ABA Provider Meeting-Rate Methodology - Draft Rates

Sep 20, 2026

Applied Behavioral Analysis (ABA) therapy reimbursement review prepared for the Indiana Family and Social Services Administration’s Office of Medicaid Policy and Planning. It outlines strategic objectives for rate setting aligned with CMS requirements, focusing on continuity, sustainability, person-centered value-based purchasing, and disparity reduction. The review compares current reimbursement to HCBS and waiver programs, highlights misalignment using code 97153, and presents provider survey data, cost-per-unit calculations, assumptions, and proposed ABA therapy rates with a timeline.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages26

Reading Time1 h 6 min

AccessFree to download

FSSA Strategic Objectives for Rate Setting

Alignment, Sustainability, and Value-Based Purchasing

Reduce Disparities and Ensure Predictability

Reimbursement Currently Lacks Alignment

Code 97153 Average Paid Claim and Location Coverage

ABA Reimbursement vs. Waiver Rates

HCBS Rate Comparison and Load Assumptions

ABA Provider Survey Data

Wage Inflation Assumption and Non-Allowable Costs

Cost per 15 Minute Unit Calculation

Applied Behavioral Analysis (ABA) Therapy Services Reimbursement Review ABA Provider Meeting-Rate Methodology /Draft Rates Indiana Family and Social Services Administration Office of Medicaid Policy and Planning 1August 8, 2023 ABA Therapy Provider Reimbursement • Objectives / Environment • ABA Provider Survey Data • Rating Methodology / Assumptions • Proposed ABA Therapy Rates • Timeline FSSA Strategic Objectives for Rate Setting To develop rate setting methods that comply with Centers for Medicare and Medicaid Services (CMS) rules and achieve the following: • Alignment-Bring continuity and alignment across rate methodologies, providing a consistent framework and supporting payment rates that advance FSSA goals . • Sustainability-Facilitate adequate participant access to quality services, as required by CMS. Cost effective, provide for long-term workforce growth and provider stability, and affordable by the State . Reduce administrative burden. Ensure predictability. • Promote Person-Centeredness and Value-Based Purchasing-Striving to align provider and participant incentives to achieve access to person-centered services, encourage services that drive healthy outcomes and participant satisfaction . • Reduce Disparities – Analyze and quantify disparities in access, quality, site of care, and person-centeredness, then build payment structures to level the playing field. Reimbursement Currently Lacks Alignment Code 97153 – Average Managed Care Paid Claim = $91/hour • Bars shown in chart represent average paid claims for each of the 199 locations that billed MCEs for 3Q 2022 • Paid hourly rates averaged $91 and ranged from $46 to $222 • Implementation of a Minimum Fee Schedule will increase rate alignment across ABA providers 4 ABA Reimbursement vs . Waiver Rates ABA Spend does not align with other State Programs $100.00 $90.00 $80.00 $70.00 $60.00 $50.00 $40.00 $30.00 $20.00 $10.00 $0.00 HCBS Rate Comparison • Current HCBS rates include a load of 98% -135% of base direct care wage to cover supervision, program costs, admin costs, etc. • Current ABA reimbursement represents load of 310% for comparable cost categories Participant Assistance and Care Residential Habilitation Services ABA Services (97153) Respite LPN Behavior Management (MS degree) Respite RN Direct Care Wages All Other Costs Applied Behavioral Analysis (ABA) Therapy Services Indiana Medicaid Expenditure Growth Rate of 50%+ • ABA Services are primarily provided through Waiver programs (FFS) and Hoosier Care Connect (Managed Care) • Rate of expenditures increases presents sustainability challenge ABA Reimbursement Comparison of Medicaid Reimbursement by State | $140.00
$120.00
$100.00
$80.00
$60.00
$40.00
$20.00
$ - | Hourly Reimbursement Rates Code 97153
Median Hourly Rate of $60.00

| | | --- | --- | --- | | | | | Other States Indiana ABA Provider Survey Data Clarification of Summary Data Slide Wage Inflation Assumption Program Costs Non-Allowable Costs ABA Provider Survey Data Calculation of Average Cost per 15 Minute Unit Cost / Utilization data shown is for all services / codes | Total Units of Service | 13,516,663 | | --- | --- | Direct Care Staff Salaries Average for all staff is $39.92 / hr. Average for RBT is $20.79 / hr. | Cost Description | Total Costs | Cost per 15 Minute Unit | | --- | --- | --- | | Direct Care Staff Salaries and Fringe Benefits | $ 134,890,221 | $ 9.98 | | Other Direct Care Expenses (Non-Staff) | $ 12,071,616 | $ 0.89 | | Administrative and Facility Overhead | $ 83,237,291 | $ 6.16 | | Non-allowable Costs | $ 33,068,527 | $ 2.45 | | Total Costs | $ 263,267,655 | $ 19.48 | | Total Costs Excluding Non-allowable Costs | $ 230,199,128 $ 17.03 | | --- | --- | Admin / Facility Overh

FAQs

What strategic objectives guide Indiana’s ABA rate-setting methodology?

The methodology targets alignment across rate methods, sustainability for adequate access to quality services, person-centeredness and value-based purchasing, and reduction of disparities in access and quality.

How does current ABA reimbursement misalign with other programs?

The review notes lack of alignment using code 97153, where average managed care paid claims are $91/hour and rates vary widely across locations, contributing to inconsistent payment outcomes.

What cost and wage assumptions are used in the provider survey data analysis?

The model uses a 7.5% annual wage inflation assumption applied from the midpoint of the provider fiscal year to the midpoint of the rate implementation period, and it includes direct care staffing salaries, overhead, and identification of non-allowable costs.

Sep 20, 2026

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