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).
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a federally mandated Medicaid benefit ensuring comprehensive, preventive health services for individuals under 21. It covers physical, mental, and dental screenings, as well as necessary diagnostic and treatment services to correct or ameliorate health conditions. States must ensure access to these services.
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.
It is estimated that there will be a decrease in annual expenditures. This change will be effective April 1, 2026.
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.
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