To contain costs, the Families and Social Services Administration, which oversees Medicaid, is proposing standardizing rates for the therapy at a level that many providers worry could threaten their ability to continue providing these services. FSSA disputes this, saying the rate they came up with is based on providers' own cost data. That's true, but FSSA is proposing rates at the low end of a wide scale.
Currently, the hourly reimbursement providers receive from the state varies from $46 an hour to five times that. The average is $91 an hour.
Now the state is proposing instituting a flat rate of $55 an hour for the most common form of therapy ― meaning, in comparison to what the providers have been accustomed to receiving, a small handful of providers would get a bump, but most would experience a dramatic decrease.
Providers, too, agree that there needs to be a standardized rate. But choosing $55, as FSSA is proposing, goes too far, too quickly, they argue.
"I definitely think there’s some middle ground, but what we're experiencing now, if these in-center ABA therapy centers are to close, they (the children) are going to be pushed into the school system that’s already overwhelmed," said Hillori Wanninger, a board certified behavior analyst with Shine Pediatric Therapy. "This is a very rippling effect."