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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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Are you looking for a qualified ABA therapist for your child or teen with Autism?

Check out our new ABA in PA Provider Directory.

 

ABA in PA Provider Directory:

little puzzleABA in PA Provider Directory June 2016.pdf

 

 

 

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On April 22, 2016 the ABA in PA Initiative hosted its second annual strategic planning meeting at the Hershey Medical Center. Over 100 participants from across the state attended this all-day meeting. The agenda included developing an action plan for advocacy efforts to improve access to the most effective behavioral treatment for children with autism, Applied Behavioral Analysis (ABA).

 

ABA is effective for individuals withautism as well as other developmental disabilities. This group, under the leadership of Dr. Cheryl Tierney, Section Chief of Behavior and Developmental Pediatrics at Penn State Hershey Children's Hospital, has been in existence since 2012. The group took flight in 2014 when the Sonny O lawsuit was filed against the Department of Human Services of Pennsylvania. "It is important for someone to stand up and do something. Children in Pennsylvania are not getting the services that they need to maximize their developmental outcomes and our group focuses on improving access to Quality ABA programming for all children throughout the Commonwealth," states Dr. Tierney.

 

At the 2nd Annual strategic planning meeting, presenters from across the state discussed ways of improving access, reimbursement, awareness, and the quality of therapies currently available.  Thegroup advocates for ABA, because it is clinically proven to help children communicate more effectively, be more independent with activities of daily living, and to socially interact with their peers.  ABA not only targets the behavioral symptoms of autism but also helps to develop the skills necessary for communication, socialization, and interaction with others.

At the conclusion of the all-day event, providers were energized and ready to make a difference. The ABA in PA Initiative has already been successful at improving access across the state but "there is more work to be done", says Tierney. This year the group’s  objectives include: Helping the public understand the importance of ABA as the foundation of treatment, enhancing training opportunities for providers, and to help unite BHRS providers who want quality now.  

Speaking for the ABA in PA Initiative, Dr. Tierney states, “We promise not to stop short so that our children can have a brighter future!”  

 

 

 

 

 

 

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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.  

ABAinPA Senator Teplitz 1