Waiver Consulting Group — Start any program. In any state.

Nevada - Autism Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Nevada's Division of Health Care Financing and Policy (DHCFP) covers Applied Behavior Analysis (ABA) under the EPSDT benefit for children with Autism Spectrum Disorder, utilizing Provider Type 85 for enrollment. Agencies must designate a licensed clinical supervisor who is already enrolled as an individual Nevada Medicaid provider before the group application can be submitted through the Provider Flex system.

Approval requires securing a Nevada Secretary of State Business ID and completing the Provider Type 85 Specialty 000 enrollment checklist. Services are delivered by Board Certified Behavior Analysts (BCBAs) and Registered Behavior Technicians (RBTs), with all treatment components except initial assessments requiring prior authorization from DHCFP.

1. Service Definition and Scope

In Nevada, Applied Behavior Analysis (ABA) is defined as the design, implementation, and evaluation of environmental modifications using behavioral stimuli and consequences to produce meaningful changes in human behavior. DHCFP covers these medically necessary services under the EPSDT benefit for Medicaid-eligible children.

The scope of covered services includes initial and ongoing assessments, adaptive behavior treatment delivered individually or in a group, and adaptive behavior family treatment. Family treatment may be conducted with or without the child present, depending on clinical appropriateness.

2. Regulatory and Oversight Agencies

Oversight of ABA services in Nevada is divided between the state Medicaid agency, which manages facility and group enrollment, and the professional licensing boards that regulate individual practitioners.

Medicaid enrollment and claims processing are managed by Gainwell Technologies (formerly Hewlett Packard Enterprise) through the Provider Flex system.

3. Gatekeeping Prerequisites: Who Can Even Apply

Nevada does not impose Certificate of Need (CON) requirements, Request for Proposal (RFP) procurement limits, or closed-network moratoria on ABA provider enrollment. Any entity that meets the clinical and corporate prerequisites may apply at any time.

The mandatory structural precondition for group enrollment is the clinical supervisor affiliation. A group cannot enroll as a Provider Type 85 Specialty 000 entity unless it has a designated clinical supervisor who is already licensed in Nevada and actively enrolled as an individual provider with Nevada Medicaid.

4. Licensure and Certification Requirements

Nevada does not issue a distinct facility-level license for ABA agencies. Instead, the agency's authority to operate and bill Medicaid is derived entirely from the individual licensure and certification of its clinical staff.

Supervising clinicians must hold active state licensure, while direct-care technicians must maintain national certification through the Behavior Analyst Certification Board (BACB).

5. Medicaid Provider Enrollment

Group practices enroll as Provider Type 85 (ABA), Specialty 000 (Entity/Agency/Group) using the Provider Flex system, which replaced the legacy Online Provider Enrollment portal. Applicants must submit the specific PT 85 enrollment checklist along with required attestations.

If an existing facility, such as a Psychiatric Residential Treatment Facility (PT 63), wishes to provide ABA services, it must enroll separately as a PT 85 with a distinct NPI to bill for these services.

6. Staffing, Training and Background Checks

Agencies must employ a tiered staffing model consisting of licensed clinical supervisors and credentialed direct-care technicians. The clinical supervisor is responsible for overseeing all ABA treatment services delivered by the entity.

Registered Behavior Technicians (RBTs) provide the direct adaptive behavior treatment to the child and must be supervised by the licensed behavior analysts in accordance with state and BACB standards.

7. Documentation, Policies and Records

Providers must maintain comprehensive clinical and administrative documentation that aligns with the Medicaid Services Manual (MSM). All services furnished must be identified in the recipient's individualized treatment plan.

Agencies are required to maintain an ongoing quality assurance (QA) program to monitor service quality and problem resolution, which must be available for DHCFP review upon request.

8. Billing, Rates and Claims

ABA services are billed using specific Current Procedural Terminology (CPT) codes assigned to Provider Type 85. With the exception of initial assessments, all ABA services require prior authorization from DHCFP before delivery.

Reimbursement rates are established by DHCFP. Historically, direct services provided by an RBT (Specialty 314) under codes such as 0364T and 0365T were reimbursed at $15.65 per 30 minutes ($31.30 per hour).

9. Approval Sequence and Timeline

The approval sequence begins with establishing the corporate entity with the Nevada Secretary of State and ensuring the clinical supervisor is fully licensed and enrolled with Medicaid as an individual. Only then can the group application be initiated.

Once the prerequisite individual enrollment is active, the agency submits the PT 85 Specialty 000 group application through Provider Flex, attaching the signed clinical supervisor attestation and compliance self-evaluations.

10. Common Denials and Survey Findings

Group enrollment applications are frequently rejected or delayed due to missing prerequisite registrations, such as failing to obtain a Nevada Secretary of State Business ID prior to submission.

Another common point of failure is the clinical supervisor attestation; if the named supervisor is not already actively enrolled as an individual Nevada Medicaid provider, the group application cannot proceed.

11. Key Contacts and Resources

Prospective ABA providers should utilize the Gainwell Technologies Provider Enrollment Unit for all questions regarding the Provider Flex system and application status.

For questions regarding ABA coverage policy, prior authorization requirements, and the Medicaid Services Manual, providers should contact the DHCFP Clinic Policy Unit.

See all Nevada services · Nevada Medicaid consulting · book a consultation.