Indiana’s Family and Social Services Administration on Tuesday announced it will pause enrollment of new autism therapy providers for at least six months, beginning Saturday.
Applied behavior analysis therapy is often used to improve communication and learning skills in children and young adults with autism or other developmental disorders.
More than 6,000 Hoosiers were accessing ABA therapy through Medicaid as of January, according to FSSA slides — costing the agency upwards of $35 million that month alone.
“Indiana has seen an incredible surge in ABA spending over the past several years — a trend that raises concerns about sustainability and program integrity,” FSSA Deputy Secretary Eric Miller said.
He described the moratorium as a “targeted, responsible step to ensure that growth in ABA services remains accountable and aligned with the needs of Hoosier families.”
The move, approved by the U.S. Centers for Medicare & Medicaid Services, also applies to ownership changes for existing providers, according to the news release.
“By pausing new agency enrollments, we are taking action to strengthen oversight, prevent waste, and support a system that delivers quality outcomes for those who need it most,” Miller said.
A Braun-established ABA working group recommended last November that FSSA request federal approval for a pause — but presented it as a way to curtail offerings in areas with overly high concentrations and encourage expansion in underserved communities.
The strategy took on more importance after the Wall Street Journal in March highlighted an Indiana ABA provider as an example of out-of-control costs billed to the state’s Medicaid program.
That month, FSSA Secretary Mitch Roob demanded providers “self-report” any practices that could constitute fraud, waste or abuse by early April, the Capital Chronicle reported.
Indiana Medicaid spending on ABA therapy rises 2019%
Indiana began Medicaid coverage for applied behavior analysis therapy, a primary treatment for autism spectrum disorder, in 2016. Eight years later, spending has grown by 20 times — rising from 0.2% of the state’s total Medicaid expenditures to 2.3%.
Agency leaders quoted the WSJ article during a quarterly financial reporting meeting in late April. They announced a Medicaid state plan amendment authorizing the moratorium was awaiting federal approval — and warned of increased auditing.
Provider applications received before Saturday will be processed “as usual,” per the news release.
The moratorium is set to extend through early December, but FSSA could seek six-month extensions.
The agency left the door open to accredited providers in underserved areas to pursue exceptions. Such organizations can contact OMPPProviderRelations@fssa.in.gov.
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This article was written by Indiana Capital Chronicle reporter Leslie Bonilla Muñiz.
