Law Office of Claudia I. Pringles, PLLC

ABA and Medicaid in Vermont: We’re Almost There

Many of the states now have laws that provide for insurance coverage of autism related treatments. These laws allow individuals with autism to access much needed therapies at home and in the community by requiring coverage of these treatments by health insurance plans. Our Vermont law (2010 and 2012) also includes this coverage for children on Medicaid… at least on paper.

In practice, only children on private insurance (with few exceptions) have been able to access the therapy that is for many considered to be the most important therapy for individuals with autism: ABA (Applied Behavior Analysis).  ABA is an intensive therapy which is used to assist individuals with autism in developing positive skills and minimizing less desirable skills, such as aggression. The therapy can also be successfully applied to individuals with other developmental disabilities, including individuals with Down syndrome.

ABA programs are developed and overseen by Behavior Analysts. Unlike other professionals who work with individuals with autism and other disabilities, such as occupational therapists, speech and language pathologists, physical therapists and special educators, Behavior Analysts are not a licensed profession in Vermont.

This inexistence of licensure of Behavior Analysts became a major stumbling block for payment of Behavior Analysts through Medicaid.  Our state’s Medicaid office at the Dept. of Vermont Health Access (DVHA) was uncertain of whether the federal Medicaid office (CMS) would allow payment of Behavior Analysts who are not licensed.

For purposes of public safety and access to ABA therapy for children on Medicaid, a licensing statute was pursued at the 11th hour. Although the hope of getting licensure this session was a dismal prospect a couple of months ago, the legislature passed our bill and Governor Shumlin signed into law the licensing of Behavior Analysts on May 28th.

Like other licensing statutes, this law is targeted at keeping the public safe by using background checks, verifying credentials and monitoring satisfaction of continuing education requirements.  Once the law is implemented (July 2016), the public will have a mechanism for filing a complaint at the Office of Professional Regulations (OPR), the state agency tasked with monitoring most of our state’s licensed professionals. Our statute also include an advisory panel which will be comprised of two behavior analysts and a parent of a child with autism or developmental disability who is currently receiving ABA therapy.

Even though OPR will need time to develop regulations and details for licensing of the Behavior Analysts, there is a much faster track as far as access to ABA therapy for kids on Medicaid. DVHA is moving forward as quickly as possible to finalize guidelines and fee structures to begin allowing payment to Behavior Analysts by July of this year.

Finally.

If you have any questions or are still experiencing barriers after July, please call my office or send me an email. I’d love to hear from you.

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