DIVA says ABA billing changes and a family‑planning rate increase cannot be implemented as written

During the BAA briefing, agency staff described two policy adjustments affecting providers and patient services: coding changes for applied behavior analysis (ABA) services and a separate family‑planning payment increase that the agency says it cannot implement under current payment systems.

ABA coding: agency staff said federal guidance and updates to procedure‑code rules will bar concurrent billing of two clinicians for the same unit of service, which reduces billed revenue where concurrent billing previously occurred. The agency estimated this concurrent‑billing correction results in roughly a 12% reduction in provider revenue for that billing practice but emphasized that the clinical benefit would not be eliminated; staff said the two codes may still be billed for the same member on the same day when clinically appropriate. Commissioner Deshaun Rose and agency staff said they will provide more granular provider‑level fiscal impacts when they return to the committee.

Family planning: the legislature added an $850,000 family‑planning rate increase to the FY26 budget during the last session, but agency staff said that as written the increase is not implementable in the state’s current payment system and therefore the agency is recommending removing the line item from its BAA. Staff said they submitted an intent document explaining why the annotation could not be operationalized and offered to work with the legislature to craft implementable language if the committee still wants the increase enacted.

Next steps: staff agreed to return with a deeper dive on provider fiscal impacts, separate out telehealth changes related to ABA coding, and provide the number of providers and the patient‑service implications for the ABA changes and the family‑planning adjustment. The briefing closed without votes on these items.