Medicaid ABA Benefit An Update

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