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Contracting for Applied Behavioral A l i (ABA) Th S iAnalysis (ABA) Therapy Services
University of Missouri Thompson Center for Autism and Neurodevelopmental Disorders
Catherine Noel, Assistant Director for Managed CareUniversity Physicians, University of Missouri Health System
December 2, 2011
Thompson Center MissionThompson Center Mission
To improve the lives of individualsTo improve the lives of individuals with autism and other neurodevelopmental disordersneurodevelopmental disorders through world class programs that integrate research clinicalthat integrate research, clinical service delivery, education & public policypublic policy
Thompson Center ServicesDiagnostic & Medical: Treatment & Support:
• Autism Diagnostic Clinic• Autism Toddler
Assessment Clinic
• Early Intensive Behavioral Intervention
• Behavior Supports ClinicAssessment Clinic• Autism Medical Clinic• Child Development Clinics
• Behavior Supports Clinic• Leaps Ahead• Occupational TherapyChild Development Clinics
• Child Neuropsychology Clinic
p py• Speech/Language Therapy• Individual and Family
h• Clinical Assessment Team Therapy• Family Resource Services
Contracting Targets
• Behavioral Health plans covering State PublicBehavioral Health plans covering State, Public and University employees
• Larger commercial plans with agreements that i l d b h i l h l h iinclude behavioral health service coverage
Time Line
Jan 2011 HB1311 becomes effectiveMar 2011 Negotiations with payors initiatedMar 2011 Negotiations with payors initiatedApr 2011 Contracts and/or LOA’s in placeJun 2011 Commercial payor billing beginsJun 2011 Commercial payor billing beginsNov 2011 Still learning!
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Current AgreementsCurrent Agreements
United Behavioral HealthMH Net Behavioral HealthAnthem BCBSHealthlinkTriwest (demonstration project)
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Standards
• Classification for payor credentialing/billingClassification for payor credentialing/billing– Agency
Individual Provider– Individual Provider• Role of BCaBA
• Service classification standards– Codes – Units– Modifiers
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Crosswalk Direct ABA Services
ABA Services
Modifier HO HP (blank) HN HM
Education masters doctoral bachelorsless than bachelor
BCBA BCBA‐D BCaBA Other OtherBCBA BCBA D BCaBA Other Other
CPT SERVICE DESCRIPTION TIME UNIT
Direct ABA Services
BCBS H2012 ABA Therapy provided directly by a BCBA or BCaBA 1 hr unit
H l hli k H2012 ABA Th id d di l b BCBA BC BA 1 h iHealthlink H2012 ABA Therapy provided directly by a BCBA or BCaBA 1 hr unit
MH NET 99347 Evaluation, ABA services and periodic treatment plan review 15 min unit
UBH H2012Direct ABA services by a BCBA, or Licensed Mental Health Professional 1 hr unit
Triwest S5108 15 min unit
Established standards would facilitate:
Coding Rate settingUnit Productivity reportingUnit Productivity reportingModifiers Simplify billing process
Role of BCaBA Staffing
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New ProcessesNew Processes
• Credentialing process for ABA providersCredentialing process for ABA providers (internal)
• Line Therapist– Must bill under supervising BCBA– Employment
Initial OutcomesInitial Outcomes
• Agreements completed fairly quicklyAgreements completed fairly quickly
S ll l f i ll i d li• Small volumes of commercially insured clients to date (volumes are increasing a bit)
• National standards would be beneficial
• We are still learning!• We are still learning!