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Emily:

Article 317:30-5-314(b).3.G specifies that ABA services provided by a clinic or agency owned or partially owned by the child/youth’s responsible adult would be an 'excluded' service.  This is unethical and feels very targeted.  I personally own a clinic that offers ABA therapy.  My son has needed ABA therapy for many years.  He has gone to multiple other clinics and has gotten sub-par care.  Therefore, we have established an ethical way for him to receive services in the clinic we own.  My husband and I have absolutely no connection to his care whatsoever, other than as parents, as we contract a third party BCBA to supervise the RBT that provides his treatment.  Excluding services due to a patient's parents' level of ownership in a clinic is unethical and should have no bearing on whether the services would be covered or not.  Many individuals' own clinics where they don't even work and have nothing to do with daily operations.... a client should not be penalized for this.  I adamantly oppose this specific exclusion and deem it unethical.  No other insurance has such an exclusion, and Medicaid should not be allowed to exclude this.  Furthermore, if this is deemed to be acceptable, patients and clinics should be given at minimum a year or two years to transition to another clinic as that is the average wait list for therapy and it is unethical to stop medically necessary services so abruptly.  Thank you for your consideration.

Kent:

As a parent and small business owner, I am deeply disheartened by the emergency action order that has abruptly stripped my child of critical access to behavioral therapy. This decision not only impacts my family but unfairly penalizes families like mine, who dedicate their lives to providing high-quality care and resources for children in need.

My child, like so many others, relies on therapy to develop essential life skills, manage daily challenges, and thrive in ways that were once thought impossible. To deny access to these services simply because the clinic providing care is owned or operated by a parent or guardian is not only unethical but deeply discriminatory. It creates an unfounded stigma against parents who are professionals in this field, as though their dual roles as caregivers and clinicians somehow compromise the integrity of their child's care.

This policy assumes a conflict of interest where none exists. Behavioral therapy is evidence-based and data-driven, with measurable outcomes that ensure accountability regardless of ownership. The professionals providing services are licensed and operate under strict ethical and regulatory guidelines that safeguard the quality and impartiality of care. Why, then, should my ownership of a clinic disqualify my child from receiving the same state-covered services available to others?

The sudden nature of this order has placed my family in an untenable position. Beyond the financial strain, it disrupts the continuity of care, jeopardizing the progress my child has worked so hard to achieve. Behavioral therapy is not a luxury; it is a necessity for children with developmental and behavioral needs. This action effectively denies children their right to equitable healthcare, punishing them for circumstances beyond their control.

I urge you to reconsider this harmful policy, specifically Article 317:30-5-314(b).3.G. Rather than targeting families, let us focus on strengthening accountability and transparency measures across all providers. Denying children access to care sets a dangerous precedent and erodes trust in our healthcare system. I am not just advocating for my child but for all families who have been unjustly affected by this sweeping and ill-conceived decision.

Our children deserve better. They deserve equal access to the resources that allow them to reach their fullest potential, regardless of who owns the clinic providing those resources. I implore you to rescind this order and work with parents and professionals to find solutions that prioritize the well-being of our most vulnerable citizens.

Rachael:

In response to APA WF 24-23 Circulation Document:

C. A description of the classes of persons who will benefit from the proposed rule:

 The proposed rule changes will benefit all SoonerCare members who receive ABA services by ensuring a sufficient standard of care.

This statement is false concerning ABA therapy in the school environment.  By eliminating this service when it is clinically necessary, the standard of care for that client is lessened possibly to the detriment of the client's total school success. 

D. A description of the probable economic impact of the proposed rule upon the affected classes of persons or political subdivisions, including a listing of all fee changes and, whenever possible, a separate justification for each fee change:

There is no probable economic impact and there are no fee changes associated with the rule change for the above classes of persons or any political subdivisions.

This statement is also untrue, while the fees associated with the services are not changing, eliminating the services in certain environments potentially causes families in low SES statuses to suffer financially due to frequent suspension from school when children engaging in maladaptive behaviors are not given needed supports in the school environment.  This lack of work by the families can lead to job loss, and potentially dire family circumstances only exasperated by the needs of a child with autism. 

If the OHCA thinks that there are issues with providing ABA services in the daycare/school settings. In that case, a revision of services/requirements should be instituted, not a total and complete omission of the services.  Schools and families have written these services into IEPs which are binding documents.  This should be considered when moving forward to permanency. There are many stakeholders involved in this decision.  All should be considered equally. 

Esther:

While many of the new criteria read similar to some private insurance requirements, the proposed restrictions on location, intensity and modality of services will not lead to improved measurable outcomes. For example, parent training can be effective when delivered via telehealth. Practicing interventions plays a role in generalization. I can see the argument that it is best to do that in the physical presence of a BCBA. That does not equate to it cannot be done via telehealth. Sometimes the obstacle is in understanding how the intervention addresses the function. That is a discussion. A discussion that is equally effective physically or via telehealth. Follow up and reporting of data on how parent implemented intervention is going can be done with physical paper data sheet exchange just as easily with an electronic copy of the same data sheet, via telehealth.

Discontinuing coverage for services that improve daily living, social functioning and relationship skills and services rendered in the community are also not in the best interest of the client. Simply eliminating or reducing problem behavior does not translate to an improvement in the life of the client or those in their surroundings. Where is the line between teaching a child to make requests politely and teaching them to share politely. Teaching them not to destroy the roll of toilet paper does not mean much if they never learn to use the toilet independently.  There are instances where the persons in the natural environment are part of the learning history keeping maladaptive behavior going. A neutral third party (ABA practitioner) can disrupt that learning history and create a new history of appropriate behavior that can then be transferred back to those in the natural environment. This is true in settings other than the home. Clients need to learn function in all the natural environments they are a part of. ABA practitioners are well versed in generalization across settings. Limiting their ability to do this will not improve measurable outcomes. Similarly placing time limits for achieving generalization or target levels of proficiency goes against the BACB code of ethics. Treatment duration is data driven not deadline driven. That would equate to setting up one-size-fits -all-trials-to -criteria-requirements for clients in settings outside the home. That also goes against the code of ethics which states that treatment is to be individualized to each client.  Just as the BACB requirements must be met by practitioners, the code of ethics that guide those practitioners should not be overlooked.