Gov. Braun signs executive order related to Medicaid costs for ABA therapy

INDIANAPOLIS — The office of Indiana Gov. Mike Braun announced on Wednesday that Braun recently signed an executive order surrounding Medicaid costs for Applied Behavior Analysis, or ABA, therapy.

According to a news release from Braun’s office, the order establishes a group that would explore the containment of the cost for the therapy while maintaining the quality of care for Hoosier children and young adults. ABA is a therapy for the early treatment of autism.

Officials said that from 2017 to 2019, state Medicaid payments for ABA increased from $14.4 million to $120 million. Over the next year, Braun’s office said that payments are expected to increase even more, with $645 million projected to be spent for around 8,000 children in 2026.

The release said that through an audit by the U.S. Office of the Inspector General, officials found that Indiana made at least $56.5 million in improper Medicaid payments for ABA. Officials said this was largely due to “problems with credentialing for providers and a lack of evaluations, referrals and documentation.”

“Indiana’s $1 billion Medicaid budget shortfall last year means we need to take bold action to contain costs where they are clearly getting out of hand. When the price our state pays for one service is soaring from $14 million to $120 million in just two years, with over $39 million of improper payments identified in an independent audit, something is clearly wrong and needs to be addressed immediately,” Braun said in the release. “We’re taking decisive action to contain these massive cost increases while maintaining quality of care for the Hoosiers that rely on these treatments.”

The release said the working group of parents, legislators, experts, physicians and ABA therapy providers will help find cost-containment solutions to help minimize the costs of ABA to Medicaid. The group will be tasked with presenting Braun with three “actionable recommendations” while evaluating:

• The best clinical care models to provide the right therapy, at the right ages and in the right setting.
• Recommendations for a better coordinated experience for those who need ABA therapy, but in a financially sustainable manner
• Proper transitions for children as they grow in their educational, family and social settings
• Quality metrics for ABA therapy
• Potential caps on hours for therapy provided each weeks
• Potential caps on the number of months a child can recieve therapy
• Creating an appeals process for extenuating circumstances
• Establishing new provider enrollment and billing requirements for ABA providers to address issues identified in the audit.

For a look at the other executive orders that Braun has signed, click here.