Molina Healthcare of Nebraska is the newest Heritage Health MCO — it entered January 1, 2024, replacing Healthy Blue — and has the least Nebraska-specific published ABA infrastructure of the three plans. No Nebraska-specific ABA clinical policy has been published: Molina applies the state Medicaid Service Definitions plus its corporate behavioral-health criteria, so treat it as state-baseline clinically and expect the differentiation to be operational — Availity intake, corporate forms, and quarterly PA code-list churn.
Molina's Nebraska Medicaid PA page establishes the machinery: requests submit through Availity Essentials (preferred), by fax to (833) 832-1015, or by phone at (844) 782-2678, with a Behavioral Health Certification of Need for Services form published for BH services and quarterly PA code-change PDFs posted for the current year. What it does not establish is an ABA-specific rulebook: we found no published Nebraska statement on whether the ABA assessment codes need PA, and third-party descriptions of Molina's ABA treatment-PA specifics could not be verified against a Molina document. Practically: assume the state MSD rules govern clinically, confirm ABA code-level PA requirements through Availity or the plan's PA look-up tool before every new intake cohort, and re-check quarterly — the PA lists genuinely change.[1]
Molina took over from Healthy Blue on January 1, 2024 under a five-year contract (with a two-year option), alongside Nebraska Total Care and UnitedHealthcare. Its ABA utilization management is done in-house — the plan hires Nebraska-based "Care Review Clinician, ABA" roles requiring an LBA license — so expect clinical conversations with licensed analysts rather than a delegated vendor. Rates follow the state schedule per DHHS's Health Plan Advisory 25-08, the same as the other two MCOs. Given the thin published ABA surface, the operating posture at this plan is verify-first: every code, every quarter, in the portal.[2][7]
The questions that decide whether a family can start with Molina Healthcare of Nebraska, and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the Nebraska Medicaid rule: admission is "Age: 0-20" under both ABA service definitions, with DD-waiver recipients able to receive the ABA assessment codes (97151/97152) regardless of age. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it.[3][5][1]
Follows the Nebraska Medicaid rule: an Initial Diagnostic Interview completed within the previous 12 months of admission must establish the need for the ABA assessment, with an IDI addendum where the clinical presentation has changed significantly inside that window. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it.[3][5][1]
Follows the Nebraska Medicaid rule: the IDI is performed by "A licensed practitioner who is able to diagnose and treat major mental illness within his/her scope of practice" — Physician, Physician Assistant, APRN/NP, Psychologist or LIMHP — and the qualifying diagnosis is ASD or a developmental or intellectual disability. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it.[4][3][1]
Follows the Nebraska Medicaid rule: no ASD diagnostic instrument is required; the ABA assessment must include skills-based and standardized/norm-referenced or criterion-referenced assessments, and the treatment plan must carry baseline and ongoing measurement "using norm-referenced / standardized assessment tools, for example Vineland, VB-MAPP, ABLLS." Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it.[5][3][1]
Follows the Nebraska Medicaid rule: no referral or physician order is a condition of the benefit — the gate is the IDI establishing need plus the ABA assessment, filed with the treatment plan on the initial PA request. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it.[3][5][1]
Follows the Nebraska Medicaid rule: audiovisual telehealth is available for 97155 (only while 97153 runs concurrently), 97156 and the 97151 assessment under the conditions the service definitions spell out, while 97152, 97153, 97154 and 97158 cannot be delivered remotely. Molina publishes no Nebraska-specific ABA clinical policy — its Nebraska Medicaid prior-authorization page sets only the machinery (Availity Essentials, fax (833) 832-1015, phone (844) 782-2678, a Behavioral Health Certification of Need form, and quarterly PA code-change PDFs), with no ABA criteria, caps or code rules on it.[3][5][1]
Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.
Molina's 2026 Nebraska manual is out of date against federal law. Its table still reads "Prior Authorization Standard: 14 Calendar days" and "Prior Authorization Urgent: 72 hours." Heritage Health rating periods run by calendar year, so from January 1, 2026 the federal floor caps standard decisions at "7 calendar days after receiving the request for service." Expedited decisions stay at 72 hours, and either clock can be extended up to 14 calendar days. Hold Molina to seven days. Urgent requests must include "Supporting documentation … to justify the expedited request." After a denial, a peer-to-peer can be requested "within five (5) business days of the denial notification." Molina publishes no ABA reauthorization lead time.[8][9][10]
Ask the plan: Molina Nebraska Provider Services (844) 782-2678: confirm the standard turnaround it now applies and any ABA reauthorization lead time. Its manual still prints 14 days.
"Medicaid is always the payer of last resort," except for Indian Health Service, Ryan White and similar federal programs. "If third-party liability can be established, Providers must first bill the primary payer and submit a primary explanation of benefits (EOB) to Molina for secondary Claim processing," and "Primary carrier payment information is required with the Claim submission." Timely filing restarts: "the Provider must submit Claims to Molina within 180 calendar days after final determination by the primary payer." Molina "will not deny Provider Claims on the basis of untimely filing for Claims that involve coordination of services or subrogation." Molina pays the secondary amount "based on the state regulatory COB methodology." The manual does not say whether Molina's ABA prior auth is required when another plan is primary.[8]
Ask the plan: Molina Nebraska PA look-up tool on Availity Essentials or (844) 782-2678: ask whether ABA prior authorization is still required when a commercial plan is primary.
Coverage decides whether Molina Healthcare of Nebraska pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Follows the Nebraska Medicaid rule: direct supervision by observation of the technician at no less than 10% of weekly direct service hours (97153/97154/97155), documented in progress notes with a corrective action plan when missed; at least one hour a month of in-person observation of each technician or LaBA; at least one hour a month of in-person direct service by the treating LBA or psychologist; and no more than 24 technicians per LBA. Molina runs ABA utilization management in-house with Nebraska-licensed LBA care review clinicians, but publishes no supervision standard of its own.[3][1]
Follows the Nebraska Medicaid rule: direct ABA "may not exceed 6 hours in a single day or a total of 20 hours per week," with additional hours available on prior authorization and clinical justification; group work runs one technician to 2-5 children on 97154 and one licensed clinician to 2-5 on 97158. No per-code MUE table is published by the state, and Molina publishes none either — what Molina does publish is quarterly PA code-change PDFs, so unit handling is a quarterly re-check rather than a fixed table.[3][1]
Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.
Nebraska says what a progress note must contain, sets the deadline by reference, and never names a session-note signer. Progress notes "must be completed within the time frame specified in the program's policies and procedures" and must substantiate each service through narrative description, "Include an accurate start and end time for the service," tie the service to plan goals and priorities, document participation and revision of goals, and record the individual's response "in the individual's own words if possible, if age and developmentally appropriate." Signatures attach to the other documents: the treatment plan must "Be approved and signed by the licensed clinician or supervisor if provisionally licensed" and carry the individual's or guardian's signature (a parent or guardian where the individual is under 19); the ABA assessment report "must be signed by the licensed clinicians who participated in the development of the report, including the supervising practitioner, when applicable"; and the discharge summary must "contain the signature of the supervising clinician and date of signature." Supervision itself must be documented in progress notes. Molina publishes no ABA-specific documentation policy for Nebraska.[6][5][3]
Community, home, office or clinic — and school is not yours to bill. The treatment MSD lists the allowable settings as "Community, Home, Office or Clinic," then carves the school out entirely: "ABA services are covered as part of the Medicaid school-based services program, and are the responsibility of the school as outlined in Nebraska Administrative Code Title 471, Chapter 25 and the Medicaid State Plan. Independent providers may not bill Medicaid directly for services provided at a school." The assessment MSD keeps School on its settings list under the same carve-out. Where ABA does run in an educational setting, "A school plan is required for all educational settings, to include both public and private schools" (not daycare or after-school), it must be included in the student's IEP, it must focus on reducing behaviors that impede academic engagement rather than on general skill acquisition, and it must be time-limited with a transition plan shifting instructional control to school staff. Excluded outright: "Services delivered in the school setting as a shadow, or an aide, or to provide general support to the child or youth," and training for school personnel. Group homes are not addressed. Molina publishes no deviation from this.[3][5][1]
Not stated in billing terms, though the definitions read as if it happens. The telehealth rule allows 97155 by audiovisual telehealth only where "The individual is receiving 97153 services concurrently," and the supervision percentage is measured against "direct service hours (97153/97154/97155)" as a single weekly pool — both of which presume the analyst and the technician on the clock at the same time. But neither MSD says in terms that both codes may be billed for the same clock time. What Nebraska does prohibit by name is a different concurrency: "Services delivered concurrently (at the same time) as another treatment modality (i.e. ST, OT, PT)," and "Services delivered by 2 LBAs unless non-duplicative and clinically appropriate." Molina publishes nothing ABA-specific for Nebraska, so the state position is the only one on the record.[3]
Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.
Nebraska controls this through code-level provider eligibility rather than a modifier set. Licensed clinicians who may bill 97151 — and who render 97155, 97156 and 97158 — are a psychiatrist, physician, psychologist or provisionally licensed psychologist, each with training in ABA, or a Licensed Behavior Analyst. Technicians who may bill 97152, 97153 and 97154 under a licensed clinician's supervision are a Licensed assistant Behavior Analyst or a Registered Behavior Technician. Since January 1, 2025 every BCBA must be licensed as an LBA and every BCaBA as a LaBA, so the state license rather than the BACB certificate is what makes the claim payable, and RBT is enrolled as its own Medicaid provider type (85) on the fee schedule. Which NPI carries the claim line is not stated. Molina publishes no Nebraska ABA billing policy.[3][5][1]
Ask the plan: Molina Nebraska via Availity Essentials or the PA look-up tool, and the current-quarter PA code-change PDF — Molina's PA code lists change quarterly, so re-check per cohort rather than per year.
Yes — as a Heritage Health MCO it administers the Nebraska Medicaid ABA benefit under the state Medicaid Service Definitions. Molina publishes no Nebraska-specific ABA clinical policy, so the state rules plus corporate BH criteria govern.
No published Nebraska-specific answer exists — Molina's PA requirements live in quarterly code lists and its PA look-up tool. Verify the ABA codes in Availity or with the plan directly, and re-check each quarter.
Availity Essentials is the preferred channel; fax (833) 832-1015 and phone (844) 782-2678 are the fallbacks. Include the state-required package — treatment plan, ABA assessment, and IDI.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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