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Treatment of autism spectrum disorder is a rapidly developing field

• Applied Behavior Analysis (ABA) is widely accepted as an early intervention option. However, in the United States, insurance coverage, reimbursement rates, and coding for such treatments are still evolving.

Coverage and reimbursement rates for ABA vary widely in the United States

• TRICARE's proposed rate of $68 per hour for one-to-one ABA therapy provided by a Board Certified Behavior Analyst, reduced from $125 per hour, is below the mean commercial insurance rate in ten of the 17 states where data figures were available and above the mean commercial insurance rate in seven of the 17 states.
• The $68-per-hour rate is below the reimbursement rate in the 11 states that specify rates for master's- and doctoral-level ABA providers in Medicaid.
• The U.S. weighted mean reimbursement rate for ABA services by a provider with a master's degree or doctorate is $94.72, based on local Medicaid and commercial insurance reimbursement rates, weighted by the number of children with ASD covered by each type of insurance in each location.
• The weighted mean U.S. reimbursement rate for one-to-one therapy by paraprofessional is $65.16 per hour.
• Adoption of the proposed $68 rate may prompt providers to either leave TRICARE's networks or prioritize ASD children from other health insurers over TRICARE–covered children.