Autism therapy providers in Idaho are facing a potentially foundation-rattling change in the state’s Medicaid program.

On Oct. 31, the Idaho Department of Health & Welfare informed organizations that provide “behavior modification and consultation” that such services would no longer be offered through its behavioral health managed care organization, Magellan Healthcare. Rather, the services would be managed directly by the state through the Children’s Habilitation Intervention Services (CHIS) program and be deemed “behavioral intervention” services.

The move also eliminates Magellan Healthcare’s authorization to reimburse providers for a range of CPT codes related to applied behavior analysis (ABA), effective Dec. 1. This includes codes used to bill the assessment, treatment and supervision of treatment individuals with autism.

The notice does not detail how comparable services would be billed through the CHIS program, nor does it include how the behavioral intervention services will be coded. While still covered and administered through Medicaid, at the very least, the change in which entity manages the service could create a raft of potential administration challenges for autism therapy providers and patients.

The state uses the contractor Gainwell Technologies to reimburse services. It also has an organization called Telligen that handles prior authorizations. Existing service authorizations for behavior modification and consultation dated to end on or after Dec. 1 will be approved for behavioral intervention on the original expiration date or 90 days after Dec. 1, whichever is later.

“Notifications of this change will be sent to Magellan Healthcare members whose authorizations are affected,” the notice reads.

Children’s Habilitation Intervention Services offer additional services, including crisis intervention, habilitative skill building and interdisciplinary training.

“CHIS are also used to produce positive meaningful changes in behavior that incorporate functional replacement behaviors,” the notice states. “While behavior modification and consultation authorizations will transition directly to behavioral intervention, there are other services that may benefit members.”

Representatives of the Idaho Department of Health & Welfare have not responded to a request for comment.

Several details remain unclear, especially regarding reimbursement rate parity between the two programs. The apparent removal of these services from a managed care structure to a state-managed fee-for-services schedule suggests the state wants tighter control over reimbursement costs and integrate them with other services.

It’s also notable that the services are no longer managed as a medical benefit by a managed care organization, making determinations of medical necessity. The reclassification of autism therapy as a habilitative service may indicate how the state will assess the needs of individuals with autism generally and specifically how it will pay for services in the future — potentially bringing it in line with its companion services.

This is the most drastic of recent state actions regarding autism therapy and ABA. States have opted to cut reimbursement and cap hours to curb increased spending, rather than reclassify the benefit entirely. Over the summer, Nebraska cut its higher-than-average rate for ABA, framing the move as an existential issue for the benefit within Medicaid.

Idaho was among the last states in the nation to mandate the coverage of autism therapy within health insurance, establishing that mandate in April 2018.