This measure is important because the DVHA Clinical Integrity Unit works to ensure that Vermont Medicaid members are receiving Applied Behavioral Analysis (ABA) services that are medically necessary and clinically appropriate. 

Biennial Clinical Documentation Reviews with ABA providers are completed to ensure that Vermont Medicaid members are receiving quality care, in part by verifying that members’ charts contain the required clinical documentation that follows the ABA Policy and Clinical Guideline Standards.  The Standards require that a standardized screening be administered at a minimum of every 6 months for members receiving ABA services and the results are incorporated into the treatment plan.  There are currently 14 ABA providers enrolled with Vermont Medicaid; the Autism Specialist reviews up to 4 member charts at each Clinical Documentation Review.  Providers can earn full, partial or no credit for several targets within each reviewed chart.  Full points are earned if a standardized screening or assessment tool was used in the last 6 months to assess progress on goals (PEAK, VB-MAPP, ESDM), partial points are earned if one of the authorized tools is unclear or incomplete and was outside the 6-month timeframe, and zero points are earned if no authorized assessment was used.

As shown by the above data, there was a steady downward trendline in % of members receiving a standardized screening from CY21 to CY22. This may be a result of providers not making the recommended changes to their clinical practice per the Clinical Documentation Review feedback in CY21, or to new providers being audited for the first time.  We saw a score of 100% in CY23 Q1, though noted another dip in compliance for CY23 Q2 and Q3.  The trendline remained steady in CY23 Q4 though the goal is to bring provider compliance back up to 100% through ongoing provider education.

Last Updated: 08/01/24

• Vermont Medicaid enrolled ABA providers.