Community protest for better treatment options for children with developmental disorders

On Thursday, dozens of local parents and service providers came together to rally for better treatment options for children with special needs.

They gathered outside the local health care administration building in Hogan’s Creek.

Action News Jax's Courtney Cole spoke to service providers who explained how treatment to improve children's conditions is being denied.

Concerned citizens chanted "Stop the delays" in front of the local health care administration building in Jacksonville on Thursday hoping to get the attention of someone inside.

"The options for these families are nothing. We are leaving these families with nothing to support them and help them,” said Candy Hurst.

Hurst is the president of the First Coast Association for Behavior Analysis.

She said that ever since the Agency for Health Care Administration switched its administrator at the end of March 2018, families who have children with developmental disorders have been left to fend for themselves.

They can't just be treated  at a hospital or mental facility.

They require what's called behavior analysis services, which requires authorization from the ACHA.

“Without an authorization, the provider cannot be reimbursed for the services,” Hurst told Action News Jax.

Services providers said it's taking anywhere from three to five months to receive it, but the authorization could also mean the for three to five months, children aren't receiving the care that they really need.

"We need to not disrupt the services. It really impacts the children. They can regress in the skills that they’re gaining,” said a service provider who wished to remain anonymous.

The group said it is asking the health agency to move more efficiently to prevent more gaps in treatment.

"It creates a very dangerous environment for everybody," X said.

Action News Jax contacted the local health care administration office in Jacksonville to ask what is being done to make sure children are receiving the services they need moving forward and received this response from Mallory McManus, the communications director for the Agency for Health Care Administration:

"Under the Florida Medicaid program children have access to all medically necessary services, including applied behavioral analysis services.  If any recipient is having difficulty accessing services, please encourage them to contact the Florida Medicaid Helpline at 1-877-254-1055 or file a complaint using this online form. To be clear, there have been no cuts to funding or coverage for behavioral analysis services, and this service is still available.

"Earlier this year, the Agency for Health Care Administration (Agency) reassessed its delivery of Medicaid behavior analysis (BA) services. The Agency determined through this reassessment that the authorization process for BA services needed to be changed and that a review of the providers furnishing these services needed to be conducted. There is also concern that the number of children receiving BA services is higher than expected, and the Agency is also conducting a review to ensure there is a medical/behavioral need for these services.

"BA is a service provided to children enrolled in Medicaid with significant behavioral issues (e.g., children with autism who are injuring themselves or others). It is usually provided in the child’s home. It is critical that the Agency ensure the health, safety, and welfare of the children receiving this service. The Agency must also ensure that Medicaid services are being furnished by providers who are in full compliance with Florida Medicaid law and who are providing the services professionally and ethically. Between January 1, 2018, and June 7, 2018, 14,441 unique Medicaid recipients received BA services.

"In February 2018, the Agency for Health Care Administration (Agency) began transitioning its prior authorization process for BA services from Beacon Health Options to eQHealth Solutions. To inform providers and recipients of the change, the Agency mailed provider and recipient letters and issued electronic provider alerts. Throughout this transition, the Agency honored existing authorizations and has reimbursed for services approved by Beacon as long as the provider had received a letter with a prior authorization number. 

"Effective March 26, 2018, providers could submit new requests for authorization to eQHealth, using an abbreviated process. During this initial authorization period, from March 26, 2018, through April 30, 2018, eQHealth issued administrative approval for up to 20 hours of BA services per week.  eQHealth then conducted prior authorization reviews for any service hours requested beyond 20 hours per week and provided an authorization or denial based on medical necessity.  Effective May 1, 2018, eQHealth began conducting prior authorization reviews on all authorization requests submitted to them regardless of the number of hours being requested per week.  eQHealth reviews each request and provides an approval or denial based on medical necessity.

"As of June 27, 2018, the average time to process a completed prior authorization request for BA assessment services was 12 days.  The average time to process a completed prior authorization request for BA treatment services was 16 days.  These averages are a result of the transition from Beacon to eQHealth and the need for eQHealth to not only review new requests but any pending requests that Beacon had not completed.  In addition, approximately 400 new requests for services are submitted to eQHealth weekly for review. eQHealth is committed to reducing the average number of days for both assessment and treatment services and they continue those efforts daily.    

"If a denial was issued, the requesting provider is able to request a reconsideration of the denial from eQHealth.  Additionally recipients continue to have the ability to request a fair hearing if eQHealth upholds the denial. The request for a fair hearing is submitted to the Agency’s Office of Fair Hearings and the Office of Fair Hearing would then send the Notice of Hearing to the recipient once the request is processed. Information regarding how to file for a fair hearing is included on the denial notices that are sent to recipients. At this time, the Agency has received only a handful of requests for a fair hearing. Recipients who request a fair hearing will continue to receive services throughout the fair hearing.

"If a provider is having difficulty with enrolling in Medicaid, or obtaining service authorizations, please encourage them to contact the Florida Medicaid Helpline at 1-877-254-1055 or file a complaint using this online form. Providers may also contact eQHealth at 1-855-444-3747 and via the web at http://fl.eqhs.org/ if they have questions regarding the authorization process."

Cox Media Group