What Nevada Parents Need to Know About ABA Insurance

Nevada families have solid insurance options for ABA therapy coverage. The state’s autism mandate features one of the higher annual dollar caps in the country at $72,000 per year, and Medicaid provides coverage without caps for qualifying families. Whether you’re in Las Vegas, Reno, or a rural area, understanding your insurance options will help you get services started as quickly as possible.

Nevada’s Autism Insurance Mandate (AB 162)

Nevada passed Assembly Bill 162 in 2011, establishing an autism insurance mandate with the following provisions:

• Age limit: Coverage for individuals under age 18, or up to age 22 if still enrolled in high school
• Annual cap: $72,000 per year for ABA therapy services, one of the higher caps nationally
• Applies to: State-regulated commercial health insurance plans, including individual and group policies

The $72,000 annual cap is notably generous. For most treatment plans, even intensive early intervention programs, this cap provides enough room to cover the full recommended hours of therapy. This puts Nevada well ahead of many states that impose much lower dollar limits.

Nevada Medicaid Coverage

Nevada Medicaid covers ABA therapy through its managed care system, and for eligible families, this can be even better than commercial coverage because Medicaid operates without the annual dollar cap.

Nevada Medicaid Managed Care Plans

Nevada Medicaid uses managed care organizations in the Las Vegas and Reno metro areas:

• SilverSummit Healthplan (Anthem)
• Molina Healthcare of Nevada
• UnitedHealthcare Community Plan / Health Plan of Nevada

Under the EPSDT benefit, children under 21 enrolled in Medicaid are entitled to all medically necessary services, including ABA therapy, without annual caps. Each MCO has its own authorization process, so contact your plan directly for specifics.

Check which insurance plans we accept to see if your Medicaid MCO or commercial plan is included.

TRICARE Coverage for Military Families

Nevada is home to several military installations, particularly in the southern part of the state. TRICARE provides excellent ABA therapy coverage for military dependents.

Nevada Military Installations

• Nellis Air Force Base (Las Vegas)
• Creech Air Force Base (Indian Springs, near Las Vegas)
• Naval Air Station Fallon (Fallon)
• Nevada Test and Training Range

TRICARE ABA Benefits

TRICARE covers ABA therapy with no dollar caps and no age restrictions beyond medical necessity reviews. For families stationed at Nellis AFB or other Nevada installations, TRICARE offers straightforward access to ABA services through authorized providers.

If you’re a military family in Nevada, reach out to our team to get started with the TRICARE authorization process.

Commercial Insurance Coverage

Nevada’s strong cap means commercial coverage is practical for most families. Here are the major carriers in the state:

Anthem Blue Cross Blue Shield

Anthem is a major presence in Nevada and covers ABA therapy under the state mandate. Pre-authorization is required, and they have a growing network of behavioral health providers in both Las Vegas and Reno.

UnitedHealthcare (UHC)

UHC covers ABA therapy through Optum behavioral health. They are one of the larger carriers in the state, particularly through employer-sponsored plans.

Health Plan of Nevada

Health Plan of Nevada, part of the UnitedHealth Group family, is one of the most widely used HMO plans in southern Nevada. They cover ABA therapy with pre-authorization and have an established behavioral health network.

Sierra Health and Life

Sierra Health and Life is a Nevada-based carrier that covers ABA therapy. They are common in employer-sponsored plans throughout the state.

Prominence Health Plan

Prominence is a regional carrier based in Reno that covers ABA therapy. They are particularly common in northern Nevada employer plans.

Hometown Health

Hometown Health is affiliated with Renown Health in northern Nevada. They cover ABA therapy under the state mandate and are a popular choice for families in the Reno/Sparks area.

Navigating ABA Coverage in Nevada

Here’s how to move forward with getting ABA therapy coverage for your child:

1. Get a formal diagnosis. You’ll need a documented autism spectrum disorder diagnosis from a qualified provider. In Nevada, this can come from a psychologist, developmental pediatrician, or other qualified clinician.
2. Verify your benefits. Contact your insurance company and ask specifically about ABA therapy coverage, pre-authorization requirements, and any provider network restrictions.
3. Find the right provider. Look for a BCBA-supervised ABA program in-network with your plan. Provider availability can vary, especially outside of Las Vegas and Reno.
4. Start the authorization process. Your ABA provider should handle this, including submitting the treatment plan and managing periodic reauthorizations.

Rural Nevada: Special Considerations

If you live outside the Las Vegas or Reno metro areas, finding ABA providers can be more challenging. In-home ABA therapy can be a good option for families in rural communities, as it eliminates the need to travel to a center. When exploring coverage, make sure your plan includes in-network providers who serve your area.

Treetop’s Nevada Services

Treetop provides ABA therapy across Nevada, including both center-based and in-home service options. We accept most major insurance carriers in the state and handle the insurance verification and authorization process for you.

Visit our Nevada locations page to find services near you.

Get Started Today

Nevada’s generous insurance coverage means most families can access ABA therapy with little or no out-of-pocket cost. Our team at Treetop is ready to help you understand your specific benefits and get services started. Contact us today for a free benefits check and consultation.