Providers sound alarm over reimbursement rates as some clinics close their doors
Tomash said those financial problems have snowballed into an industry-wide crisis that comes as autism rates nationwide rise and patient numbers increase. According to the Centers for Disease Control and Prevention, 1 in 36 children nationwide were diagnosed with autism spectrum disorder in 2020. In 2010, that figure was 1 in 68.
BehaviorSpan is currently breaking even financially, but that means they can’t increase their workforce to alleviate workload or burnout. Employees, not only at BehaviorSpan, but across the industry, occasionally leave the field to pursue other behavioral health jobs or even retail or food service jobs.
Other clinics haven’t been so lucky.
Brian Lopez, founder of the New Mexico-based JumpStart Autism Center, opened a site in Denver in 2008. He says that when Medicaid eligibility was expanded through the COVID-19 public health emergency declaration, now expired, the state has not increased reimbursement rates to compensate. the fact that more families were able to access autism care.
Ultimately, we were never able to overcome the challenges of the public health emergency and we decided to move forward and close rather than reduce the quality of service we provide, Lopez said.
Lopez and JumpStart aren’t the only providers pulling out of Colorado. Hopebridge, a company with operations in nearly a dozen states, closed 6 of its 8 Colorado locations earlier this year, with the CEO blaming the state’s Medicaid rates.
These closures have an impact on remaining providers, but in many cases they are unable to accommodate new clientele.
We have had an influx on a waiting list of children who have been seen by providers who have moved out of state and it is sad because I can only serve one child out of a hundred applications our center receives . “
JJ Tomashfounder of BehaviorSpan
We have had an influx on a waiting list of children who have been seen by providers who have moved out of state and it’s sad because I can only serve one child out of a hundred applications that our center receives, Tomash said.
For Leitao, what’s happening to pediatric autism care providers feels like a repeat of what happened to adult autism care centers in Colorado years ago, when she was first starting out in the industry. She had adult autistic clients, but companies stopped providing the service when public funding dried up and only paid for periodic sessions.
Over time, it has become more profitable to work with children than with our adult population, and not only that, Leitao said. It’s difficult to make changes or change in adults’ lives when you only see them for an hour a week. What will it do?
Kevin J. Beaty/DenveriteIt’s unclear whether the state is willing to provide the amount of money providers are requesting.
At a September hearing before the Joint Budget Committee, Adela Flores-Brennan, Medicaid director for HCPF, told lawmakers they had heard providers’ complaints and would ask the Legislature to increase rates during the next session.
For us, the discussion is about the extent to which we can reasonably increase these provider reimbursement rates in the context of other provider rate increases that may need to occur, in the context of overall state budget priorities in partnership with you, when these increases increased. refunds can take effect and what other policy changes we should consider together, she said.
A group appointed by the state Legislature, known as the Medicaid Provider Rate Review Advisory Committee, or MPRRAC, advises the state on how Medicaid rates should change. Under its 2023 recommendations for the next legislative budget cycle, Colorado Medicaid pays about 78% of the benchmark amount set by 10 other states for pediatric behavioral health, which includes reimbursements for autism care.
The MPRRAC recommended that Colorado Medicaid increase its rates to meet the benchmark, which would cost approximately $35 million.
However, the HCPF disagreed. In the same document, they said the inclusion of Nebraska in the MPRRAC analysis raised the benchmark too high, arguing it was an extreme outlier. Without Nebraska, Colorado Medicaid pays about 91 percent of the benchmark and they are only willing to meet that benchmark, which would cost $13 million, or only a third of EM-PRACK’s recommendation.
Maureen Welch, a former MPPRAC member and disability rights advocate, said this follows a frustrating trend she witnessed during her 2019 to 2021 tenure.
Our recommendations were very rarely reflected in the HCPF Medicaid director’s recommendation, Welch said.
For now, Colorado’s autism care centers are waiting until Nov. 20, when HCPF will present its budget request to the Joint Budget Committee, which providers say will indicate whether their pleas for help have been successful of success.
This is part one of a two-part series. The second part will be published on Friday November 17.
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