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Does Nebraska Total Care Pay for ABA Therapy?

Applied behavior analysis (ABA therapy) is the gold standard treatment option for children with autism spectrum disorder (ASD). It’s an intensive treatment plan that often requires multiple hours a day and multiple days per week, but produces excellent results over time.

ABA therapy is a time commitment that’s definitely worth it for both patients and their families, as children with autism can make tremendous strides in improving communication and social skills while also modifying certain negative and/or harmful behaviors.

It can also be a hefty financial commitment, too, because of the hours required to provide the proper support.

If you live in Nebraska and your child has insurance coverage through Nebraska Total Care, you might be wondering whether their ABA therapy is considered a covered service.

In this article, we’ll discuss whether Nebraska Total Care pays for ABA therapy.

Learn more about ABA Therapy in Nebraska

Table Of Contents

What is Nebraska Total Care?

Nebraska Total Care was established to improve the overall health of all its beneficiaries by providing compassionate, coordinated and focused care. It bases its approach on the core belief that quality healthcare is best when it’s delivered locally.

The program is considered a Managed Care Organization (MCO) and is a subsidiary of Centene Corporation. They provide healthcare services that include Health Insurance Marketplace, Medicare Advantage and Medicaid plans.

Nebraska Total Care is a part of Heritage Health, which is the state’s Medicaid managed care program that combines pharmacy, dental, behavioral and physical health programs into one comprehensive program.

Does Nebraska Total Care Pay for ABA Therapy?

Yes, Nebraska Total Care does pay for ABA therapy. However, exactly what services are covered, and how much, will depend on the specific health insurance plan your child is subscribed to. So, make sure you check your plan to see what coverages are available.

Generally speaking, Nebraska Total Care plans will provide coverage for ABA therapy that is considered “medically necessary.”

Some of the services that it typically covers include behavioral assessments and evaluations conducted by BCBAs that will determine what your child’s specific needs are; individual sessions of ABA therapy where RBTs will help support your child by targeting specific skills and behaviors; training for parents, caregivers and other family members so that you can help emphasize skills learned once sessions are over; and some telehealth services for children and families who need it.

Topic Details
Is ABA therapy covered? ✅ Yes, when deemed medically necessary.
Who qualifies? Children 21 or younger, enrolled in Nebraska Total Care, with a formal ASD diagnosis.
What’s covered? Behavioral assessments, individual ABA sessions, parent training, some telehealth services.
Requirements ASD diagnosis, referral stating medical necessity, prior authorization.
Provider example Blue Gems ABA (in-network with Nebraska Total Care)

What Are the Requirements for ABA Therapy to be Covered by Nebraska Total Care?

Nebraska Total Care has some criteria in place to determine whether a child is eligible to have ABA therapy services covered by one of their insurance plans.

First and foremost, the child must be actively enrolled in one of Nebraska Total Care’s insurance plans. They also must be 21 years old or younger to qualify for these services.

Next, they must be formally diagnosed with ASD by a healthcare provider who is licensed to give these diagnoses.

Finally, all ABA therapy services must receive prior authorization before they will be covered by a Nebraska Total Care plan.

What Steps Should I Take to Have My Child’s ABA Therapy Covered by Nebraska Total Care?

There are four steps that you must take to have your child’s ABA therapy covered by Nebraska Total Care.

First, scheduled a formal ASD evaluation with a healthcare professional who is licensed to provide such a diagnosis.

Second, obtain a referral for ABA therapy from this healthcare professional or other specialist who is qualified to do so. Make sure that the referral states that the therapy is medically necessary.

Third, verify your coverage with Nebraska Total Care, and find a provider who is covered by your plan to provide ABA therapy, such as Blue Gems ABA.

Finally, receive the prior authorization that is required for the therapy to be covered, and set up an appointment with the provider of your choosing.

Step Action Notes
1 Get formal ASD evaluation Must be done by a licensed healthcare provider.
2 Obtain referral for ABA therapy Referral must state therapy is medically necessary.
3 Verify coverage with Nebraska Total Care Make sure your plan includes ABA therapy.
4 Get prior authorization Required before sessions can begin.
5 Start therapy with in-network provider Example: Blue Gems ABA.

Blue Gems ABA is Part of the Nebraska Total Care Network

If your child with autism is covered by a Nebraska Total Care plan, you will be happy to know that their ABA therapy is a covered service. There are some requirements and criteria that your child must first meet, though, so ensure that you follow all the steps and procedures outlined below.

At Blue Gems ABA, our team of experienced professionals can evaluate children for autism, give an official ASD diagnosis if appropriate, and even administer ABA therapy on a one-to-one basis.

In doing so, we provide comprehensive, all-around care for children on the autism spectrum.

To learn more, please contact us today.

Service Type Covered by Nebraska Total Care? Requirements
Behavioral Assessments ✅ Yes Must be conducted by a BCBA.
1:1 ABA Sessions ✅ Yes Prior authorization required.
Parent & Caregiver Training ✅ Yes Often part of ABA treatment plan.
Telehealth ABA Services ✅ Sometimes Based on plan and eligibility.
Diagnostic Evaluation ✅ Yes Must be by licensed provider.