INDIANAPOLIS, Jan. 17, 2025 /PRNewswire/ -- Families of children with autism in Indiana face alarming challenges as Medicaid introduces three drastic changes to Applied Behavior Analysis (ABA) therapy coverage. Without input from families or providers, Medicaid announced:

1. A 30-hour weekly limit on ABA therapy per child.
2. A three-year lifetime cap on ABA services per child.
3. Mandatory credentialing for all Registered Behavior Technicians (RBTs).

"These policies would create significant barriers for children with autism to access the most basic, evidence-based treatment for their diagnosis," said Emily Roche, VP of Payer Contracting at Bierman Autism Centers. "Medicaid's proposed effective date of April 1, 2025, is clearly rushed. We believe they are pushing this timeline because these ambiguous policies won't hold up under adequate review."

Impact on Indiana's Children with Autism

The changes will disproportionately impact the most vulnerable children in Indiana. Decades of clinical research support intensive treatment—30+ hours per week over multiple years—as essential for children with the most significant needs. "These caps will harm the children who need care the most," Roche emphasized. Medicaid's approach prioritizes cost-cutting over the well-being of vulnerable children. In addition, lawmakers agreed long ago that insurance, including Medicaid, cannot arbitrarily cap mental health services in the interest of saving money. This new policy puts Indiana Medicaid in violation of federal Mental Health Parity laws.

Medicaid is required, per their own regulations, to provide medically necessary treatment, including the necessary dosage, and should not be allowed to implement these caps," Roche added.

Some of these new requirements for authorization of services include additional assessments and paperwork that are inconsistent with standard clinical practices for medical treatment. For example, the new guidelines require an assessment called the Behavior Assessment System for Children, Parenting Relationship Questionnaire (BASC-PRQ). This assessment cannot be used with children under 2 years old. However, providers are already seeing treatment requests being fully denied if the BASC-PRQ is not administered for a child under age two. These denials of services have begun even before the proposed new rules go into effect.

Bierman is already working with one family that received a full denial because of the assessment requirements. This further highlights that these new regulations were not created with proper input from clinical experts, and that Medicaid is using these arbitrary rules to deny medically necessary treatment to children.

Industry and Legal Concerns

Cora Steinmetz, Indiana's Medicaid Director, has defended the policy, citing adherence to MCG Medicaid Necessity Criteria. However, autism care advocates, including Mariel Fernandez, VP of Government Affairs at the Council of Autism Service Providers (CASP), have raised significant concerns about both the policy and its context.

"One critical consideration is the role of the recent Office of the Inspector General (OIG) report in the decisions made by Indiana Medicaid," Fernandez explained. "The OIG report was unfavorable and did not paint ABA providers in a positive light, citing serious implications related to potential fraud, waste, and abuse. However, the report also fairly acknowledged that Indiana Medicaid failed to provide adequate policy requirements, training, or oversight for the ABA benefit."

Fernandez continued, "CASP has serious concerns with the proposed hard caps, which limit care to 30 hours per week for up to three years. These caps disregard the evidence-based needs of children and the best practices for ABA therapy. We also understand that the new Registered Behavior Technician (RBT) enrollment requirements create additional administrative burdens for providers, which will further hinder access to care."

Fernandez emphasized the broader impact of these proposed changes, stating that Medicaid must recognize its responsibility to support systemic reform rather than implementing policies that penalize children and providers. "It is essential to acknowledge the context provided by the OIG report and the need for improved oversight and training to ensure Medicaid services meet the needs of children with autism."

Procedural Concerns

Roche added, "Medicaid bypassed the proper rule-making procedures, failing to hold a required public comment period or public hearing. It is also unclear whether these changes were approved by the Attorney General and Governor." Bierman Autism Centers and other advocates are calling for Medicaid to adhere to state and federal procedural requirements before implementing such drastic changes.

"Medicaid needs to be held accountable to their obligations—not only to follow federal law and state procedures—but to protect our most vulnerable children," Roche said. "As a government agency, Medicaid should not be allowed to implement such harmful policies that violate a host of laws and regulations."

Call to Action

Bierman Autism Centers urges policymakers to immediately pause these harmful changes and collaborate with families, providers, and advocates to ensure Indiana's children continue receiving essential care. "This is not the time for rushed decisions. It's time to listen to the people who understand the importance of evidence-based ABA therapy," Roche concluded.

About Bierman Autism Centers

Bierman Autism Centers is a trusted leader in autism care, dedicated to helping children with autism grow, play, and thrive. Since 2006, Bierman has successfully graduated over 300 children and has been transforming lives through individualized therapy, empowering children to build essential skills like self-advocacy, communication, and independence. Learn more at www.biermanautism.com.

About the Council of Autism Service Providers

Founded in 2016, the Council of Autism Service Providers (CASP) is a non-profit trade association of over 380 autism service provider organizations from all 50 states and multiple countries. It supports members by cultivating, sharing, and advocating for best practices in autism services. From developing clinical practice guidelines for applied behavior analysis to educating legislators about good policy, CASP works every day to ensure individuals with autism receive quality care. Learn more at www.CASProviders.org.

Media Contact:
Carol Gifford
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388924@email4pr.com

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SOURCE Bierman Autism Centers