Autism Care: Beyond ABA and Federal Policy
Autism care is bigger than ABA. Federal policy should be, too - Behavioral Health Business
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Autism care: A Complex Landscape
The Centers for Medicare & Medicaid Services (CMS) recently took a significant step by releasing a new toolkit for states on applied behavior analysis (ABA) services for individuals with autism.
The growing Medicaid and CHIP spending on ABA, far exceeding the number of autistic children receiving services, raises concerns about:
- Utilization
- Spending per beneficiary
- Fraud, waste, and abuse
- Treatment and payment models that may incentivize billable hours over individualized care.
CMS is addressing these valid concerns, while also:
- Rejecting the idea that 40 hours of ABA weekly is a default standard of care.
- Recognizing that higher intervention intensity doesn't always equate to better outcomes.
Moving Beyond ABA
While the toolkit acknowledges the diverse needs of autistic individuals, a crucial point is often overlooked:
ABA is not synonymous with autism therapy.
Autistic people's needs span a wide range, including communication, behavior, health, education, employment, and daily living. A one-size-fits-all approach based on ABA can be limiting.
The CMS toolkit, despite its benefits, contains a tension: it heavily references guidelines developed by organizations with a strong ABA focus, potentially undermining the toolkit's call for flexibility and individualized care.
Policymakers must remember:
- Autism therapy is multifaceted.
- Individual needs vary greatly.
- Reimbursement and policy should reflect this diversity.