Forest man first person diagnosed with autism
Justin Sellers/The Clarion-Ledger
Wayne Williams, director of clinical operations and services for the Mississippi Center for Autism and Developmental Disabilities, took a mental note as he watched parents in the D’lberville-based clinic’s reception area wrangling over the phone with representatives of the state Medicaid division.
Cellphone usage is generally restricted, if not outright banned, in these type of settings.
But Williams knew the families had good reason to deviate from traditional waiting room culture.
Because more than half of the clinic’s young patients are on Medicaid.
And almost two years after Mississippi enacted a mandate requiring insurers to cover a type of autism therapy known as applied behavior analysis, providers say the state’s largest insurer of children is not reimbursing services.
“It hurts us severely,” said Williams. “We don’t like to put people off. Every case that comes in we shouldn’t have to triage. We shouldn’t have to worry that we’re not seeing the ones in the most need.
“All of them have needs,” he emphasized. “There’s no difference when you do this. You treat the person who’s there, it doesn’t make any difference whether the next person is milder or severe.”
For Williams and other providers The Clarion-Ledger spoke with, the problem is two-fold.
The first is a matter of timing.
Mississippi submitted an amended state plan to the Centers for Medicare and Medicaid Services last year. The document details the scope of behavioral therapy services that will be covered for eligible beneficiaries under the age of 21 diagnosed with autism. CMS works on a 90-day turnaround schedule, meaning if the plan is approved before the end of this current quarter, the new policy will go into effect on July 1.
“We’ve all been in limbo for over a year now,” said Jessyi Bryant Reed, a behavior analyst at the Autism Center of North Mississippi-based in Tupelo.
When she spoke with The Clarion-Ledger last week, Reed said three families had called within the last 48 hours to put their children on the waiting list. All of them were on Medicaid.
“Bottom line: We’ve got a tight window to deliver services. Every minute that passes by. It’s a grain of sand you don’t get to pull back. (I’m hopeful) this moves forward so children can start receiving services,” said Jim Moore, director of the state Autism Board, which is charged with licensing board-certified behavior analysts.
The second and perhaps more pressing issue for providers is the reimbursement rates proposed by the division. In public comments, providers protested the fee schedule. Most insurers stipulate that applied behavioral analysis therapy programs must be supervised and coordinated by a licensed behavior analyst in order to receive payment.
The billing guideline proposed by Medicaid would have paid a behavioral analyst with a master’s degree $30 an hour. In neighboring Louisiana, the rate is $72 per hour.
“We respectfully believe that the reimbursement rates offered … will compromise and possibly stifle efforts to recruit, hire and retain (board-certified behavior analysts) in Mississippi,” wrote two certified psychologists with Hattiesburg-based Will’s Way provider who are board-certified behavior analysts with doctoral training.
Also troubling to respondents was the rate proposed for the behavior identification assessment. Williams explained this is the process where providers develop a treatment plan for their patients and is often labor-intensive, often taking no less than five to 10 hours. Medicaid suggested a reimbursement of roughly $132. A number of providers argued the rate was not in line with what other insurers such as Blue Cross Blue Shield and Acclaim offered. TriCare, which provides insurance for the military, for example, offers a reimbursement rate of $500.
Milliman, a consulting firm, produced the actuarial report that formed the basis for the state’s rates. Erin Barham, a spokesperson for the state Division of Medicaid, said the state is in the process of reevaluating the rates and that Milliman has been asked again to present a second report. A spokesperson for Milliman would not comment on providers’ concerns, citing long-standing policy. Barham could not provide specifics concerning the timeline for the process.
Providers have taken a sort of patchwork approach to covering their expenses while they await the plan’s approval.
Clinics with psychologists on staff might bill to codes separate from applied behavioral analysis, Moore explained.
Others such as the Mississippi Center for Autism and Developmental Disabilities and the Autism Center of North Mississippi that operate as nonprofits rely on grants and fundraising. Some providers have also opted to charge families on a sliding scale.
Securing a reasonable reimbursement rate from Medicaid is seen as an important step for many providers who are quick to acknowledge there is a shortage of board-certified behavior analysts in the state.
One in 68 children are estimated to have been identified with autism spectrum disorder, according to the U.S. Centers for Disease Control and Prevention.
In 2014, the state Department of Education identified 4,360 children, ages 3-21, with the educational ruling of autism.
But less than 40 providers have been certified in the state to deliver applied behavioral analysis therapy.
Advocates say this underscores a multilayered problem in the state.
Landry Nance of Clarksdale received a Healthier Mississippi waiver from Medicaid for her 2-year-old son Cash, but quickly found that regional clinics had a waiting list. That’s meant she’s had to travel to The Boling Center in Memphis to receive treatment. The center accepts Mississippi Medicaid on a case-by-case basis but did not approve Cash’s plan. Instead, Nance will have to pay a sliding fee for Cash’s treatment.
Nance, who works as a teacher, has not received her first bill, but she said she believes the sacrifice will be worth it.
Cash was diagnosed shortly after turning 1. In the time that has passed since then, she’s seen both setbacks and gains.
Applied behavioral analysis along with his speech therapy has played a role, she said.
Nance remembers how her little boy would say, “mama,” until, one day he was no longer able to.
Now, he’s started to call for her again.
“It gives me chills thinking about it,” she said.