Dayshia Bean, a registered behavior technician at LOGAN’S Riverside autism center in South Bend, asks a 3-year-old boy to point to objects she names on an iPad.
“Where’s the door?” Bean asks. He points.
“Door,” she says. “Good job.”
He giggles.
“Ok, let’s do the next one,” Bean continues.
He’s receiving applied behavior analysis, or ABA, therapy. Alissa O’Hara, senior director of clinical operations in LOGAN’s autism services, explains.
“He’s attending to her different questions and then pointing to things,” O’Hara says. “And then he’s also using that device to communicate so you can see those are his words he uses to communicate, so she knows what he wants to work for. Once he finishes his work, he’ll get to watch something on the iPad.”
The number of Indiana children receiving ABA therapy has skyrocketed since the state began covering it through Medicaid in 2016. Last year Indiana spent $420 million on ABA therapy for 6,200 kids.
Over the past three years that spending has grown 50 percent a year, a growth rate that the Indiana Family and Social Services Administration says is not sustainable.
Because it had no history to base provider reimbursement rates in 2016, the state has been allowing providers to set their own rates, based on the costs they report. That’s led to a wide variety of rates to providers, both non-profit and for-profit.
The FSSA has proposed setting the same rate for all providers. That will mean significant cuts for many providers. The state agency says its survey of providers found a $91-an-hour average reimbursement rate. It has proposed lowering that to $55 an hour.
Matt Harrington is CEO of LOGAN. He notes that survey was voluntary and only included six providers across the state.
Harrington agrees rates should establish a methodology for setting the same rate for all providers. But he says $55 an hour is well below the nonprofit’s costs to provide services. About half of LOGAN’s clients with autism use Medicaid. Harrington worries that providers will prioritize children with private insurance.
“At some point you’ve got to balance the different people that need services,” Harrington says. “We don’t want to be in a position to only serve a select few by funding source.”
In Elkhart on County Road 10, just east of Granger, about 80 percent of the for-profit Behavioral Analysis Center for Autism’s clients receive Medicaid, says Stacy Apraez, senior clinical operations director. She says Indiana is part of the only 20 percent of states that requires technicians at Medicaid-funded autism providers to be trained and certified, which increases providers’ costs.
“So they actually require more training and ongoing support and want to pay us less than our private payers that don’t require the certification, and if these rates went into effect, would pay us more,” Apraez says.
While ABA therapy’s one-to-one technician-to-client ratio is costly compared to most other direct services for children with special needs, LOGAN’S Harrington says early intervention will save the state money in the long run. He notes that early intervention is critical for kids with autism since most brain development happens by age five.
Children with autism who can’t find ABA therapy will require more intensive special needs education in public schools that already are strapped for resources. And the state will see higher costs to provide an array of services once those kids become adults.
The FSSA’s public comment period on the proposal ended Aug. 25, and the agency has said it could announce a final decision on a rate as soon as this month, to take effect late this year or early next year. Providers have asked their parents to lobby, through the public comment period and contacting their elected representatives in the legislature.
They may have some reason for cautious optimism. Lawmakers from both parties have expressed concern about the FSSA’s proposed new rate, including Republican Lt. Gov. Suzanne Crouch, who is running for governor.
Said Apraez, “I think everyone knows someone who could be affected, and we need to look at this not as a today issue, but as a lifetime issue for these individuals and these families.”
