Concerns about billing changes for behavior analytics

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A new way to charge Medicaid for behavior analysis has some parents of children with special needs and their caregivers concerned.


They say they fear this will compromise and limit access to therapy, leading to coverage by less skilled caregivers.

Organizers of Bay Area rallies to oppose the change said they were trying to get the attention of the Florida Agency for Health Care Administration, which oversees and administers Medicaid. Despite public outcry, the new billing codes came into force on August 1

Board-certified behavior analyst Andrea Holladay said some therapies previously billed based on the education level of the provider can now be billed at an entry fee, which would mean a pay cut for some carers .

“How that would impact if, say, this person is a behavior analyst and they received their degrees and are now providing direct therapy,” she said. “It’s basically a reduction in our hourly rate of about 36 percent.”

Julie Dang-Martinez said she has seen the impact of behavior analysis therapy firsthand. This type of treatment began with her daughter, Tyanna, when she was a minor and continued into adulthood. Dang-Martinez hoped other families would continue to benefit.

Diagnosed at birth with a rare genetic condition, she attributes Tyanna’s growing independence to the constant care provided by experienced professionals.

She said the support from caregivers, such as a personal support coach and a board-certified assistant behavior analyst, had a significant impact on Tyanna and the entire family.

“It’s just night and day when it comes to our standard of living and our family’s mental health,” Dang-Martinez said.

Melanie Donnelly, a board-certified assistant behavior analyst, has been with the family for more than five years.

“She’s learned quite a few skills with us when it comes to independent living skills,” Donnelly said.

Skills like communication and daily living – washing clothes and watering plants are part of Tyanna’s household chores, Dang-Martinez said.

Donnelly says continued support helps keep Tyanna on track.

“She’s becoming more independent and needs fewer prompts from mom or us to go through this process independently,” she said of Tyanna. “And that’s ultimately our goal, is to get them to do it all on their own so Mom has a little more time and they can learn to do things themselves.

Feeling comfortable with the level of care Tyanna has received over the years, Dang-Martinez said she felt confident going to her photography studio for work.

“I make my own hours,” she said. “The longest day I have from start to finish is about six hours, then I can take breaks, I can come home and watch her, come back, I can kind of do my own job time.”

The things Dang-Martinez says he loves about photography are confidence and the ability to capture a moment in time.

It is this same confidence that she wants her daughter to maintain.

From learning through praise when goals are achieved to completing household chores, Dang-Martinez says the therapy that began as a child has continued into adulthood.

But the recoding of how Medicaid bills behavior analysis therapy continues to concern some parents and concerned specialists.

“They won’t have someone as qualified, there will be less help for them,” Donnelly said.

While Florida AHCA officials say the changes shouldn’t impact services, not everyone is convinced.

“Even minimally limited, it will cause a huge disruption in behaviors and family dynamics, in terms of having good conflict behaviors and communicating them,” Dang-Martinez said.

This communication is something that can help the whole family, she says.

“The quality of life she has now, the mental health she has, it’s thanks to the behavior analysts who were able to come and help me know what triggers to put in place, or what measures to put in place, to may she be well day after day,” Dang-Martinez said.

As Tyanna gains independence, Dang-Martinez hopes other families can count on the same kind of therapy that continues to help her family.

AHCA officials say the changes do not constitute a pay cut for providers and should have “no impact” on services.

The agency did not respond when asked about carers’ concerns about how compensation was now coded without considering credentials.

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