Medicaid Funding in Texas

On June 15, 2019 Governor Abbott signed HB1 which included Rider 32: Intensive Behavioral Intervention. Contingent on the Health and Human Services Commission (HHSC) adding intensive behavioral intervention (IBI) as a Medicaid benefit for persons under age 20 with a diagnosis of Autism Spectrum Disorder, HHSC may expend funds appropriated above in Strategy A.1.5, Children, to reimburse for provision of IBI services.

 

Update:

As of November 20, 2019 TxABA PPG has been informed of the following timeline for implementation:

Currently, HHSC is finalizing revisions to the state plan and responding to public comments.

Public Comments on the draft policy were submitted to HHSC with an October 7, 2019.  At this time, we are still awaiting the revised policy.

Rate hearings that were set to occur on or about December 13, 2019 in Austin have been pushed back to early 2020; date is TBD.

Implementation will occur sometime in 2020; exact date is TBD.

TxABA PPG held a town hall discussion via GoToMeeting on August 28th to provide additional updates. If you would like a copy of the meeting minutes, please e-mail TxABA PPG at: behavioranalysispublicpolicytx@gmail.com

TxABA PPG has put together an FAQ list, below, we will continue to update this information as we have it.

Throughout the FAQ section, we will refer to Board Certified Behavior Analysts (BCBA's) as Licensed Behavior Analysts (LBA's). Licensure is required for BCBA's to practice in the state and Medicaid will require licensure.

FAQ's (11.20.2019 update)

  • Do I need to contact my Senator, Representative or the Governor’s offices to get the bill passed?

    • No! The Governor signed HB1, on June 15, 2019. HB 1 includes Rider 32: Intensive Behavioral Intervention. Contingent on the Health and Human Services Commission (HHSC) adding intensive behavioral intervention (IBI) as a Medicaid benefit for persons under age 20 with a diagnosis of Autism Spectrum Disorder, HHSC may expend funds appropriated above in Strategy A.1.5, Children, to reimburse for provision of IBI services.

 

  • When will this go into effect?

    • HB1 goes into effect on September 1, 2019

    • The initial draft of the revised HHSC Autism Policy, including IBI/ABA, was available for review in late September, 2019.  Public comments were due on 10/7/2019. 

    • Rate hearings will be  in early 2020 in Austin. An exact date and location is to be determined. Please note, this is a recent change and the hearing is no longer formally set for December 13, 2019.

    • At the rate hearing, HHSC will be hearing public testimony regarding their proposed rates. Rates may or may not be revised following this hearing.

    • Implementation will occur in 2020, exact date is TBD.

 

  • My child is enrolled in the HHSC CAP Program, will I lose funding?

    • Funding for the HHSC Children's Autism Program will continue for two years according to the recently approved State budget. Beyond that, we cannot say what will continue, though the TxABA Public Policy Group intends to monitor the situation closely, supporting continuation of the HHSC Children's Autism Program because some families without insurance will not qualify for Medicaid funding and cannot afford to pay for ABA services out of their own pocket.

  • Will all ABA Providers accept Medicaid?

    • No, just like private insurance, an ABA program can elect to go “in network” with any funding source.An ABA provider will need to contract and credential with the MCO's (Managed Care Organizations) before they can provide services.

  • Will there be wait lists?

    • This will vary clinic by clinic; but, yes, there will probably be some type of wait for services.

  • I’m a provider, how do I contract with Medicaid/ the MCO’s (Managed Care Organizations)?

    • HHSC is working with the MCO's to determine an appropriate method to contract and credential providers as quickly as possible and believe that this information will be available as soon as the rates have been formally set.

  • How long will it take to complete the contracting and credentialing process?

    • Much like private insurance, it may take as much as 180 days to complete this process. While this seems like a long time, please be aware that HHSC/ The MCO’s will be inundated with numerous contracting and credentialing packets. You can help to speed up the process by ensuring that your packets are complete and accurate and/or that you follow the steps outlined once we have this information.

 

  • What are the rates?

    • There will be a formal rate hearing in early 2020 in Austin. We believe that HHSC will be adopting a code set from the Category I CPT code set (97151 etc.).

  • What services will LBA's be able to bill?

    • In the draft policy, HHSC included a seven code set for billing and at least one of these codes is an indirect interdisciplinary meeting code. These codes will correspond with the CPT codes which rolled out in January 2019 (97151 etc.).  Once the HHSC policy is finalized, we will have additional information regarding which CPT codes will be valid and billable.

  • Will LBA's have to provide services directly?

    • HHSC will be adopting a tiered service delivery model, with LBA's and a behavior technician. We are unsure if there will be a third level for LaBA's (Licensed Assistant Behavior Analysts).  We believe that the RBT credential WILL BE required.

 

  • Why does this apply to only individuals age 20 and under?

    • The Center for Medicaid Services (CMS) at the Federal level, advised state Medicaid offices in July 2014 that they needed to pay for ANY medically necessary treatment for autism spectrum disorders, including ABA.CMS indicated that the benefit applies through a program within Medicaid called EPSDT (Early Periodic Screening Detection and Treatment). EPSDT is for children, individuals under age 21, and is a more robust benefit. The intent is to prevent, treat or decrease the risk of chronic illness or disease of any kind- from diabetes to autism. 

 

  • Will this apply to CHIP?

    • Funding will apply to all areas of Medicaid where EPSDT is applicable. At this time THSteps (EPSDT) is not a benefit for children enrolled in CHIP or CHIP Perinatal.  However, this being said, we plan on asking HHSC to apply the benefit to CHIP plans as well. We do not know if CHIP will end up including ABA as a covered benefit.

 

  • Will ISD’s be able to bill Medicaid for behavioral services?

    • This will be dependent upon how HHSC defines the program through the state plan amendment. At this time, HHSC has suggested that ISD billing WILL NOT be part of the first phase of this program; and may be available at a later date.

© 2017 by TxABA Public Policy Group. Proudly created with Wix.com

  • w-facebook
  • Twitter Clean
This site was designed with the
.com
website builder. Create your website today.
Start Now