Thank you for this opportunity to post comments on EPSDT Behavior Therapy:

1. ABA should not be limited by location, but the services should be provided in the location that is most appropriate to the needs of the individual.  This may be a clinic, the community, a social group, or the home, or other place that meets the needs of the individual.  Limiting location also limits the ability to bill DMAS/Magellan as a secondary payer, as the insurance mandate requires private insurance to cover ABA services.  Private insurance does not limit services by location.  

2. ABA clinics should be required to obtain a license that is appropriate to their business, which is not available at this time.  It is this analyst's professional opinion that DBHDS is the appropriate licensing agency, as was previously done.  DBHDS licensed ABA Outpatient facilities in the past; they ensured that appropriate codes for the facility were met (i.e. water temperature checks, emergency exits, emergency exit plans, fire safety plans and checklists completed), staffing regulations and backgrounds checks and licensces were met, and policies and procedures for health and safety and incident reporting were in place.  DOH is not the appropriate agency as we do not fit into "daycare facilities" and cannot meet those regulations while meeting insurance requirements.

3. In order to facilitate secondary claims, T codes would be beneficial.  Most private insurances are using T codes for authorizations and billing of claims.  It is difficult to process secondary claims through DMASMagellan when the primary payer is using T codes.

4. Almost all other medically necessary services can obtain an authorization through their primary insurance and then simply submit secondary billing to their secondary insurer.  With the current set up, there has to be two independent assessments and authorizations.  This is a duplication of our time and is costly to DMAS/Magellan.  It would be very helpful if Medicaid/Magellan would accept the primary insurances' authorization and we simply bill DMAS/Magellan as secondary without obtaining a second authorization.

5.  ABA and Behavioral Therapy should be separate treatments and ABA should be solely guided by the DHP regulations governing behavior analysts.  Often behavioral therapy run by non-LBAs looks more like counseling or behavior modification and not the science of ABA.  It is confusing to lump the professions together, and the distinction is necessary.

6. ABA does not necessarily need to be provided individually, but may be appropriate for some individuals in a group setting.  The service should be available in a group setting or one-on-one with an individual as is dictated by the individual’s needs and outlined in the ISP. 

I appreciate this amazing opportunity to offer public comment and appreciate everything that you do for our community each day!!  Thank you so much, Lissa D. Hoprich, MA, BCBA, LBA