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Nebraska Medicaid receives federal approval to cover treatment for children with autism

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Nebraska Medicaid receives federal approval to cover treatment for children with autism

LINCOLN — The final piece has fallen into place for Nebraska Medicaid to cover an intensive but effective type of treatment for Nebraska children with autism.

Courtney Phillips, chief executive officer of the Nebraska Department of Health and Human Services, announced Monday that the state has gotten federal approval for coverage of applied behavioral analysis and other behavioral modification services.

“This is good news,” she said. “Having access to these services will help many of the children we serve through the Medicaid program lead more fulfilling lives.”

The approval was received March 30 and is effective retroactively to Oct. 1, when the state started offering the coverage.

Services approved for coverage include day treatment, community treatment aides and outpatient therapy. Treatment models approved for coverage include cognitive behavioral therapy, comprehensive behavioral intervention and applied behavioral analysis for children.

Applied behavioral analysis uses positive reinforcement and other techniques to change behavior. It can eliminate symptoms of autism for some children and dramatically reduce the symptoms in others. But depending on a child’s needs, it can be very intensive and expensive.

“We heard from families and advocates that these services are very important,” said Calder Lynch, director of the state’s HHS Division of Medicaid and Long-Term Care. “This is a great addition to the Nebraska Medicaid program.”

Previously, Nebraska Medicaid barred coverage of behavioral modification services, including applied behavioral analysis. The program also prohibited coverage of mental health treatments when aimed at treating developmental disabilities.

State officials long resisted efforts to add the coverage, citing concern about potential costs.

But they reversed course after a judge ruled against the state in a class-action lawsuit filed in the name of two boys, identified as K.D. and S.L.

Lancaster County District Judge John Colborn found that the prohibitions violated federal law and ordered the state to start paying for applied behavioral analysis and similar treatments if recommended by medical professionals.

State officials cited other factors as well in their decision to start coverage. Among them was a directive from the federal government and changes in what professionals consider best practices in autism treatment.