To interest more therapists in treating children with autism in a new state pilot, Utah's Medicaid program is planning to increase their pay.
It recently sought permission from the federal Centers for Medicare & Medicaid Services to boost what the reimbursement rate for tutors who will provide free applied behavior analysis therapy (ABA) to children with the social and communication disorder.
Authorized by the Utah Legislature, the pilot program will cover 250 children ages 2 through 6, through June 2014.
The children were chosen by lottery for slots distributed throughout the state. The Utah Department of Health has already started enrolling 225 children and continues to notify other families who made the cut.
The families must verify their child has a diagnosis of an autism spectrum disorder. Then, they must enroll in Medicaid. However, unlike traditional poverty-based Medicaid plans, the family's income is not taken into account.
Once they're fully enrolled, the families will be able to pick a provider.
The increased pay rate, along with other assurances from Medicaid, means families will have more contractors to choose from than before.
Just two providers had initially applied to work with the children. The pay rate was originally set at $21.52 an hour for the tutors, who would provide 20 hours of in-home therapy a week. ABA therapists had said the rate was too low for their experienced tutors.
After surveying the therapists about what rate was practical, Medicaid bumped it to $28.32, based on satisfying three out of five providers who responded to the survey. As of Tuesday, seven providers had sought Medicaid contracts.
Still, as before, a tutor could make as little as $14.42 an hour depending on what providers allot for insurance and training costs.
To stay within the $15 million pilot budget, children will receive 15 hours of therapy a week, said Medicaid spokeswoman Kolbi Young. It won't reduce the number of children served, she added.
One of the critics, Breanne Berg, with Apex Behavior Consulting, said she will now apply to be a provider even though the rates remain low.
"We feel that the health department made a good faith effort in raising the rate," she said in an email. "We are excited to start serving some of the families who have been chosen in the lottery."
Jeff Skibitsky, owner of Alternative Behavior Strategies, said he decided to seek the Medicaid contract even before the rates increased.
His main concern had been the low qualifications Medicaid set for tutors: age 18 with a high school diploma and 20 hours of autism training.
That makes sense in a group therapy setting where the tutors have constant supervision, he said. But not when the tutor will be working alone with the child in their home with occasional supervision.
The qualifications haven't changed, but Skibitsky said he received assurances that Medicaid would continue to evaluate it.
"They're listening. They're trying to do what they should be doing," he said.
He noted that the new Medicaid rate, which is about 70 percent of what some private insurers pay, would allow contractors to make a small profit.
Applied behavior analysis
ABA » It has been used since the '60s to help people with autism. Through positive reinforcement, children can acquire basic skills, including looking, listening and imitating, the advocacy group Autism Speaks says.
In some cases » Preschoolers who have intensive therapy can eventually participate in regular classrooms with little extra support. But some show no improvement, so it is hard to predict how much each child will benefit.
The federal Centers for Medicare & Medicaid Services has 90 days to review Utah's proposal to increase the pay for tutors in its autism pilot program.