Tuesday, Oct. 20, 2015 | 2 a.m.
When Stephanie Hill’s son was 3 years old, doctors diagnosed him with an autism-spectrum disorder and predicted he might never speak.
On Monday, Hill brought her now 11-year-old son, J.C., to sit before the Nevada Division of Health Care Financing and Policy as a testament to how important early therapy can be for children diagnosed with autism.
“Most people wouldn’t know J.C. is affected,” said Hill, seated next to her son who wore khakis and a blue dress shirt. “The truth is he’s a miracle.”
It’s a miracle that Hill fears won’t be repeated.
Hill, a Las Vegas resident, was one of more than a dozen parents and advocates who spoke during a public hearing held by the division, which operates Nevada Medicaid and is preparing reimbursement rates for applied behavior analysis therapy. They are worried that the proposed reimbursement rate of $29.61 per hour for registered behavior technicians (RBTs) — effectively the wages of those who provide the bulk of therapy — is too low to attract and retain skilled providers.
As of Jan. 1, more than 1,870 autistic children in Nevada will be eligible to receive ABA therapy, which doctors recognize as an effective treatment for autism, through Medicaid, per a mandate last year from the Centers for Medicare and Medicaid Services.
“My son will be fine,” Hill said during the video conference meeting between Las Vegas and Carson City. “I have fought tooth and nail for him. But we have a population we are setting up to simply disregard.”
Nevada Medicaid held three public workshops this year, raising its proposal five different times from a low of $17.33 to $29.61, state spokeswoman Chrystal Main said. The state determined the rate based on average wage information and normal business costs, such as health care, sick leave, vacation and supervision, among others.
Autism advocates, however, said the proposed rate fell below the $40 to $50 per hour Medicaid reimbursement rates for RBTs in many other states. The Center for Autism and Related Disorders, which has a location in Henderson, called Nevada’s rate calculation “critically flawed.”
“The proposed RBT rate of $29.61 would be, if finalized, the lowest in the country, and CARD would regrettably have no choice but to close its Nevada location,” said Dana Aronson, a case supervisor representing the Center for Autism and Related Disorders at the meeting.
Former Assemblywoman Barbara Buckley and current Assemblyman James Ohrenschall, both of Las Vegas, also urged Nevada Medicaid officials to reconsider the proposed rate.
Buckley, now head of the Legal Aid Center of Southern Nevada, said low reimbursement rates would lead to an understaffed program that would be a “false hope” for thousands of families with children who badly needed the services. She also dismissed the state’s assertion that increasing the rate would bust the budget.
“Please re-examine this one small part of the program,” she said. “I’m convinced this needs to be tweaked.”
The Centers for Disease Control and Prevention estimates that 1 in 68 children are diagnosed with an autism spectrum disorder. In Nevada, there are more than 6,200 students, ages 3 to 21, who have been diagnosed with autism, according to the state Department of Education.
Betsy Aiello, deputy administrator for the Division of Health Care Financing and Policy, said written comments about the proposed rate would be accepted through 5 p.m. Wednesday.
The state will then submit its amendments to the Nevada Medicaid Plan to CMS sometime after Thursday.
“I think they will certainly review all public comment,” Main said. “Where it goes from there, we will just have to wait and see.”