Advocates dismayed at policy change
Treatment centers versus in-home treatment is the debate
Advocates of autism treatment centers are fearful that autistic children will be hampered by a new state policy to cut back some treatment paid by Medicaid at service centers.
The new policy, effective Sunday, requires that if it is determined that the center-based individual treatment is medically and clinically necessary, it will be continued.
If not, treatment will be provided at home.
The type of treatment is known as applied behavior analysis, which is therapy that focuses on improving social and learning skills, grooming and job competence, advocates say.
Thousands of children in Pennsylvania with autism are thriving because of the treatment, according to Kristine Quinby, founder, president and CEO of Potential, a Newtown, Delaware County, autism treatment center.
More than 100,000 children in Pennsylvania have autism, according to Jim Sharp, children’s director of policy at Rehabilitation and Community Providers Association in Harrisburg.
“No one is going to lose any service,” said Ali Fogarty, communication director of the state Department of Human Services.
Fogarty said that treatment provided at the service treatment centers is for one individual at a time.
“When it is determined to be medically necessary and clinically appropriate, Medical Assistance will pay for ABA services provided in a center-based setting,” said Erin James, press secretary for the state Department of Human Services.
James said the department will be providing guidance on how to bill for individual treatment at a service center.
“DHS is committed to ensuring children, youth and young adults receive appropriate clinical services to meet their individual needs, and to do so in settings best able to provide a therapeutic environment to meet those needs,” James said.
James said the agency recognizes that changes to program regulations and design can create uncertainty about continuity of care.
Under Pennsylvania law, private insurance companies are required to pay $36,000 a year in costs to children and young adults under age 21 who are autistic.
The change is based on guidance from Pennsylvania’s Office of Mental Health and Substance Abuse Services, which indicates that a home setting is preferable to a treatment center.
But Quinby said that research has shown that children with autism have the best outcomes when they receive one-on-one treatment in a predictable, controlled environment — such as a treatment center.
Providers and advocates statewide have responded with ABA Our Way, an advocacy campaign aimed at ensuring the state agency supports services in a center for children who need them without conditions. For more information: ABAOurWay.com.