Contracting for Applied Behavioral A l i (ABA) Th S iAnalysis (ABA) Therapy Services

University of Missouri Thompson Center for Autism and Neurodevelopmental Disorders

Catherine Noel, Assistant Director for Managed CareUniversity Physicians, University of Missouri Health System

December 2, 2011

Thompson Center MissionThompson Center Mission

To improve the lives of individualsTo improve the lives of individuals with autism and other neurodevelopmental disordersneurodevelopmental disorders through world class programs that integrate research clinicalthat integrate research, clinical service delivery, education & public policypublic policy

Thompson Center Services ModelThompson Center Services Model

Thompson Center ServicesDiagnostic & Medical: Treatment & Support: 

• Autism Diagnostic Clinic• Autism Toddler 

Assessment Clinic

• Early Intensive Behavioral Intervention

• Behavior Supports ClinicAssessment Clinic• Autism Medical Clinic• Child Development Clinics

• Behavior Supports Clinic• Leaps Ahead• Occupational TherapyChild Development Clinics 

• Child Neuropsychology Clinic

p py• Speech/Language Therapy• Individual and Family 

h• Clinical Assessment Team Therapy• Family Resource Services

TC Clinical Services FY11FY11

• Number of children seen: 2,380

• Number of visits: 10,073

Contracting Targets

• Behavioral Health plans covering State PublicBehavioral Health plans covering State, Public and University employees

• Larger commercial plans with agreements that i l d b h i l h l h iinclude behavioral health service coverage

Time Line

Jan 2011 HB1311 becomes effectiveMar 2011 Negotiations with payors initiatedMar 2011 Negotiations with payors initiatedApr 2011 Contracts and/or LOA’s in placeJun 2011 Commercial payor billing beginsJun 2011 Commercial payor billing beginsNov 2011 Still learning!

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Current AgreementsCurrent Agreements

United Behavioral HealthMH Net Behavioral HealthAnthem BCBSHealthlinkTriwest (demonstration project)

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Standards

• Classification for payor credentialing/billingClassification for payor credentialing/billing– Agency

Individual Provider– Individual Provider• Role of BCaBA

• Service classification standards– Codes – Units– Modifiers

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Crosswalk Direct ABA Services

ABA Services

Modifier HO HP (blank) HN HM

Education masters doctoral bachelorsless than bachelor

BCBA BCBA‐D BCaBA Other OtherBCBA BCBA D BCaBA Other Other

CPT SERVICE DESCRIPTION TIME UNIT

Direct ABA Services 

BCBS H2012 ABA Therapy provided directly  by a BCBA or BCaBA 1 hr unit

H l hli k H2012 ABA Th id d di l b BCBA BC BA 1 h iHealthlink H2012 ABA Therapy provided directly  by a BCBA or BCaBA 1 hr unit

MH NET 99347 Evaluation, ABA services and periodic treatment plan review 15 min unit

UBH  H2012Direct ABA services by a BCBA, or Licensed Mental Health Professional 1 hr unit

Triwest S5108 15 min unit

Established standards would facilitate:

Coding Rate settingUnit Productivity reportingUnit Productivity reportingModifiers Simplify billing process

Role of BCaBA Staffing

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New ProcessesNew Processes

• Credentialing process for ABA providersCredentialing process for ABA providers (internal)

• Line Therapist– Must bill under supervising BCBA– Employment

Initial OutcomesInitial Outcomes

• Agreements completed fairly quicklyAgreements completed fairly quickly

S ll l f i ll i d li• Small volumes of commercially insured clients to date (volumes are increasing a bit)

• National standards would be beneficial

• We are still learning!• We are still learning!

Questions?