Governor DeSantis administration's proposed rule will delay access to care for poor, autistic children, providers say

Governor DeSantis administration’s proposed rule will delay access to care for poor, autistic children, providers say

Providers are warning that poor children with autism will not be able to receive timely and important applied behavior analysis (ABA) services under new regulations proposed by the government. Ron DeSantis administration.

The proposed rule requires children to have what is called a full diagnostic assessment service before qualifying for ABA services, and a follow-up assessment every six months to continue qualifying for care.

Providers say the requirement violates federal Medicaid law because it will slow access to care. Additionally, vendors claim that it will unnecessarily increase their operating costs by more than $1 million in the first year alone if left unmodified.

The high price is driven by a proposed rule requirement that assessments include the administration and scoring of two proprietary standardized behavior assessments: the Vineland-3 Comprehensive Parent Interview Form, including the Behavioral Domain maladaptive and behavioral assessment system for children, referred to as Vineland, and the third edition, Parenting Relationship Questionnaire, referred to as BASC-3 PRQ.

Mary Riordanpresident of the Florida Association of Behavior Analysis (FABA), called the biennial assessment “excessive”.

FABA attorneys sent a letter to the Secretary of the Agency for Healthcare Administration (AHCA) Simone Martiller September 19 asking the state to consider alternative regulations that would cost less, what is permitted under state administrative law.

As an alternative, FABA attorneys have suggested that the state change the rule to require ABA providers to perform only one of the assessments that AHCA requires in the proposed rule. Additionally, FABA recommended that assessments be conducted once every three to five years, not twice a year.

“This would be more consistent with how the tools were designed and how they are often used in the education system and other contexts with similar recipients of behavior analysis services,” the attorney wrote. FABA. Karen A. Putnal with the Tallahassee-based company Moyle Law Firm.

FABA’s request that the state seek alternative, less costly regulations means the AHCA must either adopt a another rule or provide a statement of why they continue to support the proposed settlement. AHCA will also be required to develop a statement of estimated regulatory costs, known as SERC, or amend the SERC that was previously developed for the proposed rule.

Applied Behavior Analysis is a therapy based on the science of learning and behavior, according to autism speaks. The The Autism and Developmental Disabilities Surveillance Network (ADDM) of the Centers for Disease Control and Prevention has released a study an estimated 1 in 44 eight-year-olds in 2018 were diagnosed with autism spectrum disorder (ASD).

Council of Autism Service Providers Vice President of Government Affairs Judith Ursitti traveled from Boston to attend a September 20 meeting in Tallahassee where the rule was the subject of a workshop.

Currently, pediatricians can refer a child to autism services. Ursitti said the state’s decision to require a CDE before the child can receive ABA services violates federal Medicaid periodic early testing and treatment rules that require states to provide comprehensive services and provide all Medicaid-covered, appropriate, and medically necessary services to correct and improve children’s health conditions.

“They cause delays,” she said of the state’s proposed rule. “Children on Medicaid deserve access to care. And if they don’t get it, they can’t get that time back. They grow. There is no redesign.

Although her organization does not argue, she predicted that unless changes are made to the proposed rule 59G-4.125it will be disputed.

“We’ve seen Medicaid litigation in other states, Texas was one,” she said. “It’s a shame it has to come to this, but sometimes it does.”

Although Florida uses a managed care delivery system for most Medicaid-covered services, managed care plans are not required to provide ABA services for children. Instead, it is reimbursed on a fee-for-service basis.

About 30 people attended the Sept. 20 rulemaking meeting in Tallahassee and another 318 people participated in the meeting virtually, according to the AHCA.

The proposed rule is the latest move by the state to change how it provides and pays for ABA services in an effort to root out fraud and abuse. The proposed rule works in tandem with a new rule that, effective August 1, requires ABA providers to use the national standard Current Procedural Terminology (CPT) code structure. for behavior analysis.

CPT codes are developed by American Medical Association (AMA) Behavioral Analysis.

While ABA suppliers said on Tuesday they support switching to CPT codes, they have raised concerns this summer with some changes made by Florida Medicaid officials to the CPT codes developed by the WADA.

AAmong other things, Florida changed codes to prevent providers from charging for ABA services provided at recreational, hobby, or educational camps or during after-school activities. Other changes include requiring a parent or guardian of an autistic child to attend every treatment session.

Providers warned that changes to CPT codes would prevent children from accessing services and could put the state in non-compliance with federal law, but the state made no changes.

The proposed new rule, along with the recently enacted CPT rule, comes as the state struggles to maintain costs for ABA services. While Florida relies on managed care plans to administer most Medicaid-covered services to the poor, elderly, and disabled, care for children with autism is provided on a pay-as-you-go basis. deed.


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