Payers Press Autism Providers on Outcomes Amid Spending Scrutiny
At Behavioral Health Business' Autism Investor Summit East, payer and provider executives said rapid growth in autism services spending has drawn increased scrutiny from health plans, including tighter prior authorizations, auditing and case-by-case review. Speakers from the Association for Behavioral Health and Wellness, the National Society of Autism Professionals, Soar Autism Center and Magellan Health said cost growth exposed gaps in program integrity and a lack of outcomes data linked to utilization. The discussion referenced recent Office of Inspector General reports finding that several state Medicaid programs failed to properly oversee autism spending and compliance. Speakers said providers and payers need to align on which outcome metrics matter and that blanket limits on ABA service hours risk one-size-fits-all authorizations rather than needs-based care.