FISHERS, Ind. (AP) — Indiana autism therapists are cutting staff and services and worrying about their futures amid steep cuts by the state’s largest health insurer.
The changes by Anthem Blue Cross and Blue Shield are a sharp departure for Indiana, which in 2001 became the first state to require health insurers to cover autism therapy in a meaningful way, the Indianapolis Business Journal reported.
“If they were to cut again, we’re all done. The whole system’s done,” said Carl Sundberg, executive director of the Behavior Analysis Center for Autism, which operates locations in Fishers, Zionsville and Elkhart. “If the rates were cut again, we would have to provide a service that I wouldn’t want to have my name on.”
Anthem began implementing the changes two years ago, when the Indianapolis-based insurer said children age 7 and older need to receive a portion of their autism therapy from public schools, as required by state and federal law.
“Anthem cannot duplicate coverage for services that are available through the public school system,” Anthem stated in a May 2012 letter to parents of autistic children.
That meant Anthem would pay for fewer hours of therapy, often limiting it to 20 hours a week instead of 40.
In January 2013, the insurer cut its reimbursements for applied behavior analysis therapy — the leading approach to helping autistic children overcome their cognitive, social or behavioral deficits — by 40 percent.
Many autism therapists and parents say they aren’t sure what the future holds.
The Hope Source in Indianapolis, where 85 percent of clients are age 9 or older, nearly closed in March because it couldn’t make payroll. Sundberg’s center laid off 15 people, nearly 10 percent of its staff.
Julie Brant Gordon, founder of The Hope Source, said her center dropped health benefits for its employees and partnered with the Indiana Cyber Charter School to enroll the center’s school-age clients so it could receive state funding for their “at school” care, which they still receive through the center.
But that arrangement still doesn’t cover the full costs of the cuts.
“What Anthem needs to understand is that the funding to the schools is so limited, that it’s still not as much as what I’m losing,” Gordon said. “I wish that Anthem wouldn’t have simultaneously cut reimbursement rates and cut hours. And abruptly. Usually, if they’re going to go down, they don’t go down 40 percent — overnight.”
Anthem spokesman Tony Felts said the insurer needed to bring its reimbursement rates “more in line with our fee schedule.”
“In some cases, we were paying therapists almost twice as much on autism claims as we were paying MDs for an office visit,” he told the IBJ in an email.
But many therapists contend autism therapy does not fit well with the “medical model,” because time with a therapist is only a fraction of the treatment the centers provide.