Health Plan of Nevada is the UnitedHealthcare-owned Medicaid plan NVHA lists alongside Anthem, CareSource, Molina and SilverSummit. Its Medicaid members are served at myhpnmedicaid.com, and its ABA rules changed in late 2025: from November 17, 2025, HPN’s own Behavioral Health team reviews every ABA therapy request against InterQual, and prior authorization is required for all ABA therapy. The same change hit HPN’s commercial plans (Health Plan of Nevada, Sierra Health and Life, Sierra Health-Care Options) on November 1, 2025.
HPN’s October 22, 2025 notice says that “our Behavioral Health team will review all ABA therapy authorization requests, according to InterQual guidelines. A copy of the guidelines is available upon request. As part of this transition, prior authorization is required for all ABA therapy services, regardless of billed charges per service line.” The Medicaid change took effect November 17, 2025. Contracted providers submit requests with supporting documentation through the Online Provider Center at provider.healthplanofnevada.com; non-contracted providers may phone 702-240-8733 or fax 702-341-7681.[3][4][5][10][8]
One caution for intake: the “Applied Behavioral Analysis form” still posted on HPN’s Medicaid prior-authorization page carries an older version of the state certification, which has the practitioner certify the individual “is between 0 and 21 years of age” and lists GARS-2. Nevada’s current FA-11F (updated June 2025) certifies the member is “Medicaid Eligible (any age)” and lists ADOS-2, CARS-2 and GARS-3. For an adult member, ask HPN which form it wants rather than signing the outdated age certification. Nevada’s managed-care rules give members (or a provider acting with the member’s written permission) 60 calendar days from the notice of adverse benefit determination to appeal to the plan, allow one level of internal appeal, and require a standard appeal decision within 30 calendar days (expedited within 72 hours); after the plan’s appeal, the member may request a State Fair Hearing (MSM 3604).[3][4][5][10][8]
Not without a Nevada license. NRS 641D.900 bars anyone from engaging “in the practice of applied behavior analysis unless he or she is licensed or registered as required by the provisions of this chapter.” Telehealth does not get around that: NRS 629.031 counts “A behavior analyst, assistant behavior analyst or registered behavior technician” as a provider of health care, and NRS 629.515 says that before a provider at a distant site “may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State,” the provider “must hold a valid license or certificate to practice his or her profession in this State.” A BCBA directing a Nevada child’s program from another state is therefore treated as practicing in Nevada and is “subject to the laws and jurisdiction of the State of Nevada.” The fast path is licensure by endorsement under NRS 641D.340: a behavior analyst who holds “a corresponding valid and unrestricted license as a behavior analyst” in another state or D.C. may apply, and unless the Board denies for good cause it must issue the license within 45 days of the application or 10 days after the fingerprint background report, whichever is later. Payers add their own layer: credential the clinician with each plan before billing.[15][16][7]
Federal Medicaid rules set the payment floor for every managed care plan: a state’s contract with an MCO "must provide that the organization will meet the requirements of § 447.45(d)(2) and (d)(3)" (42 CFR 447.46) — pay 90 percent of clean claims from practitioners within 30 days of receipt and 99 percent within 90 days — unless the plan and the provider agree in writing to an alternative schedule stipulated in the contract. A "clean claim" is one that "can be processed without obtaining additional information from the provider of the service or from a third party" (42 CFR 447.45(b)). HPN’s own Medicaid timely-filing, corrected-claim and secondary-claim limits were not in the documents read for this guide; take them from your HPN agreement or Provider Services (702-242-7088).[1][2]
The questions that decide whether a family can start with Health Plan of Nevada (Nevada Medicaid), and what they have to bring. Each maps onto something intake should ask on the first call.
HPN’s form asks for an ADOS, CARS or GARS-2 score with subscales; the state’s FA-11F asks for ADOS-2, CARS-2, GARS-3, an FASD category or documented DSM-5 criteria.[5][10]
HPN publishes nothing different. Nevada Medicaid’s rule (MSM 3704.1, FA-11F): ABA “must be rendered according to the written orders of” a physician, physician assistant, psychologist or APRN/NP, who certifies the diagnosis on FA-11F with the first request.[7][10][5]
HPN publishes no ABA telehealth rule. Nevada Medicaid’s rule: MSM 3403 gives telehealth “parity with in-person health care services,” requires the originating site to be in Nevada and lists only personal care, home health and private duty nursing as in-person-only; NRS 422.2721 bars extra prior authorization for telehealth. Bill POS 02 or 10 with modifier 95 (audio-video) or 93 (audio-only). The clinician needs a Nevada license (NRS 629.515). No Nevada ABA document lists which ABA codes may be delivered remotely.[11][12][18][16]
HPN publishes no ABA-specific rule. Medicaid is the payer of last resort (42 CFR 433.139), and Nevada Medicaid denies what a primary denied for not following its rules; bill the primary first.[14][19]
The state benefit has no age limit (MSM 3704.1), but HPN’s posted ABA form still has the practitioner certify the member “is between 0 and 21 years of age.” Confirm HPN applies the any-age rule before an adult intake.[7][5][10]
Ask the plan: HPN Provider Services, 702-242-7088 (option 2, then 5): ask whether the 0–21 certification on its ABA form is still applied.
HPN’s form has the ordering practitioner certify the diagnosis and lists “a Physician, Physician’s Assistant, Advanced Practice Registered Nurse (APRN), Psychologist, Ph.D. or a Board Certified BCBA.” The current state FA-11F drops the BCBA and limits it to physician, PA, APRN or psychologist.[5][10]
Ask the plan: HPN Behavioral Health, 702-240-8733: confirm which practitioners may sign the diagnosis certification.
HPN publishes no ABA decision timeframe. The federal managed-care limit applies: 7 calendar days for standard requests in rating periods starting on or after January 1, 2026, 72 hours expedited.[13][3]
Ask the plan: HPN Behavioral Health, 702-240-8733: ask the standard turnaround and how early to submit continued-service requests.
Not published by HPN; InterQual review criteria are licensed. The state rule is that the diagnosis is “completed only one time.”[3][7]
In licensed criteria: Ask HPN for its InterQual ABA criteria (“available upon request”) or call the Behavioral Health team at 702-240-8733.
Coverage decides whether Health Plan of Nevada (Nevada Medicaid) 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.
HPN publishes no ABA supervision rule. Nevada Medicaid’s rule (MSM 3704.3A, MSM 3704.2A(1)(j)): supervision follows NRS 641D.610, “must be overseen by a Licensed Psychologist, BCBA-D or BCBA who has experience in the treatment of autism,” may be delivered by a BCaBA at their direction, and is capped at 20% of direct therapy hours unless clinical documentation supports more. MSM 3600 requires MCOs to provide services with the same amount, duration and scope as fee-for-service.[7][8][3]
HPN publishes no ABA unit limits; authorized hours are set per request under InterQual. The state limits underneath: Nevada Medicaid’s limits (MSM 3704.2A(4); PT 85 billing guide): 12 hours of ABA per provider per day, 40 hours per recipient per week; focused 15–25 and comprehensive 25–40 hours a week counting 97153, 97155 and 0373T together; 97151 one 16-unit and 97152/0362T one 4-unit session per 180 days; 97156 4 units a week. Limits may be exceeded with prior authorization and documented medical necessity.[7][9][3]
HPN publishes no ABA note rule. Nevada Medicaid’s rule (MSM 3704.4G): a progress note for each day of service with the recipient’s name, place of service, date, actual start and end times, the name and credentials of the provider who delivered the service, and “The signature of the provider who delivered the service.”[7][8]
HPN publishes no ABA setting rule. Nevada Medicaid’s rule (MSM 3704.1, 3704.2A(8)): ABA may be delivered in a clinic or office, the community or the home, and in “the natural setting (i.e. home, school and community-based settings, including clinics)”; resorts, spas, camps, education services, respite and child care are not covered. Telehealth is billed POS 02 or 10.[7][18]
Its state contract must hold it to the federal Medicaid standard: 90% of clean practitioner claims paid within 30 days of receipt and 99% within 90 days (42 CFR 447.46, 447.45), unless the provider contract sets an alternative schedule. Its own filing limit comes from the provider manual or your agreement.
Yes. Since November 17, 2025, prior authorization is required for all ABA therapy services, regardless of billed charges, reviewed by HPN’s Behavioral Health team on InterQual.
HPN is a UnitedHealthcare company, but its ABA reviews are done by HPN’s own Behavioral Health team on InterQual, not the Optum criteria UnitedHealthcare uses elsewhere.
Nevada Medicaid covers ABA at any age, but HPN’s posted ABA form still certifies ages 0–21. Confirm with HPN Provider Services before starting an adult.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo