Autism Details To Come After Rollout

At the first stakeholder meeting last week to review California’s new autism Medi-Cal coverage, state health officials said many details have yet to be worked out. Medi-Cal is California’s Medicaid program.

New benefits, which include coverage of applied behavior analysis —  also known as ABA therapy — begin next week.

Department of Health Care Services officials said many details — including the crucial figure of what the reimbursement rates will be — still need to be worked out. Rates will be discussed at the next stakeholder meeting Oct. 16, officials said.

The department still is on schedule to submit an autism coverage state plan amendment to CMS by Sept. 30, officials said.

“We will talk about rates later. We will have a separate session on rate setting,” said Sarah Brooks, branch chief of the Medi-Cal managed care division at DHCS. “We are working with different ABA providers so health plans can build their networks. We will be working with them to make sure we have proper network adequacy.”

According to Laurie Weaver, chief of the benefits division at DHCS, the new benefit will cover the broad area of Behavior Health Treatment, which includes ABA therapy as one type of treatment, but the department first will focus on ABA, since it’s at the heart of the new benefit.

“The state plan amendment will address ABA first and we’ll go from there,” she said.

According to Abbie Totten, director of state programs for the California Association of Health Plans, it’s unusual to launch a benefit before setting up the network.

“You have to understand,” Totten said to stakeholders at Thursday’s meeting, “we are implementing this benefit in a backwards manner. Usually when you implement a benefit you have time … you can develop all of those pieces, and we are not being provided that opportunity in this case.”

The health plans will work with the state to implement the benefit as best they can — but right now, she said, people will need to bear with the process, which may be rocky and a little confusing at first.

“We have no rates, we have no idea what payment looks like, we have no idea what licensing or provider criteria will look like,” Totten said.

“So, just as a caution, we will work together on this, we are committed with the department to make this work, but we don’t even have a [state plan amendment] that’s approved yet,” she said. “We’re going to do our best and try to make sure the providers are reimbursed properly.”

“This is day one,” said Rene Mollow, deputy director of health care benefits and eligibility at DHCS.

“You can look at this and say, ‘Oh no, there’s so much to do,’ ” Mollow said. “Or rather you can say, ‘Wow, look at what we’re doing here.’ “

Mollow said the department is committed to implementing the benefit with full involvement of stakeholders — and that lengthens the process somewhat.

“We are just starting down this pathway, and we know there will be improvements and there will be efforts to inform what the state of California will be doing,” she said. “It’s a process. I would look at it as: Day one. Woo-hoo!”

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