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Nov. 1, 2023

AHCCCS Sets Rates for Applied Behavior Analysis Services

PHOENIX - AHCCCS announces a designated Fee-for-Service (FFS) fee schedule effective for dates of service beginning November 1, 2023. The new fee schedule includes a change to the Applied Behavioral Analysis (ABA) rates for fee-for-service providers.

Setting rates for ABA services will not change the services covered by Medicaid. The array of covered services remains the same. Additionally, the proposed rates only pertain to Fee-for-Service claims.

The proposed rates ensure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available at least to the extent that such care and services are available to the general population in the geographic area.

Historically, ABA providers who bill the Fee-for-Service program were reimbursed a percentage of the billed amount. This payment methodology, known as “by report,” left AHCCCS exposed to potentially fraudulent billing and exploitation by criminal actors. Across the payment system, AHCCCS is evaluating all “by report” rates and establishing set rates, in alignment with current market values, in order to thwart fraudulent billing practices.

During a public comment period in September about the proposed rate change, AHCCCS received response from the provider community who assumed a set rate would necessarily cut the service array, as providers would be paid less than they had received in the past.

Based on provider response, AHCCCS incorporated changes to the final rates, including adding a “in-home” reimbursement rate for ABA services and adding a rate differential on codes for a practitioner with a masters degree.

See the Frequently Asked Questions About ABA Services for more information.

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