six months at most, down from 12. ABA assessment requests cap at 200 units. Magellan follows in Somerset and Bedford counties on October 1. Read more → 🎧 Listen📤 Pass it on Know someone in ABA who should be reading this? We will send them one invitation from you — and nothing else unless they subscribe. Invite a colleague → |
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