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 18 ABA providers enrolled with Vermont Medicaid. DVHA currently reviews approximately 6 charts for members at each Clinical Documentation Review.  Beginning in January 2025 DVHA added additional staff to review charts, therefore the number of reviews per quarter has increased, which is reflected in the above data. 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.

In CY24 100% was achieved outside of Q3, which had one review where a member was not screened within the previous 6 months, therefore meeting 75%.  Providers noted staff documentation as a reason for not receiving full points for completion of assessment. DVHA provides reports after clinical documentation reviews are completed. Within these reports, feedback and education are provided.  
 

Narrative Updated: 04/24/25

• Vermont Medicaid enrolled ABA providers.