Controlling ABA Therapy Costs

Gov. Mike Braun has signed an executive order aimed at curbing rising Medicaid costs for applied behavior analysis (ABA) therapy, a type of treatment for individuals diagnosed with autism.

The order creates a task force comprising parents, legislators, subject matter experts, physicians, and ABA therapy providers to find solutions that contain the soaring costs of ABA therapy without compromising care quality.

The task force is tasked with creating three recommendations to address ABA therapy costs. Braun wants possible caps on the hours of therapy services per week and how many months a child can receive therapy.

The executive order aims to create best-care models for ABA therapy, providing guidance on the "right therapy, at the right ages, in the right setting" to serve children and families effectively.

The task force will also provide recommendations for quality metrics and better care coordination for children who require ABA therapy. Families will have access to an appeals process for extenuating circumstances. Additionally, therapy providers will face new enrollment and billing requirements.

Medicaid payments for ABA therapy have soared from $14.4 million to $120 million, with expected increases of five times over the next year.

An audit of Indiana's ABA payments in 2018 and 2020 revealed at least $56.5 million in improper Medicaid payments.

"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. "We're taking decisive action to contain these massive cost increases while maintaining quality of care for the Hoosiers that rely on these treatments."