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Utah Medicaid considers higher pay for autism tutors

Published November 7, 2012 3:05 pm

Health • Providers say wages may still be too low for free treatment program to succeed.
This is an archived article that was published on sltrib.com in 2012, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Before they even start, tutors in a state autism pilot project may be getting a raise.

Utah's Medicaid department is looking into increasing how much it will pay tutors who will provide free applied behavior analysis (ABA) therapy to children with the social and communication disorder. Authorized by the Utah Legislature, the pilot program will cover 250 children ages 2 through 6, through June 2014.

Medicaid set the rate for the tutors, who would provide 20 hours of in-home therapy a week, at $21.52 an hour. But they could make as little as $14.42 an hour because of insurance and other training costs.

Few existing ABA therapists were interested in applying, saying the pay was too little for their experienced employees and wasn't enough to train less-qualified applicants. The rate is also lower than other two state-funded pilots through the Public Employees' Benefit and Insurance Program and the Autism Treatment Account.

Supporters hope the pilot projects will show good results and lead to broader autism therapy coverage.

Medicaid sent a survey to autism therapists late Friday night after the Thursday publication of an article in The Salt Lake Tribune detailing the concerns of providers. Medicaid has asked the providers to outline specific costs associated with the tutors to justify a potential $40 an hour reimbursement rate.

The responses are due Monday and Medicaid staff will decide by the next week whether to boost the rate, according to spokeswoman Kolbi Young.

"What they're doing is asking us for a cost analysis for the tutor position, which they've never asked before," said Breanne Berg, with Apex Behavior Consulting, one of the providers through the PEHP pilot who raised concerns. "It makes me feel like they are coming to the table and asking for our input so this can be more successful."

The Medicaid office had warned that increasing the pay would mean fewer children would be served. It is now evaluating whether it should instead reduce the number of therapy hours, Young said.

Berg agrees the hours could be reduced to 12 a week, noting that her company provides fewer hours and still gets results. "Kids can't get that many hours anyway" with school and other therapy, she said.

Applications for the Medicaid pilot were due Oct. 31, though applications may still be arriving in the mail. Young said 392 people had applied so far. Medicaid will randomly pick children lottery-style, while maintaining geographic representation.

Young said the winners will be notified beginning next week and will have 10 business days to submit documentation verifying their child has an autism spectrum disorder. —

Applied behavior analysis

ABA • It has been used since the '60s to help people with autism. Through positive reinforcement, children can acquire basic skills, including looking, listening and imitating, the advocacy group Autism Speaks says.

In some cases • Preschoolers who have intensive therapy can eventually participate in regular classrooms with little extra support. But some show no improvement, so it is hard to predict how much each child will benefit. —

About the pilots

Thirty-two states require health insurance companies to cover autism services. Utah's autism community had been pushing for a similar mandate, but lawmakers during the 2012 legislative session instead passed HB272, which created the three pilot programs. Officials will report on the costs and effectiveness of the treatments by next November.

The Medicaid pilot will serve up to 250 children through June 2014.

Utah Department of Health is managing the Autism Treatment Account — $1 million from the state, $500,000 from Intermountain Healthcare and $300,000 from Zion's Bank. It is expected to treat 25 children.

The Public Employees' Benefit and Insurance Program will cover up to 50 children whose parents work for state or local government.