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Do you ever wonder if your child’s care would be better if your ABA therapist (BSC/BCBA) worked with your child’s other therapists (ex. SLP, OT) at the same time?  I know many of you do!  Having your ABA therapist working with your child's provider team (speech, OT, special instruction etc.) is part of good care coordination and will help your child make the best progress possible. It also keeps everyone on the same page and allows your ABA Team to lead the program. Co-Treatment is considered a “best practice”.

So what can you do if you are told "This can't happen” or “We are not allowed to do that”?

If you are told that your BSC (Board Certified Behavior Analyst, BCBA) cannot co-treat with say, your speech pathologist, you should be complaining about that.

First you should distinguish between your provider agency saying you can't do this and a true insurance denial. If you have a formal denial from your MCO (managed care insurance company) then you can file a grievance by following the instructions on the denial notice.  If it is just your provider agency saying you can't do it, you can call your MCO (the number on your insurance card) and request help filing a complaint against the agency itself.

Obtaining a brief doctor's letter explaining why it is medically necessary and best practice to submit to the insurance plan, in the case of a denial, can help.  (Do you need a sample letter to give to your child’s doctor?  That’s easy!  Go to our website, abainpa.com, click on our Resources tab, and under our Document Downloads you will find a sample letter.)

But the best approach is a proactive one that addresses this at the ISP meeting and clearly has this written into the plan. If the provider agency "thinks they can't", they should get a formal response from the MCO. If the MCO says "NO" by denying the request, you should also write to This email address is being protected from spambots. You need JavaScript enabled to view it., and copy Rachel Mann, This email address is being protected from spambots. You need JavaScript enabled to view it. so they will take it up with the DHS (Department of Human Services).  This is an issue that we hope to address in the new regulations coming out by the state and hope to streamline this issue for EVERYONE.  

We hope this information is helpful to everyone who follows us.  We want the care your child receives to be as good as it can be.  If you aren’t following us, make sure you like and follow us so you don’t miss out on all our news and updates.  

 

 

 

little puzzleTemplate for Providers: Letter of Medical Necessity for Providing ABA w/Another Provider Type

From my family to yours, Have a Great Labor Day weekend!

Cheryl Tierney, MD

President, ABA in PA INITIATIVE

Section Chief, Developmental Pediatrics, Penn State Children's Hospital

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FOR IMMEDIATE RELEASE

Tuesday, June 07, 2016

Contact:

Rachel Mann, Staff Attorney
(215) 238-8070, ext. 205

Kelly Darr, Legal Director
(215) 238-8070, ext. 221

Harrisburg, PA – Today, the United States District Court for the Middle District of Pennsylvania issued an Order approving the final Settlement Agreement in Sonny O. et al v. Dallas.  The Order follows a Fairness Hearing held yesterday and settles a federal class action lawsuit filed against the Pennsylvania Department of Human Services (DHS) by three Medical Assistance-enrolled children with Autism Spectrum Disorder (ASD) who had been unable obtain a much-needed treatment called Applied Behavioral Analysis (ABA). They represented a class of similarly situated children who had requested ABA from DHS’s behavioral health system.

ABA is an evidence based treatment that helps children with ASD develop the basic skills (social, behavioral, communicative, self-help, and daily living) that they need to function effectively at home and in the community.  The lawsuit alleged that DHS failed to provide the full scope of ABA, focusing only on correcting inappropriate behaviors and not addressing skill deficits, used inappropriate medical necessity guidelines, failed to offer providers who had training in ABA, and failed to allow many qualified ABA providers to enroll in the Medical Assistance program, leaving children without adequate access to this critical evidenced based service.

The Settlement requires DHS to develop new medical necessity guidelines for ABA, promulgate regulations in the summer of 2017 defining the qualifications required of ABA practitioners, require behavioral health managed care organizations to identify practitioners who are currently qualified to provide ABA and seek out-of-network providers if they do not currently have the capacity to provide ABA, allow all qualified ABA providers to enroll in the Medical Assistance program, develop a bulletin explaining that ABA can be used to address skill building for activities of daily living, as well as appoint a person within DHS to receive complaints from families who feel they are not receiving medically necessary ABA based on the terms of the settlement.

“If implemented properly,” said Rachel Mann, attorney for the class, “thousands of Pennsylvania children with Autism Spectrum Disorder will have real access to the evidence based treatment of Applied Behavioral Analysis.”

A copy of the Settlement Agreement can be found at

 

https://disabilityrightspa.org/wp-content/uploads/2016/04/SonnyOExecutedAgreement.pdf

Senator Rob Teplitz being recognized by The ABA in PA Initiative  for his continued contributions to help change the future for all children in Pennsylvania with Autism Spectrum Disorder.

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The ABA in PA Initiative is an  advocacy organization made up a parents, industry professionals, and lawmakers dedicated to change the future for all children in Pennsylvania with Autism Spectrum Disorder (ASD) by ensuring access to Applied Behavior Analysis (ABA) therapy via Medical Assistance.

 

The ABA in PA Initiative aims to bring the autism community together as one united voice to urge Pennsylvania and private sector to listen to our concerns and take immediate action to address the service gap for ABA. It is our firm belief that, working together, we can assure that our children get the care they need, when they need it!

 

The ABA in PA Initiative’s impact would not be possible without the generous support of donations. Your contributions are helping to change the future for all children in Pennsylvania with Autism Spectrum Disorder. Your generosity makes our work possible! 

 

 

 

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 The ABA in PA Initiative’s impact would not be possible without the generous support of our donors and grantors. Their contributions and grants are helping tochange the future for all children in Pennsylvania with Autism Spectrum Disorder. Their generosity makes our work possible and we thank them.

ABAinPA Donate-Now

  

Diamond (Made a financial contribution of $1,000+) : 

Cheryl Tierney, MD, MPH, Section Chief, Behavior and Developmental Pediatrics

Amy Gable, ABA Support Services LLC

Kathleen Stengel, Epic Developmental Services 

Verbal Beginnings

Behavior By Design, LLC

 

Ajay and Paula Soni

 

Achieving True Self 

 

Platinum(Made a financial contribution of $500+) : 

Richard & Mary Lacey

Paul Eschbach 

Cynthia Swank, M.Ed., BCBA, LBS, Swank Early Skills Development, LLC

 

Matthew Hess 

 

Gold (Made a financial contribution of $250+) : 

Autism Behavioral Consulting, LLC

Zach Benkovitz and Randy Keech of Intervention Fundamentals

 

Silver(Made a financial contribution of $100+) : 

Behavior Development Solutions

The Journey Center

Katie Humen

Tim and Sarah Caldwell

Jodi Gregory

Tom Kitchen

Avonbrook Consulting

Valley Family Therapeutics, LLC

Elizabeth Garrison

Sheryl Watson

Jacqueline Gallagher, Esquire

Progressive Pediatric Therapy

Ashleigh Shaffer 

Jeremy DaShiell

Jim Bouder

Amy Kelly

Michele Slowik

Jim Laughman

Katrina Mellott

Potential Inc.

Amber Chase

Erin Marie (Demcher)

Dr. Boosara Ratanawongsa 

Beth L. Raiola, ABA Therapy Services, LLC

Tristan C. Dahl, MA, BCBA, LBS, CAS 

 

  Bronze(Made a financial contribution) : 

Penny Torcivia

Susan Mayes

 Mahler Autism Services

Megan Riley

Lisa LaMela

Elizabeth Crooks

Karen Potok

Cynthia Reddy

David Gates

Gerald Everette

Linda Franchock

Erin Edwards, MS, BCBA, LBS

Johanna Tesman

Carol Leeson

Kisten Yurich

Gina Brimmer

Corinne Thornton

Lisa Lamela

Iris Vallon

Rebecca McVaugh

Elizabeth Rementer

Nichole Phiambolis

David Gates

Melanie Turock

Heather Magaro

The Goofy Gators

Laura Cwynar

Sarah Foreman

Ann Heilman

Adam Jones

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