September 17th, 2012 – Today Judge Richard Jones of US District Court in Washington State approved a settlement between the advocacy group Washington Autism Alliance and Advocacy, and the Washington State Health Care Authority, our state’s Medicaid agency. The settlement provides for an ABA benefit in Washington State for people receiving income-based health insurance (attached below). HCA will offer an interim benefit now that allows children to obtain prior authorization with a current ABA order and treatment plan that meets the requirements for the program; and, for children who do not have an order from a diagnosing provider and appropriate treatment plan, HCA will arrange for children to obtain this information now so they are ready to go after January 1.
The parties will be working between now and January 1, 2013 to obtain federal approval of the ABA program and create regulatory guidance so that a final ABA program will be available after January 1. HCA is also developing a web page with provider-friendly language regarding the required information for prior authorization (so you won’t have to scrutinize a settlement agreement to understand this program).
HCA will be sending an initial notice to providers this week regarding the benefit, and the parties will send a joint public statement soon, with more guidance to follow. Because HCA is still working to create an infrastructure for this program, we want to make sure that families understand that the initial stages of creating this program may be difficult. We believe both parties are committed to seeing that HCA enrolls sufficient providers who meet high standards of quality—both in clinic and in the home—to serve Medicaid children by January 1.