DDD Medicaid Rates Announced

July 18, 2014

Assistant Commissioner of the Division of Developmental Disabilities Liz Shea and colleagues announced the results of a multi-year effort to develop a standard fee schedule for services provided through the Community Care Waiver and the Comprehensive Medicaid Waiver Supports Program. The services that fall under these programs include residential, day programs, employment, respite, transportation, clinical therapies, and more. The Department of Human Services engaged Myers and Stauffer LC and Johnston Villegas-Grubbs & Associates LLC to conduct a comprehensive rate study and sought stakeholder input throughout the process. Autism New Jersey provided input regarding 1) the higher level of funding required to meet the needs of individuals with severe behavioral challenges and 2) provider reimbursement rates for Board Certified Behavior Analysts.

We are happy to report that multiple recommendations presented by Autism New Jersey were included in the final fee schedule.

First, an “acuity” factor is included in the rates and can be used across a variety of settings. Questions remain regarding when the acuity factor will be allowed.

Second, while provider reimbursement rates for behavioral services are notably lower than those for speech, occupational, and physical therapy, further evaluation is necessary to determine the financial impact on service providers and how specialized behavioral services can be adequately funded.

As part of our ongoing Public Policy efforts, Autism New Jersey will be an active participant in the dialogue regarding acuity, behavioral provider rates, and additional topics on behalf of individuals with autism and specialized behavioral support needs.

While the full implications of these rates are currently being evaluated by providers and sister advocacy organizations, some advantages are already apparent. With the announcement of these new rates, DDD has ushered in a new era of standardization and transparency that provides clear direction for advocates. The autism community can now more readily identify, prioritize, and advance specific policy initiatives to ensure the fiscal health of providers on behalf of individuals with autism.

If you have questions about Medicaid eligibility, becoming a Medicaid provider, or would like to join our advocacy efforts, please contact us at 800.4.AUTISM or information@autismnj.org.