DHHS Defends Medicaid Pay Rates Reduction

The Nebraska Department of Health and Human Services (DHHS) has come under fire in response to reports that some Medicaid reimbursement rates are being reduced, particularly those focused on behavioral health and autism.In response, DHHS issued a press release that stated, in part, “Following months of communication with providers, it became evident that misinformation was being conveyed, including to the public. Those discussions focused on DHHS’ need to adjust payment rates to sustainable levels, commensurate with the rates of surrounding states.”On Friday, July 18, Nebraska Department of Health and Human Services (DHHS) CEO Steve Corsi, Medicaid and Long-Term Care Division Director Drew Gonshorowski, and Karoly Mirnics, dean and director of the Munroe-Meyer Institute held a news conference to provide information about the approaching adjustment to Medicaid payment rates for Applied Behavior Analysis (ABA) services to Nebraska families. Rate adjustments will go into effect August 1 of this year At that news conference, CEO Corsi reiterated that rate modifications would not result in a lapse of care for clients or their families.“I want to be exceedingly clear, DHHS is fully committed to continuing ABA services to Nebraska families receiving Medicaid,” said Corsi. “We will continue to operate in the best interest of children and families.” Behavioral HealthBehavioral health services are expected to take a major hit. According to Behavioral Health Business, a news media company that covers the behavioral health sector, “While the cuts range in percentage, one of the most drastic and most impactful is the 48 percent cut to reimbursement for direct therapy provided by a behavior technician. Fifteen-minute billing units for this service will be paid $18.70, or $74.80, for an hour’s worth of services.”The cuts will be effective August 1, 2025. Other major payment cuts anticipated, such as for parent training (51 percent ), care plan and protocol adjustments by Board Certified Behavior Analysts (37 percent) and treatment assessment development (28 percent), according to a bulletin by Drew Gonshorowski, director of the Medicaid and long-term care division of DHHS, issued on July 1. Reason for the CutsDHHS reports, “Currently, Nebraska payment rates for ABA services are the highest of any in the nation.”Rate increases are enacted by the Legislature. Per Code of Federal Regulations (CFR) 447.200, payments for services must be consistent with efficiency, economy, and quality of care. Medicaid rates are periodically reviewed for market comparison with respect to other relative payer sources, such as Medicare and other state Medicaid agencies.Per Code of Federal Regulations (CFR) 447.200, payments for services must be consistent with efficiency, economy, and quality of care. Medicaid rates are periodically reviewed for market comparison with respect to other relative payer sources, such as Medicare and other state Medicaid agencies.“These changes came as a result of a rate analysis study conducted by Nebraska Medicaid that compared our state to surrounding Medicaid markets,” said Gonshorowski. “We found that Nebraska’s rates for these services have been significantly higher, some more than twice as high, as those of other state Medicaid programs. This rate change puts Nebraska more in line with ABA rates, not just in the region, but nationally.”Dean and director of Munroe-Meyer, Dr. Karoly Mirnics stated his support for ensuring that rates were managed at a level appropriate to the services provided. “We will continue working with DHHS as close partners to develop evidence-based guardrails to provide the most meaningful, most efficient ABA services for all individuals with autism. This will be done thoughtfully, based on scientific data. We greatly appreciate DHHS’s willingness to work with us and soliciting our expert input on this process.”The Munroe-Meyer Institute is one of the biggest and oldest developmental disability centers in the world. The nonprofit organization, an academic unit of the University of Nebraska Medical Center (UNMC), provides approximately 120,000 clinical visits a year with approximately 60 percent of those providing services for individuals and families with Autism Spectrum Disorder (ASD). Rural ImpactRural Nebraska suffers from a shortage of mental health care providers.Autism Business News (ABN) acknowledges Nebraska rates are high but insists those high rates are necessary to recruit and retains providers in these underserved areas, “On the whole, providers have also told ABN that having such high rates helped attract BCBAs (Board Certified Behavior Analysts) from outside of the state to relocate there. They often did so with steep retention and relocation bonuses and industry-leading salaries. They also said that the increased rates did little to spur the development of homegrown clinicians.”

Eugene Allen Slama

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