Applied Behavioral Analysis Therapy

Updated Sept. 20, 2023

The Indiana Family and Social Services Administration, and its Office of Medicaid Policy and Planning, pays for coverage of Applied Behavioral Analysis (ABA) therapy. This therapy can improve social, cognitive and behavioral outcomes in some children with autism spectrum disorder as well as the overall wellbeing of the child and their family.

Medicaid first began covering these services in 2016. Because there was no meaningful data on which to set base rates at that time, FSSA has paid providers a percentage of the amount they chose to bill the state rather than a transparent statewide rate for ABA therapy services. Payment of a percent of billed charges has resulted in widely different reimbursement amounts for different providers of the same service. Over the last three years, ABA expenditures have increased by more than 50% per year, which is not a sustainable rate. For 2022, ABA claims payments represented a Medicaid spend of $420 million, and those costs will continue to grow at an unsustainable rate if an ABA fee schedule is not implemented. In addition, Indiana’s reimbursement amounts are significantly higher than other states providing similar services.

FSSA in 2022 began to lay the groundwork to establish a uniform rate. This included reaching out to ABA providers and seeking information about their costs. We’ve learned how other states reimburse for this service, and we’ve reviewed public data sources such as the Bureau of Labor Statistics, the Internal Revenue Service and the Indiana Department of Workforce Development.

In August, FSSA shared preliminary statewide rates for all ABA services, in alignment with our work to establish a Medicaid rate matrix. That was followed by a period for providers to give data-driven feedback on the preliminary rates.

The goal is to transition away from individual reimbursement amounts that are essentially set by providers and move to transparent statewide ABA rates that promote uniform access for families and allow providers to retain a stable workforce, while ensuring sustainability for Indiana’s Medicaid program. The established rates should cover the cost of providing the service plus a reasonable overhead.

Since receiving feedback from providers and families, FSSA has updated the preliminary ABA rates to reflect a productivity adjustment for supervisors to cover time for which they are unable to bill and to include a 20% overhead, rather than a 15% overhead.

The updated rates are:

• The rate for the primary ABA service delivered by a Registered Behavioral Technician (RBT) has increased to $68.24 per hour, up from $55.19 per hour. This is a 24% increase.
• The rate for the primary ABA service delivered by a master’s level Board Certified Behavior Analyst (BCBA) has increased to $110.52, up from $103.77.

The RBT rate is higher than the Medicaid rate paid in Kentucky, Ohio, Illinois, Michigan and Missouri, and is higher than the rate paid in Indiana under the federal TriCare program. The rate is also in line with both the average ($68) and median ($62) rate across all states with available data.

Click here for the provider presentation from Sept. 20.

FSSA plans to implement the fee schedule in January. Providers will be impacted differently by a statewide rate. More cost-effective providers may have increases in reimbursement amounts. Others may see little change, and higher-cost providers may have a decrease in their reimbursement.

The rates will be included in the Medicaid rate matrix, which means rates will be reviewed at least every four years using an evidence-based rate methodology. A yearly index will provide adjustments annually when necessary. These are both important steps toward setting a path for long-term sustainability.

ABA has been the only major service category on the rate matrix for which no established rate has been set.

You can read more about the rate matrix here.

Below are frequently asked questions and additional resources.

Frequently Asked Questions

When did Medicaid coverage for ABA therapy services begin?
Coverage for ABA therapy services was added to Indiana Medicaid programs in 2016. Demand for those services has grown significantly since that time.

How many children or young adults receive these Medicaid services and how much does it cost?
In 2022, Indiana Medicaid programs provided ABA therapy services to about 6,200 children and young adults each month, resulting in $420 million in annual claim payments to ABA providers.

What were the results from the provider survey regarding their costs for ABA therapy services?
You can find that information here.

What is the Medicaid rate matrix?
Here is information about the rate matrix.

Updated Aug. 8, 2023

The Indiana Family & Social Services Administration, and its Office of Medicaid Policy & Planning, pays for coverage of Applied Behavioral Analysis (ABA) therapy. This therapy can improve social, cognitive, and behavioral outcomes in some children with autism spectrum disorder as well as the overall wellbeing of the child and their family.

Medicaid first began covering these services in 2016. Because there was not meaningful data on which to set base rates at that time, FSSA has paid providers a percentage of the amount they chose to bill the state rather than a transparent statewide rate for ABA therapy services.  Payment of a percent of billed charges  has resulted in widely different reimbursement amounts for different providers of the same service. Over the last three years ABA expenditures have increased by more than 50% per year, which is not a sustainable rate. For 2022, ABA claims payments represented a Medicaid spend of $420 million and those costs will continue to grow if an ABA fee schedule is not implemented. In addition, Indiana’s reimbursement amounts are significantly higher than other states providing similar services.

FSSA began work in 2022 to lay the groundwork to establish a uniform rate. This included reaching out to ABA providers and seeking information about their costs. We’ve learned how other states reimburse for this service, and we’ve reviewed public data sources such as the Bureau of Labor Statistics, the Internal Revenue Service, and the Indiana Department of Workforce Development.

After sharing initial findings from the provider survey and meeting with providers to discuss their questions, we’ve drafted preliminary statewide rates for all ABA  services, in alignment with our work to establish a Medicaid rate matrix. The goal is to transition away from individual reimbursement amounts that are essentially set by providers and move to transparent statewide ABA rates that promote uniform access for families and allow providers to retain a stable workforce, while ensuring sustainability for Indiana’s Medicaid program.

The proposed rates are:

• $55.16 per hour for adaptive behavior treatment by protocol, administered by a Registered Behavioral Technician (RBT) (CPT 97153)
• $103.77 per hour for adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional (CPT 97155)

Please click here for the full findings and draft rates.

We will collect provider feedback in the coming weeks, establish the final rates and plan to implement the fee schedule in later 2023 or early 2024. Providers will be impacted differently by a statewide rate. More cost-effective providers may have   increases in reimbursement amounts. Others may see little change, and higher-cost providers may have a decrease in their reimbursement.

The rates will be included in the Medicaid rate matrix, which means rates will be reviewed at least every four years using an evidence-based rate methodology. A yearly index will provide adjustments annually when necessary. These are both important steps toward setting a path for long-term sustainability.

For example, the rate methodology used for ABA rate setting aligns with methodology used for waiver rate setting earlier in 2023.

ABA has been the only major service category on the rate matrix for which no established rate has been set.

You can read more about the rate matrix here.

Below are frequently asked questions and additional resources.

Frequently Asked Questions

When did Medicaid coverage for ABA Therapy Services begin?
Coverage for ABA Therapy Services was added to Indiana Medicaid programs in 2016. Demand for those services has grown significantly since that time.

How many children or young adults receive these Medicaid services and how much does it cost?
In 2022, Indiana Medicaid programs provided ABA Therapy Services to about 6,200 children and young adults each month, resulting in $420 million in annual claim payments to ABA providers.

What were the results from the provider survey regarding their costs for ABA Therapy Services?
You can find that information here.

What is the Medicaid rate matrix?
Here is information about the rate matrix.