AHCA Postpones BA Therapy Cuts

Florida’s Agency for Health Care Administration (AHCA) has decided to postpone planned cuts to Medicaid reimbursement rates for behavioral health therapists, many of whom work with children on the autism spectrum.

In March, AHCA proposed payment reductions for a variety of services as outlined below:

• Payments for Behavior Analysis Assessment to decrease from $385.19 to $301.31
• Payments for Behavior Analysis Reassessment to decrease from $192.59 to $150.65
• Payments for Behavior Analysis Lead, per quarter hour, to remain the same at $19.05
• Payments for Behavior Analysis Assistant, per quarter hour, to decrease from $15.24 to $10.52
• Payments for Behavior Analysis Registered Behavior Technician, per quarter hour, to decrease from $12.19 to $5.98

The decision to put a halt to the cuts followed a public hearing earlier this month in which more than 100 parents and therapists showed up to protest the plan. Opponents argued that the cuts would result in a significant reduction in services, particularly to those who most vulnerable – low-income children with special needs. AHCA is conducting a series of meetings around the state through May 10 to obtain public input.

According to published reports, about 41,000 children in Florida receive applied behavior analysis therapy through the state’s Medicaid system.

In addition to proposed cuts, behavioral health professionals have been dealing with last year’s imposition of a six-month moratorium that AHCA placed on the enrollment of new behavioral health therapists in Miami-Dade and Broward counties. AHCA said it was needed because it had identified fraud and abuse within the Medicaid program. The agency alleged, among other things, that providers were attempting to bill for “unbelievable hours,†and that some providers had “falsified qualifications.â€

AHCA said the moratorium was established to allow for a “complete and comprehensive assessment of the current provider population and remove from the provider network those who are not qualified to participate or whose participation is believed to have been based solely to commit fraud.â€

Behavioral health therapists have been complaining that authorizations were being held up, resulting in their inability to provide much needed treatment for a vulnerable population.

The area of behavioral health law is one that has been growing as a result of state and federal legislation. Everything from mental health to substance use disorders is being impacted. The Health Law Office of Anthony C. Vitale represents Provider Type 39 entities in various matters including, but not limited to, overpayments, payment restrictions and criminal referrals to the Medicaid Fraud Control Unit. Give us a call at 305-358-4500, or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.