Due to the COVID-19 pandemic in the previous year, many individuals with ASD lost access to in-person therapies and support services. This opened new opportunities for virtual therapies, which were proven as effective as in-person services for individuals with ASD.
However, according to a proposed rule issued last week by the Centers for Medicare and Medicaid Services (CMS), virtual autism therapies may remain available only through at least the end of 2023.
The proposed rule may last through December 31, 2023, only if it is added to Medicare telehealth list codes used to bill for applied behavior analysis (ABA) services.
The rule would give states the option to reimburse for virtual autism therapies delivered via telehealth- which would include live video chat, among other platforms- and would also allow for the use of store-and-forward technology, in which providers can record videos or images for patients to access at a later time.
Although the proposed rule appears to be a step in the auspicious direction for ensuring access to virtual ASD therapies, Kornack, the chair of the billing codes commission for the Association for Behavior Analysis International, Says that Virtual autism therapies were not authorized by CMS in the first place, until the pandemic came along. In other words, the concern is that after the pandemic goes away, will CMS still reimburse for these services? That’s the million-dollar question.
In February, Kornack, along with other members of the ABAI commission, submitted a request to CMS asking that virtual autism therapies be made a permanent part of Medicare – outlining its potential benefits not just for individuals with ASD but also for other underserved populations such as rural patients and those with transportation challenges.
According to an October 2021 analysis from the Kaiser Family Foundation, Most states are looking to continue to reimburse for some level of virtual care even after the pandemic ends. Representatives from 31 states favor telehealth to offer access to behavioral health services.
Patterson, the financial director for the Santa Ana, California-based ABA provider Autism Behavior Services Inc., says with enough evidence of the effectiveness of virtual ABA services, CMS will eventually make them a permanent part of Medicare. “The goal is to ensure that evidence, rather than insurance rules,” he said.
For now, though, the proposed rule offers some much-needed stability for providers of virtual ASD therapies- and will hopefully ensure that individuals with ASD can continue to receive the care and support they need, even after the pandemic ends.
Some insurers, however, have already started to roll back their coverage of virtual autism therapies- which could leave many individuals without access to these vital services.
United Healthcare, for example, plans to discontinue its coverage of virtual ABA services for people with Medicare as soon as the public health emergency ends and for those with Medicaid and commercial coverage on August 1.
According to Nadler, associate professor of pediatrics at the University of Missouri, this is a huge concern for people who were diagnosed remotely during the pandemic and have been receiving treatment virtually ever since as clinicians are already struggling to get insurance approvals for them.
The bottom line is that although the proposed rule from CMS is a step in the right direction, more work must be done to ensure that virtual autism therapies are accessible and affordable for all who need them.