ODM Proposes Updates to MRSS Rules ABA Rules

Mobile Response & Stabilization Service (MRSS) Proposed Rule Revisions:

The Ohio Department of Medicaid (ODM) has released an updated version of their proposed changes to its Mobile Response and Stabilization Service (MRSS) Rule 5160-27-13. Proposed changes to the rule outline implementation of new coverage policy and reimbursement methodology for MRSS services in response to the regionalization of services to expand MRSS statewide. The Ohio Council submitted comments on the proposed MRSS Rule Revisions, which were due on December 6th.

Applied Behavior Analysis (ABA) Proposed Rule Revisions:

The Ohio Department of Medicaid (ODM) has proposed rules for adoption as new to implement changes in the Medicaid coverage of applied behavior analysis (ABA). The Ohio Council submitted comments on the proposed ABA Rules to ODM on December 6th.

A summary of the proposed changes includes:

  • Rule 5160-34-01 “Eligible provider and qualifications”
    • Details eligibility requirements for providers of ABA services, including qualifications for independent practitioners and dependent providers
    • Defines the roles of billing and organizational providers
  • Rule 5160-34-02 “Covered adaptive behavior services”
    • Defines covered ABA services, such as adaptive behavior assessments, treatment protocols, and family guidance
    • Specifies the types of services and activities included, from assessments to intervention techniques and caregiver training
  • Rule 5160-34-03 “Coverage, limitations, and reimbursement”
    • Addresses coverage policies, documentation requirements, service limitations, and reimbursement rates
    • Specifies that services must align with individualized treatment plans and meet medical necessity criteria
    • Lists conditions under which Medicaid will cover ABA services

As ODM review stakeholder feedback, we will continue to monitor any updates to the proposed MRSS and ABA rules and will keep Ohio Council members informed of any modifications or future opportunities to provide input.