Healthcare providers sound the alarm about reimbursement rates as some clinics close
Tomasz said these financial issues are snowballing into an industry-wide crisis as autism rates rise nationwide and the number of patients increases.by Centers for Disease Control and PreventionIn 2020, 1 in 36 children nationwide was found to have an autism spectrum disorder, compared to 1 in 68 in 2010.
BehaviorSpan is currently financially break-even, but that means we can’t expand our headcount to reduce workload and burnout. Employees at BehaviorSpan, as well as across the industry, sometimes leave the field for other behavioral health-related jobs, or even retail or restaurant jobs.
Other clinics weren’t so lucky.
Brian Lopez, founder of New Mexico-based Jumpstart Autism Center, opened a facility in Denver in 2008. He said the state did not increase reimbursement rates when Medicaid eligibility was expanded through the now-expired COVID-19 public health emergency declaration. We appreciated the fact that autism treatment was now available to more families.
“Ultimately, we could not overcome the challenges of the public health emergency, so rather than reduce the quality of service we were providing, we decided to close,” Lopez said. Told.
Lopez and Jumpstart aren’t the only providers leaving Colorado. Hopebridge, which has operations in nearly a dozen states, closed six of its eight stores in Colorado earlier this year, a move its CEO blamed on the state’s Medicaid rates.
These closures will impact remaining providers, who will often be unable to accept new customers.
“The waiting list is flooded with children who have traveled out of state to see providers, and it is sad that for every 100 applications our center receives, we are only able to accommodate perhaps one child. is.”
— JJ TomasFounder of BehaviorSpan
“The waiting list is inundated with children who have traveled out of state to see health care providers. It is sad that for every 100 applications our center receives, we are only able to accommodate perhaps one child. ” Tomasz said.
To Leitao, what’s happening to pediatric autism caregivers feels like a repeat of what happened at an adult autism care center in Colorado several years ago when she started in the industry. . She had an adult client with autism, but when state funding dried up, the company stopped offering the service and started paying only for regular sessions.
“Over time, working with children not only became more profitable than working with adults, but it also became more profitable,” Litao said. “It’s hard to make changes in the lives of adults who only meet for an hour a week. What does that do?
Kevin J. Beatty/DenveriteIt is unclear whether the state is prepared to provide the amount requested by providers.
At a Joint Budget Committee hearing in September, Adela Flores-Brennan, HCPF’s director of Medicaid, told lawmakers that she had heard complaints from health care providers and would ask Congress to raise rates in the next session. Ta.
“For us, the discussion is about improving reimbursement rates for these providers, amidst the potential need for increases in other provider rates, and by working with you to consider overall national budget priorities.” “The question is how much can we reasonably increase the reimbursement increases that could come into effect, and what other policy changes do we need to consider together?”
A state legislature-appointed body known as the Medicaid Provider Rate Review Advisory Committee (MPRRAC) advises states on how to change Medicaid rates. According to the 2023 recommendations Heading into the upcoming Congressional budget cycle, Colorado Medicaid will pay about 78 percent of the standards set by 10 other states for pediatric behavioral health, including reimbursement for autism care.
MPRRAC recommended an increase in Colorado Medicaid rates to meet the standards, which would cost about $35 million.
However, HCPF disagreed with this. In the same document, they argued that including Nebraska in MPRRAC’s analysis raised the benchmark too high and that it was an extreme outlier. Without Nebraska, Colorado Medicaid would pay about 91 percent of the benchmark and only hope to meet that benchmark, which would require $13 million, just one-third of EM-PRACK’s recommended amount. It will be costly.
Maureen Welch, a former MPPRAC member and disability advocate, said this follows a frustrating pattern she witnessed during the 2019-2021 term.
“Our recommendations rarely made it into the recommendations of the HCPF Medicaid director,” Welch said.
For now, Colorado autism care centers are looking ahead to Nov. 20, when HCPF will submit its budget request to the Joint Budget Committee, and providers will indicate whether their request for assistance was successful. It is said that
This is part 1 of a two-part series. The second edition will be published on Friday, November 17th.
