Tuesday, January 15, 2019

How Do I Fund My Child's Applied Behavior Analysis (ABA)?

from IIDC:


Contributed by 
Marci Wheeler, MSW and 
Dr. Cathy Pratt, BCBA-D

Your son/daughter has just been medically diagnosed with an autism spectrum disorder (ASD) by their primary care physician or by a psychologist.  It has been recommended that you pursue Applied Behavior Analysis (ABA) therapy.  ABA is endorsed by the American Academy of Pediatrics as an evidence-based practice.  The challenge then becomes locating a provider and funding for the program.  A list of providers can be found on our website at https://www.iidc.indiana.edu/pages/where-and-how-to-find-an-aba-provider-or-center.  ABA programs should guide you on identifying and accessing funding sources.  This article is written so that you can better understand your options.  Do not be overwhelmed.

Insurance Coverage

Indiana is fortunate to have a strong autism insurance mandate.  Understanding if and how you are covered under your insurance plan should be the first step.  Your child is eligible to be covered via insurance, because ABA is considered a medically necessary part of your child’s treatment program.  There are a variety of medical coverage programs available to families. These may include employer-based health coverage, private purchase of health insurance, and state and federally subsidized programs.

If you have private employer based insurance, check to see if ABA is covered. You can determine if your plan is covered by Indiana’s or another state’s autism insurance mandate by checking with your company’s Human Resources Department. Ask if your plan is fully funded and if it was issued in Indiana or another state.  If your insurance was issued in another state, check with that states Department of Insurance and ask if that state has an insurance mandate or parity law for autism. Your insurance covers autism treatments if it is fully funded and is issued in Indiana or another state that has an autism insurance mandate.  

If your employer-based insurance is self-funded (also referred to as self-insured), the policy is regulated under federal law and exempt from any state regulation.  Your employer based self-funded plan may still voluntarily cover autism, so you should ask if they do.  Self-funded companies that are required to comply with the federal Mental Health Parity and Addiction Equity Act (MHPAEA) must cover ABA and autism treatment. Coverage cannot be limited unless the same limits apply to substantially ALL medical surgical conditions in the same category of service (inpatient, outpatient).  Some self-insured plans are exempt from MHPAEA and would not have to cover autism or ABA. Any self-insured plan that does NOT offer ANY mental health services does not have to cover autism or ABA.

If you have an Affordable Care Act Plan (ACA) purchased from the federally facilitated Indiana ACA marketplace, ABA is included in the “Essential Health Benefits” package and required to be covered in Marketplace plans because they must follow the Indiana Autism Mandate: https://www.healthcare.gov/get-coverage/.

Beginning in 2017, ALL federal employee health care plans must cover medically necessary autism treatment. This includes ABA therapy and other therapies (e.g., speech therapy, physical therapy) generally accepted by the medical community and written into the treatment plan by the child’s treating physician.

Medicaid

All Medicaid Health Plans cover medically necessary ABA.  Medicaid Health Plans must be full coverage plans and include:  Medicaid Disability, also referred to as Traditional Medicaid; Hoosier Care Connect; Hoosier Health Wise; and MED Works.  Medicaid carriers include Anthem, MHS and MDWise. These are insurance companies that are contracted by the State of Indiana to manage some Medicaid Health Plans. You do not have to “switch Medicaid types” to access ABA coverage.  You do have a choice of Medicaid carriers.

Not all ABA providers accept Medicaid insurance. They may choose to participate in all Medicaid plans, some plans, or none. It will be important to ask the ABA provider about what Medicaid options they accept.  An ABA provider must be a participating provider with Medicaid, AND be a participating provider who is credentialed by the insurance carrier who may be managing the Medicaid plan. For example, if you have Medicaid managed by MHS and your ABA provider is a participating provider in Medicaid, but NOT with MHS, they cannot be paid by MHS Medicaid managed plans. They must be “credentialed” by MHS and be in the MHS network. 

Effective August 1, 2018, if individuals under age 21 are deemed appropriate for Applied Behavior Analysis (ABA) therapy, providers should access funding under Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Visit the website at (https://www.iidc.indiana.edu/pages/medicaid-epsdthttps://www.medicaid.gov/medicaid/benefits/epsdt/index.html) for more information on EPSDT.    

To learn more about Indiana Medicaid options, visit: https://www.in.gov/medicaid/index.html. If you are unsure which type of Medicaid you have, call the Division of Family Resources at 1-800-403-0864.  
If your family receives military health care benefits (US armed services “TRICARE”), the TRICARE Comprehensive Autism Care Demonstration (Autism Care Demo) covers applied behavior analysis (ABA) services for all eligible TRICARE beneficiaries diagnosed with an autism spectrum disorder.  
Family Voices Indiana provides a helpful Fact Sheet regarding purchasing insurance for all children with special needs. This information can be found at http://www.fvindiana.org/wp-content/uploads/2018/01/FS_Guide-to-Purchasing-Insurance-1.pdf.

Note: Know your insurance policy and follow the appropriate procedures. Submit your child’s Care Plan that your ABA provider and you have developed to the appropriate person or department within your insurance carrier. Keep organized and thorough records of all dealings with your insurance carrier, especially paperwork sent and received.

Other Options

You may have insurance but find that additional coverage and services are needed for your child.  Eligibility for the three programs and services listed below varies and may be dependent upon family income, and/or the diagnosis, age, and level of care needs of your child.  Supplemental funding for services may be available from one or any of these programs. Families are encouraged to apply for the following programs:

In Indiana, there are two Medicaid waivers designated for people with developmental disabilities. These are the Family Supports Waiver (FSW) and the Community Integration and Habilitation Waiver (CIH). ABA is not a specific service of either the FSW or the CIH waiver.  However, the waivers can be a funding source for non-medically necessary behavioral supports.  ABA is not an available service for individuals 21 and older through the FSW and CIH Medicaid Waivers.  They can have access to other behavior support services. Realize there is a waiting list for the Waiver, so do not expect it will happen right away.

The Children’s Special Health Care Services (CSHCS) Program helps families of children ages 0-21 with serious chronic medical conditions get treatment related to their child’s medical condition. Autism is a CSHCS eligible medical condition. CSHCS is the payer of last resort. This means that the program may pay only after your private health insurance and Medicaid have been billed. CSHCS is not an insurance program, but can provide supplemental funding.  This program is federally and state funded, and features care coordination services that help children and their families get medical care that can include ABA. If eligible for ABA coverage through the CSHCS program, coverage is limited to $10,000 per child, per calendar year and the ABA provider must be enrolled with CSHCS. 

United Healthcare Children’s Foundation (UHCCF) purpose is to help fill the gap between what medical services and equipment a child needs and what their health insurance benefit plan will pay. UHCCF grants provide financial assistance for families with children, ages 16 and younger that have medical needs not covered or not fully covered by their health insurance plan. Award amounts are up to $5,000 or 85% of the fund balance, whichever amount is less, within a 12-month period. The grant is paid directly to the health care provider. For more information and to apply, see the UHCCF website https://www.uhccf.org/.

In addition, you may want to check out a limited number of grants that are listed on the Indiana Resource Center for Autism website. The article, Grant Funding Opportunities: For Families and Professionals is found here: https://www.iidc.indiana.edu/pages/grant-funding-opportunities. Look under the section for parents and families. Your local library may also be able to assist you in finding grants to apply for to cover some therapy costs. 

If either your ABA provider or funding source provides information that seems confusing or contradictory, contact:
Family Voices Indiana- Indiana’s Family to Family Health Information Center:  http://www.fvindiana.org/.
Call their toll free number, 844-323-4636 and ask to speak to a specialist in your area. You can also email them at info@fvindiana.org. Spanish speaking specialists are also available

Indiana Arc- Insurance Advocacy Resources Center: https://www.arcind.org/our-programs/insurance-advocacy-resource-center/.  Michele Trivedi is an INARC Manager and health advocate with many years’ experience.  You can contact Michele at 317-977-2375 or toll free 800-382-9100. Her email is mtrivedi@arcind.org

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Monday, January 14, 2019

Voc Rehab Survey

Every three years, Vocational Rehabilitation (VR) agencies are required to develop a Comprehensive Statewide Needs Assessment.
As part of the assessment, VR is requesting your feedback on the need for services, or gaps in services for job seekers with disabilities. VR wants to provide the best services possible and needs your ideas. Your answers to the survey questions are very important. They will help VR improve services for individuals with disabilities. The survey will end on January 25, 2019.
To complete the survey, click on the link 2019 Vocational Rehabilitation Survey. You can also cut and paste the following url into your browser: https://iu.co1.qualtrics.com/jfe/form/SV_e4pAodrLsEWNoYR
You may complete the full survey or only the questions you choose. The survey is anonymous and no identifying information is collected. Individuals who need help in completing the survey may call the Bureau of Rehabilitation Services at 1-800-545-7763 (toll free) or 317-234-2907 for assistance.

DOE Social, Emotional, and Behavioral Wellness website

The Indiana Department of Education's (IDOE) Social, Emotional, and Behavioral Wellness website is now live. This website is where you will find all newly created Social-Emotional Learning (SEL) resources. This week you will find three short videos: SEL IntroductionSEL 101, and SEL 201. In addition, you will find an infographic on "Why"Social-Emotional Learning is important plus Indiana's Seven SEL Competencies with classroom strategies. Next week, we will be releasing the PK-12 Social-Emotional Learning Competencies. 

Please contact Christy Berger, Assistant Director of Social, Emotional, and Behavioral Wellness, with further questions.

Friday, January 11, 2019

Opportunity to share your story: $25 stipend

Family Voices Indiana shares this opportunity to positively impact future social workers:

We are seeking 11 families of children with all kinds of disabilities of any age who are willing
to be interviewed by graduate social work students to share about their experiences raising a child with special health care needs or disabilities. Interviews will take place during the Spring Semester of 2019 (in February or March) at a mutually agreed upon location and time. The interview should take 60 to 90 minutes. We encourage the interview to be held in the family’s home if possible so the student can fully appreciate the family experience.

Families will receive a $25.00 stipend for their participation. 

Please RSVP your interest by January 16, 2019.

Interested families should send the following to sviehweg@iu.edu.

Adult Name
Child Name
Child Age
Child Diagnosis
Phone number to reach adult
Email to reach adult
Address
Best days and times to reach adult

Another Place for Medicaid Attention: Young Children’s Social Emotional Development

 

Early childhood mental health is not as widely understood and does not look the same as mental health challenges for older children or adults. But there’s good news: effective, evidence-informed, and promising interventions that support infant and toddlers’ mental health are available. That’s where Medicaid can help.

Our latest paper, Using Medicaid to Ensure the Healthy Social and Emotional Development of Infants and Toddlers, underscores the critical role for Medicaid—which insures nearly half of all infants and young children—in preventing, diagnosing and treating infant and early childhood mental health disorders. It suggests ways states can ensure the youngest children and their families receive the support they need to ensure strong mental health. It builds on our earlier report on opportunities for young children in Medicaid, and looks more specifically at social-emotional development.

Young children’s social and emotional development, also called infant and early childhood mental health (IECMH), lays the foundation for lifelong success. Because infants and young children’s brains are rapidly developing, mental health challenges look different. For example, excessive crying, developmental delays, failure to seek comfort from caregivers, or lack of curiosity could be warning signs that a young child’s healthy emotional development could be at risk. Left untreated, these early signals can escalate into more serious mental health disorders (e.g. Depressive Disorder of Early Childhood, Anxiety Disorders, Post-traumatic Stress Disorder, Attention Deficit Hyperactivity Disorder, etc.) that can upend lifelong health, as well as educational and economic success.
How we talk about this is important. Advocates and other stakeholders should be mindful of their audience when selecting terms and crafting messages around social-emotional development. ZERO TO THREE’s research suggests that while mental health experts and providers may prefer infant early childhood mental health (IECMH), parents, pediatricians, and the general public may be more comfortable with terms like social and emotional development. We use “IECMH” most often to specifically call attention to screening, diagnosis, and treatment services that may be supported in Medicaid. “Social and emotional health” or “emotional development” refer more broadly to promotion and prevention activities.

What can Medicaid do? As usual, there’s not one clear answer and it’s entirely state specific. But we offer some starting places for states, which include:
  1. Improving preventive screenings based on expert-recommended schedules and guidelines.
  2. Adopting diagnostic criteria and guidelines specific to young children’s mental health (the DC:0-5TM).
  3. Update or clarify payment policies and processes for needed IECMH services.
  4. Consider new settings or provider types appropriate for IECMH services.
  5. Include IECMH in broader Medicaid improvements and reforms.
Medicaid alone can’t solve broader system challenges, such as stigma or the need for more qualified mental health providers, but it can be a leader for improvements across payers and systems. That’s because Medicaid’s benefit for children, EPSDT, holds incredible potential to strengthen access to IECMH services. The opportunity to reach young children as early as possible —including dedicated attention on the relationships with their parents and caregivers—can prevent conditions from escalating and requiring more complex, expensive interventions.  Exploring opportunities in Medicaid is not easy. And, Medicaid can’t do this alone. But it’s essential to helping children reach their full potential.

(Where to start? We created a tip sheet for advocates to get conversations started and consider possible angles.)

We’re incredibly grateful for our partnership with ZERO TO THREE and their Think Babies campaign, which made this work possible. Learn more at www.thinkbabies.org.

originally posted here: https://ccf.georgetown.edu/2018/11/30/another-place-for-medicaid-attention-young-childrens-social-emotional-development

Thursday, January 10, 2019

Indiana Student Services Needs Assessment Report

Legislative action last year required the Indiana Department of Education (IDOE) to conduct a needs assessment of student support services and report the findings to the Indiana General Assembly. The report, which examines school system utilization of School Counselors, Social Workers, Nurses and Psychologists, has now been released by IDOE. While it suggests most schools have direct or indirect health and mental health services available to students, student access and the efficiency of services are highly variable. This report serves as a first step in an effort to improve the delivery of student support services across the state.

You can find the report here: https://www.doe.in.gov/sites/default/files/news/student-services-needs-assessment-report-dec-21.pdf

#Transition Resources for Parents


Parents’ guide to the transition of their adult child to college, career, and community An online module from the HEATH Resource Center, now part of the National Youth Transitions Center. http://heath.gwu.edu/parents-guide-transition
Getting ready for when your teen reaches the age of majority: A parent’s guide Age of majority is the age when children legally become adults. In most states the age of majority is age 18. This tip sheet for parents discusses what’s important to consider in preparing and is part of a series of briefs that includes stand-alone tip sheets on getting ready for healthcare, for managing financial matters, and for independent living. There is also a companion webinar/age-of-majority-parentguide/
Wondering what path your child will take after high school? This brochure was created to help families understand the basics of transition planning, including its purpose, who is involved, and the process as a whole. You can edit it to fit your needs. AND it’s available in English and Spanish. http://transitioncoalition.org/blog/tc-materials/transition-planning/
Planning for success: Supporting transitions through high school to college and career This  40-page booklet is written by parents for other parents, to share their experiences in preparing their children for college and career. They discuss why preparing is so important, describe the academic and personal behaviors young people need, take a look at the Common Core State Standards and testing, and much more. A publication of the NYC Board of Education. http://schools.nyc.gov/NR/rdonlyres/9FDD0841-D54D-4D16-ADAA-9F116B79F645/0/ParentGuide_forCCL_updated080712.pdf
Resources to assist youth with the transition to a successful adulthood This collection of helpful resources from the Social Security Administration provides information on and links to a wide variety of employment supports and national and community resources. https://www.parentcenterhub.org/resources-for-successful-transition-to-adulthood/
Exceptional Parent’s annual employment and transition guide For parents, obviously! Learn about youth empowerment groups and self-advocacy, transition planning for youth with complex care needs, job coaches, and more. http://reader.mediawiremobile.com/epmagazine/issues/202010/viewer?page=1
Developing financial capability among youth: How families can help This InfoBrief comes from NCWD/Youth and provides families with suggestions and resources on how to talk with youth about money and assist them in learning and practicing financial management skills through their interactions at home. http://www.ncwd-youth.info/sites/default/files/InfoBrief-42-Developing-Financial-Capability-Among-Youth-How-Families-Can-Help.pdf
Employment 101 There’s a wealth of info about jobs and “getting employed” in this resource. http://parentcenterhub.org/employers/
The 411 on disability disclosure: A workbook for youth with disabilities This workbook is designed for youth and adults working with them to learn about disability disclosure. This workbook helps young people make informed decisions about whether or not to disclose their disability and understand how that decision may impact their education, employment, and social lives. There’s also an audio version of the workbook and many accompanying materials. http://www.ncwd-youth.info/411-on-disability-disclosure