Applied behavior analysis (ABA) – Provider enrollment requirements

Washington State Health Care Authority sent this bulletin at 06/26/2023 03:31 PM PDT

June 26, 2023

Apple Health (Medicaid) Provider Alert

Attention Applied behavior analysis (ABA) providers:

This notice provides an update to the April 2023 provider alert regarding which ABA providers must enroll with Apple Health (Medicaid) and which individual providers must be identified as servicing providers on ABA claims.

Providers who render services to Apple Health clients must be enrolled with the Health Care Authority (HCA) under the billing providers Core Provider Agreement (CPA) – See WAC 182-502-0005(2). Certified behavior technicians (CBTs) and Licensed Assistant Behavior Analysts (LABAs) must be enrolled with Apple Health as a servicing provider (also known as rendering or performing provider) and their National Provider Identifier (NPI) must be listed on claims for services provided.

Effective July 1, 2024, all CBTs and LABAs working with Apple Health clients must meet the following requirements:

Have an active CBT or LABA license with the Department of Health (DOH)
Have an NPI
If part of a health care group or organization with a CPA, enroll with HCA as a servicing provider or nonbilling provider under the group’s CPA
If applicable, enroll with the managed care organization (MCO) as a servicing provider
For dates of service on and after July 1, 2024, have their NPI captured on the claim as the servicing provider for services rendered.

Additional information:

See WAC 182-502-0002 for eligible provider types.

See WAC 182-531A-0800 for ABA provider requirements.

See HCA’s Applied Behavior Analysis (ABA) Program Billing Guide.

Please contact the ABA program with any questions or comments.

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About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Applied behavior analysis (ABA) – Provider enrollment requirements

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination