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AHCA Moves Forward With ABA Therapy Medicaid Changes

May 16, 2019

The state Agency for Health Care Administration wrapped up a series of statewide public meetings last week to address proposed changes to the Medicaid program that covers applied behavior analysis therapy.

Health News Florida editor Julio Ochoa talked with reporter Daylina Miller – who has been following the issue since last summer – about what challenges this has presented for children on the autism spectrum.

So, Daylina, can you tell us exactly what applied behavior analysts do?

Applied behavior analysis therapy - previously called behavior modification - is one of the most widely accepted therapies for children with autism spectrum disorder. ABA helps children better communicate their wants and needs, and learn to be more self sufficient. It also discourages maladaptive behaviors like biting. Ninety percent of children in Florida enrolled in ABA therapy under Medicaid are on the spectrum.

Why was the Agency for Health Care Administration holding these meetings and what were they about?

About a year ago, AHCA discovered Medicaid fraud happening under the state-contracted vendor that manages this program. Between 2016 and 2018, the cost to the state for this therapy doubled -- although we don't now how much of that is suspected fraud and how much is more children being referred for ABA therapy. The state fired the company, hired a new vendor, and required all these children getting ABA therapy to be re-authorized, causing a pipeline clog that meant many of these children lost services temporarily -- and some permanently. There were also issues with credentialing new providers and frozen payments as ACHA tried to suss out the fraud. The agency even announced reimbursement rate cuts, which would have made it difficult for clinics to pay their therapists living wages.

These therapists and the parents filed complaints with AHCA, over these obstacles -- and the agency's lack of transparency -- and flooded state lawmakers with emails and phone calls. So AHCA set up a series of public meetings to announce new changes to the Medicaid program -- and allow everyone to give their feedback.

Ok, so what did these meetings accomplish?

Parents and providers packed these meetings, waving protest signs and collecting signatures on petitions. The state eventually backpeddled on their rate cut decision, saying they'll work with the Florida Association for Behavior Analysis before making salary changes in in the future. They're also implementing two new programs later this year as pilots to collect data before they expand them statewide. These include electric visit verification -- essentially GPS tracking of therapists to ensure they're working where and when they say they are --  and a new multidisciplinary approach to ensuring children need this therapy, and that they're getting the right amount of hours. AHCA has also committed to better collaboration with behavior analysts before making changes.

What does this mean for the children who use these therapists?

Many of these clinics were considering dropping out of Medicaid altogether, leaving thousands of the state's poorest children without this therapy. These behavior analysts say they're now "cautiously optimistic" that the state is trying to do right by these kids, and plan to hold off until the data is in and AHCA makes their final decisions.