We recently received information from one of our accredited providers regarding concerns with service limitations for Medicaid beneficiaries in Delaware receiving ABA therapy. These limitations are related to caps on service hours and supervision hours. There are additional barriers related to the information that must be sent that makes accessing services more challenging for families with Medicaid. Our team will be working on these barriers in 2022. If you are experiencing similar issues in Delaware, please contact our Government Relations department.
BHCOE has recently received an influx of issues related to Georgia Medicaid. These issues are primarily related to denials due to diagnostic reports, denials due to no IEP submitted, lengthy timelines between approvals, and concerns with the existing TPL process. Our goal is to collaborate with the payor to assist in solutions that can ensure children with autism are able to receive quality ABA and we are working on these specific issues and hope to see improvement soon. If you are experiencing similar issues, please email our Government Relations Department. Our team is also carefully monitoring HB412. This legislation creates a license for BCBA’s, with the most recent amendment adding RBT’s to the bill. Our experience in many states is that licensure is causing a lot of unnecessary delays in individuals with autism accessing services. We will be working with our lobbyist and the bill sponsor Representative Katie Dempsey to ensure this does not affect access to care.
The Governor of New York has threatened to veto the bill that would allow technicians to practice ABA in a tiered model in New York citing a potential $82 million dollar budget increase. BHCOE is working collaboratively with organizations advocating in the state to provide data and resources that can assist with this miss information. New York is one of 2 states that does not have Medicaid coverage for ABA therapy for children with autism. We will continue to work with everyone involved to support access to care in New York.
The bill to create license for BCBA’s in North Carolina takes effect in January 2022. We have been told that some of the board members for the license board have been named but there is still a lot of work to be done. Although the bill will be in effect in January, if you are a BCBA practicing in the state of North Carolina and are not licensed the practice act would still apply. We will continue to follow this legislation and provide updates.
The Oregon Health Plan, Oregon Medicaid department, is requesting to CMS to renew their waiver known as the 1115 Demonstration, to be exempt from EPSDT benefits. EPSDT (Early Periodic Screening Diagnostic Treatment) benefits are a federal requirement and are covered in all other 49 states providing medically necessary coverage to children under 21 years of age. BHCOE signed the letter drafted by Disability Rights Oregon in response to Oregon’s request to be exempt for cost effective purposes. Additionally, the letter addresses the discriminatory use of “Quality Adjusted Life Year” metrics and nondiscrimination in suicide prevention services.
As we near the deadline for the ABA benefit roll out in Texas, MCO’s are still scrambling to find providers for their network due to the low reimbursement rate. Although there was an increase from $30 an hour for 97153 to $45 an hour, workforce shortages create an even greater challenge coupled with the inability to pay staff reasonable rates. BHCOE along with many other organizations in the state continue to work hard with the MCO’s and HHSC to collaborate on resources and information that could assist in building a benefit that is accessible. At this time no additional rate increases have been published.
BHCOE is excited to be advocating with accredited providers in Canada to assist families who need access to quality ABA therapy. Currently ABA therapy is not covered under Canada’s health benefit but is provided through a separate funding source. Additionally, there is not a requirement to hold a BCBA certification to be on the Registry of Autism Service Providers. Children can receive up to $22,000 a year through the age of six for ABA therapy. There are changes being proposed that could potentially limit access for families of children with autism receiving ABA therapy. Our goal is to learn more about the service delivery model and be a resource for families and providers as potential changes are being proposed. We look forward to supporting our neighbors in Canada in 2022!
Looking Forward to 2022!
Thank you to all our accredited providers and to the families you serve for working tirelessly this year to continue to create equal access to quality ABA and other Behavioral Health Services for individuals with autism and their families. I cannot wait to see what we can accomplish together in 2022!
If you have any additional information on licensure or legislation that you would like us to support or share in our newsletter, please contact us at [email protected].