By Amber Roman
Jun 19, 2024, 17:49 PM EDT
In Minnesota, autism affects one in 34 8-year-old children, according to a 2020 study by the Minnesota Autism and Developmental Disabilities Monitoring Network, part of the Centers for Disease Control and Prevention. US This rate is slightly higher than the national average, which has highlighted the growing need for specialized resources and treatments for these children.
Despite the efforts of the state autism program, waiting lists indicate that many children who need treatment are not receiving it. The root cause is a shortage of qualified providers, with only one certified behavior analyst available for every 97 children. This disparity has led lawmakers to recently pass legislation to license behavior analysts, joining 34 other states. Reimbursement rates for early intensive behavioral intervention providers have also been increased by 15%, with the intention of reducing high turnover and ensuring the financial stability of providers.
The system’s reform potential is being evaluated by state officials, who are studying whether some autism centers are handling excessive caseloads and whether it is necessary to begin licensing these centers. According to Merz, when providers sign up for reimbursement through Medical Assistance, Minnesota’s Medicaid program, the department verifies that they have the proper credentials. Families must also have a service agreement to bill the Department of Human Services (DHS) and Medical Assistance.
The DHS Office of Inspector General has the authority to investigate suspected fraud and prevent providers from billing. Since 2018, the OIG has withheld payments to seven vendors, five of them for credible fraud allegations, one for denying access to records, and another to protect the public welfare. Medicaid Provider Audits and Investigations has referred five Minnesota providers to the Medicaid Fraud Control Unit.
Eric Larsson, president of the Association for Science in the Treatment of Autism and executive director of clinical services at the Lovaas Institute Midwest, noted that after years of lobbying, Minnesota implemented an autism program in 2013, although it did not become fully operational until 2018. Larsson also mentioned that the state has filed complaints with the Behavior Analyst Certification Board about providers with too many cases and low-quality services.
The average caseload at the Lovaas Institute is 3.5 children per certified doctor, while other centers can care for up to 100 children, which worries Larsson. An anonymous worker at an insurance company that administers Medical Assistance expressed concern about fraud in the autism program, indicating that some centers may be operating more like daycare centers than treatment centers.
According to this worker, there are cases of providers claiming that children are autistic without being so in order to obtain the high reimbursement associated with autism services. A child can receive up to 40 hours a week of services, such as speech therapy, depending on her individual treatment plan. Although the program requires a diagnosis of autism, the definition of autism spectrum disorder is vague, making it easy for abuse.
In some cases, insurers have paid benefits to families with multiple children diagnosed with autism, and claims have been submitted for services and transportation to autism centers that are closed on certain days. Insurance companies cover transportation of children to these centers, which sometimes means children as young as 18 months are transported five days a week, even between different centers on a single day.
This scenario poses significant challenges for the health system and affected families, underscoring the need for stricter regulation and adequate oversight to ensure that children with autism receive the treatment they need and that resources are used efficiently and ethically. . The autism community in Minnesota continues to hope for reforms that will ensure quality care and prevent fraud in a system vital to the development and well-being of children with autism.
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