THE SENATE S.R. NO. 152 THIRTY-SECOND LEGISLATURE, 2023 STATE OF HAWAII SENATE RESOLUTION requesting the department of human services' med-quest division to take steps necessary to ensure that adequate provider rates are established for applied behavior analysis services.
THE SENATE S.R. NO. 152
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII
THE SENATE
S.R. NO.
152
THIRTY-SECOND LEGISLATURE, 2023
STATE OF HAWAII
SENATE RESOLUTION
requesting the department of human services' med-quest division to take steps necessary to ensure that adequate provider rates are established for applied behavior analysis services.
WHEREAS, applied behavior analysis is a medically necessary service provided for Med-QUEST beneficiaries under the age of twenty-one with an autism spectrum disorder diagnosis; and WHEREAS, the Med-QUEST reimbursement rates for applied behavior analysis services were set in 2015 and have not increased; and WHEREAS, the State's current reimbursement rate for applied behavior analysis services, and in particular for registered behavior technicians, is below the current market rate; and WHEREAS, Medicaid agencies in other states have increased their reimbursement rates over the years while Med-QUEST reimbursement rates have remained the same; and WHEREAS, other public payors in the State, including the Department of Education and Department of Health's Developmental Disabilities Division pay higher rates for applied behavior analysis services, with the Department of Education paying a difference of $25 per hour on the neighbor islands and the Developmental Disabilities Division paying a difference of $19.45 per hour; and WHEREAS, because the American Medical Association's Current Procedural Terminology codes for applied behavior analysis services are carrier priced, the Centers for Medicare and Medicaid Services Medicare Physician Fee Schedule does not currently set rates for these services; and WHEREAS, wages in the State have increased by thirty percent since 2015, forcing applied behavior analysis service providers to shoulder increased staff costs without a proportionate rate increase; and WHEREAS, applied behavior analysis service providers across the State have reported an inability to meet the demand for services by Med-QUEST beneficiaries, largely due to difficulty in hiring and retaining providers given the State's high cost of living and the demand for increased wages; and WHEREAS, families who have been able to access services report not being able to access the full amount of services recommended for their child due to a lack of providers; and WHEREAS, families also report significant delays in timely access to services and being placed on years long waitlists for services; and WHEREAS, research demonstrates that early intensive intervention and the provision of services in line with professional standards of care produces the best outcomes for individuals and can decrease the cost of care over the individual's lifetime; and WHEREAS, under federal law, all covered Medicaid services must be provided with "reasonable promptness"; and WHEREAS, as part of the Early and Periodic Screening, Diagnostic and Treatment benefit established pursuant to Section 1905(r) of the Social Security Act, Medicaid agencies must employ processes to ensure timely initiation of treatment; now, therefore, BE IT RESOLVED by the Senate of the Thirty-second Legislature of the State of Hawaii, Regular Session of 2023, that the Department of Human Services' Med-QUEST Division is requested to take steps necessary to ensure that adequate provider rates are established for applied behavioral analysis services; and BE IT FURTHER RESOLVED that the Med-QUEST Division is further requested to assess current reimbursement rates for applied behavior analysis services; and BE IT FURTHER RESOLVED that the Med-QUEST Division is requested to submit a report of its findings and recommendations on appropriate reimbursement rate increases, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2024; and BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Human Services and Administrator of the Med-QUEST Division. OFFERED BY: _____________________________ Report Title: Applied Behavioral Analysis; Reimbursement Rates; Med-QUEST
WHEREAS, applied behavior analysis is a medically necessary service provided for Med-QUEST beneficiaries under the age of twenty-one with an autism spectrum disorder diagnosis; and
WHEREAS, the Med-QUEST reimbursement rates for applied behavior analysis services were set in 2015 and have not increased; and
WHEREAS, the State's current reimbursement rate for applied behavior analysis services, and in particular for registered behavior technicians, is below the current market rate; and
WHEREAS, Medicaid agencies in other states have increased their reimbursement rates over the years while Med-QUEST reimbursement rates have remained the same; and
WHEREAS, other public payors in the State, including the Department of Education and Department of Health's Developmental Disabilities Division pay higher rates for applied behavior analysis services, with the Department of Education paying a difference of $25 per hour on the neighbor islands and the Developmental Disabilities Division paying a difference of $19.45 per hour; and
WHEREAS, because the American Medical Association's Current Procedural Terminology codes for applied behavior analysis services are carrier priced, the Centers for Medicare and Medicaid Services Medicare Physician Fee Schedule does not currently set rates for these services; and
WHEREAS, wages in the State have increased by thirty percent since 2015, forcing applied behavior analysis service providers to shoulder increased staff costs without a proportionate rate increase; and
WHEREAS, applied behavior analysis service providers across the State have reported an inability to meet the demand for services by Med-QUEST beneficiaries, largely due to difficulty in hiring and retaining providers given the State's high cost of living and the demand for increased wages; and
WHEREAS, families who have been able to access services report not being able to access the full amount of services recommended for their child due to a lack of providers; and
WHEREAS, families also report significant delays in timely access to services and being placed on years long waitlists for services; and
WHEREAS, research demonstrates that early intensive intervention and the provision of services in line with professional standards of care produces the best outcomes for individuals and can decrease the cost of care over the individual's lifetime; and
WHEREAS, under federal law, all covered Medicaid services must be provided with "reasonable promptness"; and
WHEREAS, as part of the Early and Periodic Screening, Diagnostic and Treatment benefit established pursuant to Section 1905(r) of the Social Security Act, Medicaid agencies must employ processes to ensure timely initiation of treatment; now, therefore,
BE IT RESOLVED by the Senate of the Thirty-second Legislature of the State of Hawaii, Regular Session of 2023, that the Department of Human Services' Med-QUEST Division is requested to take steps necessary to ensure that adequate provider rates are established for applied behavioral analysis services; and
BE IT FURTHER RESOLVED that the Med-QUEST Division is further requested to assess current reimbursement rates for applied behavior analysis services; and
BE IT FURTHER RESOLVED that the Med-QUEST Division is requested to submit a report of its findings and recommendations on appropriate reimbursement rate increases, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2024; and
BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Human Services and Administrator of the Med-QUEST Division.
OFFERED BY: _____________________________
OFFERED BY:
_____________________________
Report Title:
Applied Behavioral Analysis; Reimbursement Rates; Med-QUEST