The Faison Center, Inc. appreciates the opportunity to comment on the proposed revisions to Appendix D of the Mental Health Service Manual. We recognize efforts of DMAS to clarify ABA service requirements, promote consistency across MCOs, strengthen medical necessity documentation, and improve family engagement and care coordination. However, we are concerned that the proposed revisions may negatively affect the individuals we serve while significantly increasing administrative and documentation burdens for ABA providers.
1.Required Activities
Appendix D states: “Direct family involvement in the treatment program is required at a minimum of weekly”
This requirement may impose an undue burden on families facing work, transportation, childcare, or other caregiving constraints that limit their ability to attend meetings during facility hours.
The policy should allow alternative methods of family involvement, such as virtual meetings, phone consultations, or flexible scheduling. It should also establish procedures for documenting barriers to participation, efforts to accommodate caregivers’ schedules, and alternative arrangements made before reducing or terminating services due to insufficient family participation. Without these safeguards, families may face unnecessary barriers to care, and beneficiaries risk losing services because of circumstances beyond their control.
2. Care Coordination
“Providers must communicate the results of assessment and treatment planning to the youth’s primary care provider.”
Care coordination is an effective tool for supporting beneficiary treatment. However, the current language places sole responsibility for facilitating coordination on the ABA provider without acknowledging barriers beyond the provider’s control.
The provision should allow providers to document reasonable efforts to coordinate care when barriers arise, such as a beneficiary or caregiver declining to authorize information sharing or a primary care physician (PCP) failing to respond. It should also establish clear guidelines defining the respective responsibilities of providers, families, and PCPs in the care coordination process. These safeguards would promote accountability while ensuring providers are not penalized for circumstances beyond their control.
3. Diagnosis
This restriction may disrupt continuity of care for existing beneficiaries who must meet the new requirements or risk losing services because they lack an ASD diagnosis or cannot obtain a provisional diagnosis as the revised guidelines require for beneficiaries under the age of 5.
Although we recognize that the ASD-only diagnosis requirement stems from state budget language (Item 291.WW.2), DMAS should advocate for recognizing that ABA can benefit individuals with disabilities other than ASD. The restriction creates an unnecessary barrier for those who are currently benefiting from, or could benefit from, ABA services but do not have an ASD diagnosis.
DMAS should establish a clear pathway under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children under five to access medically necessary ABA services, while protecting existing beneficiaries from disruptions in care during the transition.
4. Weekly Limit of 20 hours
“Services are authorized based on medical necessity and may not exceed 20 hours per week, except as authorized under EPSDT review.”
The current language may allow MCOs to deny requests exceeding 20 hours per week without clear criteria ensuring consistent standards for compliance with EPSDT requirements. Although MCOs are required to conduct EPSDT reviews, the provision does not clarify whether reviews occur automatically or must be requested, potentially resulting in inconsistent processes across MCOs.
DMAS should consider the establishment of clear EPSDT review criteria and require all MCOs to follow standardized procedures for requesting, conducting, and determining authorization for EPSDT reviews. This would promote consistency, transparency, and equitable access to medically necessary services across health plans.
5. Additional Administrative Burden
The updated documentation requirements for beneficiaries receiving more than 20 hours of services per week will significantly increase clinicians’ administrative workload through mandated monthly data collection and reporting, further limiting time available for direct patient care.
Smaller providers, including nonprofits, rural clinics, small businesses, and clinician-owned practices, may be disproportionately affected due to limited staffing and technological resources. Many rely on manual processes for documenting treatment, observations, supervision, and assessment graphs. The cumulative burden of these requirements could reduce clinicians’ time with beneficiaries and limit providers’ capacity to deliver services.
DMAS should consider streamlining documentation requirements and allowing flexible reporting methods that account for differences in provider resources while maintaining appropriate oversight and quality of care.
6. Effective Date of Proposed Changes and Continuity of Care
The proposed implementation timeline does not give providers sufficient time to meet the new requirements and risks disruptions to authorization requests and continuity of care for children currently receiving services. The public comment period closes just one day before the proposed effective date, leaving insufficient time for DMAS to review comments, providers to prepare, MCOs to coordinate, and DMAS to clarify broad or ambiguous requirements. Without an adequate transition period, beneficiaries risk interruptions or delays in receiving medically necessary services.
DMAS should establish an adequate timeline for reviewing and discussing public comments and transitioning to the finalized Appendix D requirements.
The Faison Center, Inc. appreciates the opportunity to provide comments and DMAS’s consideration of public input.