This measure is important because it allows us to monitor the number of Vermont Medicaid members who are receiving Applied Behavior Analysis (ABA) services. 

The Social Security Act requires state Medicaid programs to provide Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services to all Medicaid eligible individuals under age 21, which includes ABA services.  Practitioners recognize ABA as an evidence-based treatment service that best services children diagnosed with Autism Spectrum Disorder (ASD).  DVHA has made targeted improvements to the ABA benefit since it was implemented at the beginning SFY16.  Improvements included an increase in ABA reimbursement rates in June 2016, implementation of a tiered case rate payment model in SFY20, and a change from prospective to post service payment delivery system in SFY22. All changes were intended to make administrative responsibilities and service delivery less burdensome for providers, therefore allowing them to possibly provide more services to VT Medicaid members.

The number of members receiving ABA services has significantly increased over the years from 38 in SFY16 to 290 in SFY23, which is likely attributed to the changes in payment methodology noted above.  The increase in members served continued on a slow but steady trendline between SFY22 to SFY23; feedback from designated agencies and private sector providers notes that there was a lack of available mental health workers in the State.  This resulted in waitlists and providers being unable to expand the number of members being served. Additionally, one Designated Agency (DA) discontinued ABA services in September 2022. At the time they were serving approximately 5 members. Of these members, 2 transitioned to another Vermont Medicaid enrolled ABA provider.  Even with the loss of this provider, we continued to see an increase in the trendline of # of members being served. 

Narrative last updated:  03/12/24

• DVHA Policy Unit
• DVHA Payment Reform Unit

DVHA will continue to work with onboarding new ABA providers when opportunities arise. When new providers do express interest, the Autism Specialist meets with prospective providers to explain the ABA benefit to include the various payment methodologies, reconciliation, monthly tier submission, and assist with the enrollment process if necessary. The Autism Specialist created multiple PowerPoint presentations that are available on the Vermont Health Learn website where information about the VT Medicaid ABA Benefit can be reviewed in an auditory and visual platform to accommodate various learning styles.