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 327 in SFY24, 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 SFY24; 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 with the four remaining DAs discontinuing ABA services in SFY24.  A total of 37 members were being served by the five DAs. Of these members, three transitioned to another Vermont Medicaid enrolled provider. It is important to note that a few DAs planned to serve their existing members with alternate funding sources.  Even with the loss of these providers, we continue to see an increase in the trendline of # of members being served.

Narrative last updated:  08/19/24

• DVHA Policy Unit
• DVHA Payment Reform Unit

In response to DAs withdrawing from providing ABA service and indicating that the current funding was not allowing the programs to sustain, in October 2023, DVHA engaged in a comprehensive review of ABA rates. In comparing rates with other states as well as other insurers, it was determined that Vermont Medicaid rates are equal to or comparable to other insurers and states. Therefore, it was determined by the DVHA that there would not be an increase in ABA rates.  

DVHA will continue to work with onboarding new ABA providers when opportunities arise. When a new provider expresses interest, the Autism Specialist meets with prospective providers to explain the ABA benefit to include the tiered case rate payment system and assists with the enrollment process if necessary.