National Coalition for Access to Autism Services
A nonprofit organization
The National Coalition for Access to Autism Services (NCAAS) seeks to preserve and expand access to the services and supports necessary to ensure that people with autism have every opportunity to fulfill their potential.
NCAAS is the voice of the nation’s premier autism treatment providers, working with Congress, federal and state agencies, payors, and regulators to ensure access to services across all demographics and all geographies. NCAAS members provide services to tens of thousands of families affected by autism spectrum disorder in nearly every state, contracting with commercial insurers, TRICARE, Medicaid, CHIP programs, and school districts.
In the News — july 9, 2021
NCAAS SEEKS POSTPONEMENT OF NEW TRICARE POLICIES IN ABSENCE OF CLARIFICATION TO PROVIDERS
NCAAS has submitted letters to the House and Senate Armed Services Committees seeking a postponement of the implementation of new policies described in the TRICARE Operations Manual (TOM) published in March. Find a list of specific concerns in the NCAAS letters, including the elimination of services in a school setting; changes in assessment requirements; risks of recoupment for issues outside of the provider’s control; and the contractors’ general lack of clarity about how to administer the benefit in the context of this new TOM.
JAnuary 1, 2021
cms increases mue for 3 billing codes
NCAAS is pleased to announce that CMS has increased the Medically Unlikely Edits for three of the adaptive behavior codes: 97152 (increased from 8 to 16 units); 97154 (increased from 12 to 18 units); and 0362T (increased from 8 to 16 units). NCAAS continues to work with CMS to increase the MUE for 97151. Although the MUE on the Medicaid side is 32 units, it remains at 8 units for Medicare, and insurers’ claim processing predominantly defaults to Medicare MUE.
All CPT I adaptive behavior codes have an MUE Adjudication Indicator of 3, which means that all claims in excess of the MUE should be paid when services are properly coded, medically necessary, and rendered. CMS has provided clear guidance that MUE with an MUE Adjudication Indicator of 3 may be paid in excess of the MUE if services were actually provided, properly coded, and medically necessary. Providers who encounter these claims denials are encouraged to appeal them and to report the denial(s) to ABA Billing Codes Commission here.
december 9, 2020
NCAAS ISSUES Statement establishing aba employees’ status as health care workers
NCAAS issued a statement to ensure ABA providers are recognized as health care workers in the prioritization of the COVID-19 vaccine distribution. State public health departments will provide additional information on how to access the vaccine once COVID-facing workers have been vaccinated. Read the NCAAS statement here.
july 31, 2020
hhs issues 2nd extension of deadline to apply for provider relief
The US Department of Health and Human Services has issued a second extension, making August 28, 2020, the last day to apply for provider relief for Medicaid providers, including ABA providers whose patient population includes some Medicaid patients. Find out more here.
JULY 27, 2020
medicaid PROVIDER RELIEF DEADLINE EXTENDED
NCAAS lobbied Congress to secure funding for ABA providers and to ensure providers are eligible when their patient population is comprised of both Medicaid and commercially insured patients. The deadline to apply for Medicaid providers to apply for CARES Act funding has been extended to August 3, 2020. Providers who did not receive funds from the General Distribution and billed Medicaid/CHIP programs or Medicaid managed care plans for health care-related services from January 1 to May 31 are eligible to receive funding equal to 2% of gross revenues for CY 2017, 2018, or 2019, as selected by the provider. Review the application here. Read the instructions here.
APRIL 1, 2020
Following the recent passage of federal funding bills, NCAAS has launched a new effort to secure federal financial assistance for ABA providers in the wake of the COVID-19 pandemic. Since the first campaign was launched less than two weeks ago, we are proud to have secured the support of hundreds of additional providers. We are fortunate that autism is never a partisan issue and are grateful for the efforts of Nancy Pelosi, Kevin McCarthy, Senator Mitch McConnell, and Senator Chuck Schumer on behalf of the families we serve. Read and share the NCAAS letters to the Senate and the House.
MARCH 19, 2020
NCAAS has launched an effort to secure federal assistance for ABA providers in the wake of the COVID-19 pandemic. Although such an effort presents many challenges, we are proud that it has united the provider community as we all work to ensure continued access to autism treatment. We are fortunate that autism is never a partisan issue and are grateful for the efforts of NancyPelosi, Kevin McCarthy, Senator Mitch McConnell, and Senator Chuck Schumer on behalf of the families we serve. Read and share the NCAAS letters to the Senate and the House.
NOVEMBER, 2019
TRICARE: NCAAS continues to raise concerns about the annual and quarterly reports of the Department of Defense regarding the Autism Care Demonstration (ACD). In these reports, the Department asserts that there is insufficient evidence to establish that ABA is effective in treating autism spectrum disorder. Additionally, it states that nearly all beneficiaries “made little to no change in their symptom presentation.” The reports show that most TRICARE beneficiaries are receiving weekly ABA hours in the single digits, and it is not clear how the Department selected the 1,557 beneficiaries whose data were analyzed of the 14,420 beneficiaries participating in the ACD. For more information about the concerns of NCAAS, read the NCAAS response here.
- October 30, 2019
NCAAS members had a long-awaited meeting with the Centers for Medicare and Medicaid Services (CMS) to discuss ways to increase access to ABA for Medicaid beneficiaries under 21 years of age. Members voiced concerns about State Plan Amendments (SPAs) in which a state describes the ABA benefit. Some concerns raised by NCAAS include hour limits; parent/caregiver training requirements; excessive neurological, psychological, and assessment requirements; and lack of progress being used to deny or limit medically necessary treatment. We were gratified to see that the CMS representatives have such a depth of knowledge and to know that their goal is to make sure SPAs don’t include improper requirements such as the ones we described.
That same day, we met with staff from Congressman Pete Stauber’s (R-MN) office to thank him for his help in securing the language in the U.S. House Appropriations Committee Fiscal Year 2020 Labor-HHS-Education funding bill that addresses violations of Mental Health Parity and Addiction Equity Act (MHPAEA) in the context of autism treatment. We also met with Congressman Austin Scott (R-GA) who is very supportive of efforts to increase access to autism services and supports and aware of the challenges faced by families in rural counties. Finally, we met with staff from Senator Sinema’s (D-AZ) office in anticipation of seeking Senate support for NCAAS initiatives in 2020.
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MAY 8, 2019
NCAAS members lobbied Congress in February to include today’s report language to protect access to autism treatment by enforcing the federal Mental Health Parity & Addiction Equity Act.
NCAAS has secured language in the U.S. House Appropriations Committee Fiscal Year 2020 Labor-HHS-Education funding bill that addresses violations of Mental Health Parity and Addiction Equity Act (MHPAEA) in the context of autism treatment. Importantly, the language explicitly identifies parent/caregiver participation requirements, preauthorization processes, location of services exclusions, and fail-first policies as examples of MHPAEA violations. Additionally, it directs CMS to ensure compliance with MHPAEA and highlights the important role health plans and insurers can play by training their personnel about this important law in the context of access to medically necessary autism treatment.
Many thanks to the members of the House Appropriations Committee and all of the NCAAS members for their tireless efforts to promote awareness of MHPAEA and its importance to the autism community.
FEBRUARY 13, 2019
NCAAS members will be on Capitol Hill advocating for the autism community, addressing issues ranging from TRICARE for our active duty and retired military families to enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA). Check back soon for updates!
NOvember 2018
FAQ - 2019 CPT Codes for Adaptive Behavior — NCAAS surveyed its members to identify and answer the most frequently asked questions about the new 2019 CPT I codes for adaptive behavior. Click here to view the FAQs. If we didn’t answer your question, you can ask your question on the NCAAS Facebook page.
November 14-16: NCAAS is attending the American Medical Association’s CPT and RBRVS 2019 Annual Symposium in Chicago. We have collected ABA providers’ most frequently asked questions and will post an FAQ resource by the end of the Symposium.
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Adaptive behavior codes for ABA to be “Contractor Priced.”
As anticipated, CMS did not value the adaptive behavior codes in its Final Rule. Instead, the codes are “contractor priced,” which means that providers will continue to negotiate rates with payers just as they do now.
NCAAS commends CMS for not establishing valuations for these codes prematurely as the growing autism prevalence rate and accompanying shortage of behavior analysts are but two elements that contribute to the unpredictability of the cost for providers to deliver top-quality ABA. Without understanding all of the elements that contribute to the cost of delivering ABA, the risk of a valuation that is not reflective of the actual cost to serve individuals diagnosed with autism spectrum disorder represented a significant concern as we awaited CMS’s NPRM. CMS’s decision to continue contractor pricing for the services covered by the adaptive behavior codes is good news to assure continued expanded access to ABA services, regardless of where families might live in the U.S.
Check back soon for more information following the release of the CPT® Assistant and CPT Changes.
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