The Politics of Autism includes an extensive discussion of insurance and Medicaid services for people with intellectual and developmental disabilities.
[A]lmost two years after Mississippi enacted a mandate requiring insurers to cover a type of autism therapy known as applied behavior analysis, providers say the state’s largest insurer of children is not reimbursing services.Two problems:
The first is a matter of timing.
Mississippi submitted an amended state plan to the Centers for Medicare and Medicaid Services last year. The document details the scope of behavioral therapy services that will be covered for eligible beneficiaries under the age of 21 diagnosed with autism. CMS works on a 90-day turnaround schedule, meaning if the plan is approved before the end of this current quarter, the new policy will go into effect on July 1.
“Bottom line: We’ve got a tight window to deliver services. Every minute that passes by. It’s a grain of sand you don’t get to pull back. (I’m hopeful) this moves forward so children can start receiving services," said Jim Moore, director of the state Autism Board, which is charged with licensing board-certified behavior analysts.
The second and perhaps more pressing issue for providers is the reimbursement rates proposed by the division. In public comments, providers protested the fee schedule. Most insurers stipulate that applied behavioral analysis therapy programs must be supervised and coordinated by a licensed behavior analyst in order to receive payment.
The billing guideline proposed by Medicaid would have paid a behavioral analyst with a master’s degree $30 an hour. In neighboring Louisiana, the rate is $72 per hour.