CMS Applied Behavior Analysis Toolkit: Regulatory and Enforcement Implications for Healthcare Practitioners
Healthcare Senior Public Affairs Advisor Jordan Brossi and Healthcare Transactions attorneys John Arnold and John Saran co-authored an article for the American Health Law Association (AHLA) about the Centers for Medicare & Medicaid Services' (CMS) Applied Behavior Analysis (ABA) Toolkit for state Medicaid and Children's Health Insurance Program (CHIP) agencies. Framed by CMS as a response to the rapid growth in ABA utilization and expenditures – the number of children diagnosed with autism spectrum disorder receiving ABA services grew 189 percent over four years, corresponding to a 421 percent increase in spending – the toolkit functions as a menu of regulatory options for states agencies, replete with sections on benefit design, coverage parameters, provider enrollment and credentialing standards, and utilization management controls. In their article, the authors explain the federal enforcement context surrounding the release of the toolkit, one in which CMS has pivoted toward proactive payment interventions and increased focus on fraud identification and prevention. They also highlight developments at the state level, such as rate structure and reimbursement model changes and Medicaid enrollment moratoriums, before going on to list four recommended steps for healthcare counsel: reassess compliance programs, enhance transaction due diligence, revisit corporate structure and ownership, and get involved in state advocacy and rulemaking.
The authors also published a Holland & Knight alert on this topic.
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