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Medicaid ABA Benefit Update by Rebecca Peters - Clinical Program Manager

Follow the journey of Washington State Medicaid's ABA benefit from inception to ongoing improvements. Learn about provider recruitment, fee-for-service set-up, managed care transition, and future plans to enhance ABA services.

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Medicaid ABA Benefit Update by Rebecca Peters - Clinical Program Manager

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  1. Medicaid ABA BenefitAn Update Rebecca (Becky) Peters ABA and Mental Health Clinical Program Manager Clinical Quality Care Transformation (CQCT) November 3, 2017

  2. The Beginning 2012 – 2013 • ABA benefit established and implemented • Recruitment of qualified COE’s for diagnostic assessment • Recruitment of qualified ABA providers • Everyone is fee for service

  3. The Beginning Continued 2013 - 2014 • Process established linking families to ABA providers after COE evaluation • Data collected manually and through Provider One

  4. The Middle 2015 – 2016 • Change procedure codes for ABA services and created new fee schedule • Continued to build provider network for ABA and COE • Continue refining requirements for intensive day treatment

  5. The Middle Continued 2015 - 2016 • ABA transferred to managed care plans • Process change with HCA regarding how children with ABA orders transitioned from COE to ABA

  6. The Present 2017 • TPL children moved to managed care • New DOH credentials for ABA providers start date July 1st. Applications started in May • Fee for service for Native Americans, dual eligible and exempted clients (15% Medicaid eligible children)

  7. Now - Future • Review MCO data and network information • Evaluate MCO access to ABA • Rates analysis underway • Explore ABA service in schools as a Medicaid service • Verifying all fee for service providers using the ABA taxonomy are credentialed appropriately

  8. Now – Future continued • Explore communication strategies to keep everyone informed • Developed a process and schedule for updating COE and ABA lists on website for fee for service providers • Continue COE recruitment and training • Continue provider training and expansion of intensive day treatment

  9. Questions? More Information: https://www.hca.wa.gov/billers-providers/programs-and-services/autism-and-applied-behavior-analysis-aba-therapy Rebecca (Becky)Peters ABA Clinical Program Manager CQCT HCA ABA@hca.wa.gov Tel: 360-725-1194

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