Key Points:

• An AHCCCS insurer cut ties with an autism therapy center, putting 300 children at risk of losing services

• Insurer Mercy Care ended its contract with Centria Autism in a dispute over reduced reimbursement rates

• Parents of children who attend Centria are urging AHCCCS to intervene and ensure continuity of care

Several hundred Arizona children with autism spectrum disorder are at risk of losing therapeutic services as a result of a contract dispute between an Arizona Health Care Cost Containment System insurance provider and a local autism therapy center. 

Families with children receiving care at Centria Autism, a therapy center with locations throughout Arizona, received notice over the last few weeks that the program will no longer be available under Mercy Care, a managed care organization, after the insurer terminated its contract with Centria on Oct. 17. 

According to attorneys for Centria, Mercy Care abruptly terminated the contract after Centria objected to proposed provider reimbursement rates in its renewed contract with the insurer. The termination leaves nearly 300 families with less than 90 days to find either a new insurance provider or a new therapy provider. 

Centria is one of the largest providers of applied behavioral analysis services, known as ABA, to children with autism spectrum disorder who are on Medicaid in Arizona. For Mignonette Reyes, a Mesa mother whose daughter attends Centria for therapy, the termination news was “really devastating.” 

“We are so attached to them right now and very thankful for what they do,” Reyes said. “They are an extension of our family right now.”

According to a letter from law firm Snell & Wilmer sent to AHCCCS on behalf of Centria, the dispute began on Sept. 19 when Mercy Care contacted the therapy center regarding a contract amendment to decrease reimbursement rates for therapy services by 25%. Mercy Care already reduced its reimbursement rates for ABA services by 15% in July of this year.

Centria offered counter proposals to the rate reduction, but Mercy Care did not respond and instead sent Centria a notice of contract termination on Oct. 17, according to the letter. Mercy Care also terminated at least one other ABA provider for refusing to accept the rate reduction. 

“As an Arizona-based non-profit organization, Mercy Care is committed to providing access to high quality care, while being good stewards of Arizona taxpayer funds,” a spokesperson for Mercy Care said in a statement. “We negotiated in good faith but have not been able to reach an agreement. We’re dedicated to the health and wellbeing of our members and ensuring that they have access to a broad network of ABA providers.”

Arizona already has a shortage of ABA services and providers, which attorneys for Centria say will only be exacerbated by the contract termination and the abrupt reduction in reimbursement rates. The attorneys asked AHCCCS to step in and mediate the issue so patients do not lose ABA services through Centria in January. 

In an emailed statement, AHCCCS spokesman Johnny Cordoba said the agency cannot step in on private contract negotiations but is monitoring the situation and working with members to resolve any issues.

“Managed care organizations have discretion to manage their provider networks, provided they ensure members have reasonable and timely access to covered healthcare services through a sufficient and well-distributed network of contracted providers, and they comply with contractual requirements,” Cordoba said in a statement. “While AHCCCS does not approve or deny subcontractor terminations, we are closely monitoring the situation to ensure continuity of care for affected members.”

Gov. Katie Hobbs’ office did not immediately respond to questions about whether it is aware of the contract dispute. 

Centria encouraged parents to reach out to AHCCCS to switch insurance providers and continue care at the therapy center. Centria contracts with five other managed care organizations in Arizona, but Reyes and Tiana Brandon, a Gilbert mom, both said AHCCCS informed them they could not switch insurance providers.

Both moms said AHCCCS told them they could only enroll their children with a new insurance provider during their child’s birth month. Reyes’ daughter was born in July and Brandon’s son was born in September, meaning they will not be able to switch insurance providers for many months. 

Cordoba said families who are having issues accessing medically necessary services can reach out to the agency’s Clinical Resolutions Unit. 

Brandon said AHCCCS was not able to point her in the direction of any alternative ABA providers for her son Micah, who has been attending Centria for three years. 

“He’s never had any regression and he’s never had any plateau at Centria,” Brandon said. “And my greatest fear is to put him somewhere else.”

Without being able to switch insurance plans, Reyes and Brandon instead have to find a new ABA provider entirely or go several months without care, options that could have negative impacts for both Mireille and Micah. Children with autism spectrum disorder are often sensitive to change and can experience regression without consistent therapy. 

“If therapy has been stopped for more than two to three days, (Mireille) regresses, like she’s not that communicative anymore,” Reyes said. “I know it’s really going to affect her.”

Reyes said she does not have the resources to manage Mireille’s care on her own, as she has two other children and is currently expecting a fourth. One of Reyes’ other children was also recently diagnosed with autism spectrum disorder and she had hoped to enroll him at Centria as well. 

Brandon has been looking for alternative programs, but is also worried about how the change will affect her son. Her employer’s insurance does not cover Micah’s ABA therapy and other programs do not have the same hours that make up his current routine.

“I’m literally scrambling trying to make sure that I can provide a solid next step,” Brandon said.

The contract dispute between Mercy Care and Centria comes during an already difficult year for parents of children with disabilities. Parents and advocates are fresh off a tense battle to protect state funding for the Division of Developmental Disabilities, which still wages on as the state evaluates eligibility rules that could cut services for some families. 

Reyes and Brandon, whose children both receive services from the Division of Developmental Disabilities and the Arizona Long Term Care System, are hoping for some stability moving forward. If Mercy Care won’t reverse course and continue to work with Centria, they hope AHCCCS will step in and find a way to ensure continuity of care.

“I want this wrapped up within the next 30 days so I know I have the security of knowing where my son is going to be attending,” Brandon said.