Budget Amendment ID: FY2027-S4-837

OTH 837

Applied Behavioral Analysis Recoupments

Ms. Lovely moved that the proposed new text be amended by inserting after section ___ the following section: -

“SECTION XX: Notwithstanding any general or special law, procedural rule or regulation to the contrary, the executive office of health and human services, or any agency or office thereof, shall not seek recoupment of reimbursements distributed to applied behavior analysis providers claimed for services provided under Current Procedural Terminology codes 97153 and 97155 in calendar years 2024, 2025 and 2026.

SECTION XY: Not later than October 31, 2026, the executive office of health and human services shall submit a report to clerk of the senate and house of representatives; the house and senate committees on ways and means; the joint committee on health care financing and the joint committee on children, families and persons with disabilities on the methodology and legal authority employed to seek recoupment of reimbursements distributed to applied behavior analysis providers claimed for services provided under Current Procedural Terminology codes 97153 and 97155 in calendar years 2024 and 2025. Said report shall include, but not be limited to: a.) the contractual and regulatory authority under which said recoupments are authorized; b.) the methodology and justification for coding interpretations; c.) the process by which said providers may appeal demands for recoupments; d.) the fiscal impact on service providers and e.) the impact on the ability of providers to provide medically necessary care.

SECTION YY: Section XX is hereby repealed.

SECTION YZ: Section YY shall take effect July 1, 2027.”