Cambridge City Council Unanimously Urges MassHealth to Reform Autism Care

The Cambridge City Council in a 9-0 vote, approved a resolution that urges MassHealth to acknowledge assistant-level Board Certified Behavioral Analysts who are licensed by the Department of Public Health.

“Thousands of children in Massachusetts aren’t able to receive essential care. Creating a third tier of care is a proven way to cut this backlog, while potentially lowering costs, creating jobs, and providing children with ASD the care they need.”

— Vice-Mayor Marc McGovern

According to testimony from Dr. Ashley Williams, who serves as Vice President at BCI, an ABA Services Organization that provides behavior analysis services in Cambridge, “We witness firsthand the devastating impact of long waitlists on children with autism. In Cambridge, children with autism, particularly school-aged children, are facing significant wait times of greater than 6 months to access ABA therapy. The proposed resolution correctly identifies that Massachusetts operates under a two-tier delivery model rather than the three-tier model successfully implemented in states like California and Wisconsin. This middle tier of BCaBAs is essential for expanding capacity while maintaining quality care.”

In Massachusetts, some 2,000-3,000 children are waiting for access to clinically appropriate services. Early intervention and consistent, timely treatment are essential to achieve the best outcomes. The biggest reason for this waitlist is that there are not enough ABA providers, given the constraints of the Commonwealth’s current 2-tier delivery model.

BCaBAs serve as a mid-tier supervisor for the provision of autism services, operating under the direction of a licensed BCBA. This 3-tier model is used successfully in other states and carries three principal benefits. First, the clinical competency of brand new BCBAs is enhanced as they spend significant time as a mid-tier BCaBA supervisor, shadowing experienced BCBA clinicians and gaining hands-on experience that is unavailable under a 2-tier model. Second, access to care is almost doubled under a 3-tier model as one BCBA is able to oversee 10-16 clients in a 3-tier model (with support from 1-2 BCaBAs), but only 6-10 in a 2-tier model with no support supervision. Lastly, per-child costs are lower when a BCaBA mid-tier supervisor is part of the care-team, as the reimbursement level for a BCaBA is below that of a BCBA.