Medicaid reimbursement rates are largely trending upward for autism therapy providers, but burdensome regulations still pose significant hurdles to growth.
To overcome these challenges and improve rates, all players in the autism therapy industry, including private equity firms, must become involved in advocacy work, industry insiders said at the Behavioral Health Business Autism & Addiction Treatment Forum.
“No margin, no mission,” Darren Patz, partner of government affairs and public policy at international law firm DLA Piper, said at the event. “You get the rates, and everything can flow from that.”
Medicaid reimbursement for services performed by registered behavior technicians (RBTs) and board-certified behavior analysts (BCBAs) is relatively new, according to Patz, so states are still in the process of determining rates.
Applied behavioral analysis (ABA) provider LEARN Behavioral has seen positive trends in Medicaid reimbursements, according to Rob Haupt, the company’s executive vice president of autism services. About a third of the states LEARN operates in have increased their rates specific to RBTs, he said, and a few have increased rates for BCBAs as well.
“It’s becoming a lot easier of a conversation with these states — to talk through that our ability to receive these rate increases is not about creating more profits for our individual organizations,” Haupt said. “[Rather, it’s being] able to attract better staff, provide better training to these individuals, so that you can get the quality care and bring that care to more individuals.”
Baltimore-based LEARN Behavioral provides ABA therapy to children in 18 states in home, school, center and community settings. It also provides diagnostic services and early interventions.
Approximately half of the states that autism therapy provider Acorn Health operates in have increased their Medicaid rates, too, according to the company’s chief clinical and compliance officer, Krista Boe.
Coral Gables, Florida-based Acorn Health operates more than 70 clinics in Florida, Illinois, Maryland, Michigan, Pennsylvania, Tennessee and Virginia. Its services include ABA in both centers and in homes. In 2022, Acorn acquired seven centers from Breakthrough Behavior.
Increasing rates could be one way to reduce the autism therapy business’s historic struggle with filling clinicians’ job openings. Autism therapy executives often strategize the best possible methods to attract and retain staff.
However, the upward trend in Medicaid reimbursement may be subject to future changing winds in the U.S. economy, according to Patz.
“I do see the trends moving up slowly,” Patz said. “Now I will say, we have been in a relatively strong economy for years. … We’re going to have to figure out our strategy if the economy does turn, but so far, I do see trends moving forward.”
Achieving increased rates does not come easily, Boe said. Working with payers to achieve annual rate increases requires effort and rigor, she said.
Additional regulations sometimes arise with increased rates, complicating the Medicaid landscape for providers, Haupt said. While these regulations may be beneficial for safety and compliance, sometimes they can be “cumbersome and almost penalizing,” he said.
Autism providers can work with government agencies to help instill effective regulations.
Opportunities exist for autism therapy providers to improve the status quo beyond increasing rates, Patz said. For example, maintaining telemedicine, enrollment efficiency and BCBA remote monitoring regulations could benefit autism therapy providers.
Autism therapy providers must come together to advance common advocacy goals, industry experts said, and must also collaborate with academics and professional societies.
“Some of the best work that we’ve been able to do on the government relations side has come as part of consortiums of organizations,” Boe said. “It’s strength in numbers.”
Private equity-backed ABA providers must also join advocacy efforts, Patz said. Group advocacy work also provides a platform for providers to share best practices, he added.
Private equity has played an increasingly prominent role in autism therapy dealmaking. Private equity firms completed 85% of all M&A between 2017 and 2022, according to research. The federal government has also increasingly scrutinized private equity activity in behavioral health, launching a probe into private equity’s role in health care in March.
This scrutiny, which Patz predicts will only increase, is among the reasons private equity should take part in advocacy conversations.
“[Private equity firms] need to be out there advocating for themselves and talking about the improvements, the compliance improvements, the new physical spaces, that this capital brings together,” Patz said. “Private equity ought to not be shying away from this conversation and be vocal, saying we are doing a lot of great things in this space.”
Myths regarding private equity’s involvement in the autism industry exist, Boe says, and advocacy can help dispel some of those myths.
“I’ve seen an evolution of the industry over the course of the last eight to 10 years, and I fully believe it’s been a result of having equity involvement in this space, asking the hard questions, demanding better proof around whether or not we’re actually helping improve these learners’ lives over the long-range in observable, measurable ways,” Boe said.
Companies featured in this article:
