What Happens When ABA Is Moved Out of Medical Coverage

Healthcare attorney Colbey Reagan was mentioned in a Behavioral Health Business article examining a recent shift by the Idaho Department of Health & Welfare (IDHW) that moved certain autism therapy-related services out of Medicaid managed care and into the state-administered Children's Habilitation Intervention Services (CHIS) program on a compressed timeline. The article highlighted concerns from providers and advocates about limited information on how the transition will work, potential gaps in care or reimbursement, and operational impacts tied to new authorization, coding and billing requirements for applied behavior analysis (ABA) therapy. Mr. Reagan noted that the lack of transparency and transition guidance has left providers and families with significant uncertainty as the new model takes effect.

"There is next to nothing in the public record," he commented. "They simply communicated that this is the plan going forward but haven't communicated anything meaningful on how that's going to happen, how the transition will work, how payment will be made going forward, how they will bridge what I presume will be a gap in care – or at least a gap in reimbursement [for] people transitioning their kids from current ABA models to this CHIS model."

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