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An ongoing series of information on ABA, insurance coverage, and resources and support.

Special Education Advocacy

08/25/2022

In addition to being a Board Certified Behavior Analyst, I am also a Board Certified Advocate in Special Education. I've started offering training for parents on special education laws and your rights as a parent, as I've seen first hand how so many parents struggle to get services for their child. Your child does not need an autism diagnosis or a client of mine for you to access special education advocacy services. So if you're looking for ABA therapy for your child and/or special education advocacy resources and support, please reach out through the "Contact Us" page to set up an appointment for training or advocacy services.

Diagnosing Provider Update

07/12/2022

In 2014, Georgia passed insurance reform that required state funded plans to pay for ABA services for those diagnosed with ASD. It took a little while, but by 2017, Medicaid began paying for ABA. In 2019, Georgia's early intervention services, Babies Can't Wait, also began paying for ABA therapy for those with ASD. Up until this point, only Tricare, the federal insurance for military families, would pay for ABA. Now other insurance companies including Humana, Aetna, PeachState, Amerigroup, etc. are required by law to pay for ABA. However, that doesn't mean all insurance plans are required to pay for ABA. The important part is that the law requires "state funded plans" to pay for it. So if you work for the state government in some capacity, then your insurance should pay for it. Check with your insurance to see if they cover it.

However, to get to the insurance part, you have to have a diagnosis. There are very few people in Middle Georgia that can diagnose for insurance purposes (school psychologist, LCSW, and other master's degree level practitioners' assessments and diagnosis do not meet insurance standards). Local (middle GA) providers that can diagnose are:

Dr. Mark Prigatano (https://adhdmacon.com/) (ASD and ADHD)
Dr. Susan Davenport (https://www.psychologicaloffices.com/)--Does not take Medicaid (ASD and ADHD)
Dr. Donald Meck at Moody Behavioral Health (www.mgabehavioralhealth.com)
Dr. Lesli Rubin, MD is a developmental Pediatrician located in Atlanta. (https://www.therubincenterforautism.org/) He also sees ADULTS!
Children's Autism Assessment Center in Atlanta. (caacatlanta.com)
Dr. Elizabeth Young (navicenthealth.org)
Dr. Michael Johns (navicenthealth.org)
Dr. Steven Wade (https://www.youthcarepediatrics.net/)--be aware that Dr. Wade is a pediatrician and only provides assessment and diagnosis for his patients. You can get a diagnosis if you are willing to make him your child's pediatrician.
Dr. Christine Renaude is located in Thomasville. 229-551-9300

I'm always happy to help people find resources, so if you're still struggling, be sure do drop me a line through the contact page, and I'll help you any way I can!

Insurance Update

08/20/2021

There have recently been huge changes made to insurance coverage for ABA in Georgia. On a previous blog post on Medicaid, I included that a diagnoses needed to be re-confirmed every three years. This is now true for most insurance companies. If you child's diagnosis is older than three years, you will need to have him or her reevaluated.

Please see my below post on local ABA diagnosing providers. As always, feel free to call me if you have any questions or need help.

How to get started with ABA services. UPDATED!

04/28/2021

Dr. Mark Prigatano (https://adhdmacon.com/) (ASD and ADHD)

Dr. Susan Davenport (https://www.psychologicaloffices.com/)--Does not take Medicaid (ASD and ADHD)

Dr. Donald Meck at Moody Behavioral Health (www.mgabehavioralhealth.com)

Dr. Lesli Rubin, MD is a developmental Pediatrician located in Atlanta. (https://www.therubincenterforautism.org/) She also see ADULTS!

Children's Autism Assessment Center in Atlanta. (caacatlanta.com)

Dr. Elizabeth Young (navicenthealth.org)

Dr. Michael Johns (navicenthealth.org)

Dr. Steven Wade (https://www.youthcarepediatrics.net/)--be aware that Dr. Wade is a pediatrician and only provides assessment and diagnosis for his patients. You can get a diagnosis if you are willing to make him your child's pediatrician.

It is important to contact a diagnosing provider as soon as possible as they may have an extensive wait list. It is also a good idea to get on multiple wait lists. You will most likely have to wait months to get an appointment, unfortunately.

I'm always happy to help people find resources, so if you're still struggling, be sure do drop me a line through the contact page, and I'll help you any way I can!

Changes to GA Medicaid for ABA

02/04/21

A few times a year, Georgia Medicaid updates their manual for ABA providers. A recent update has modified what assessments will be accepted. If your child was diagnosed under the age of three with ASD, he or she must be re-diagnosed every year until three. Then after three, they must be re-diagnosed every three years. This is very important information for parents as appointments with diagnostic physicians are already limited. Depending on your area, you may need to begin working on getting an appointment starting one year out from the "expiration" date of your current assessment. While people do not lose an ASD diagnosis as it is a life long condition, unfortunately, Medicaid is requiring re-diagnoses for some reason.

If you need help finding a doctor for an initial diagnosis or re-diagnosis, please refer to my previous blog post about local doctors in middle Georgia who diagnose. You may also call the office at 478-313-5093 for more help.

Tricare is trying to eliminate ABA services.

01/26/21

A few years ago, Congress tasked Tricare to assess the effectiveness of ABA for beneficiaries. Since then, Tricare has required that parents and teachers submit a new PDD Behavior Inventory to gauge progress for its beneficiaries. It is the opinion of many professional organizations (Council of Autism Service Providers, Association for Behavior Analysts International and others) and Dr. Ira Cohen, the author of the PDDBI and one of the most well known ASD researcher and clinician, as well as my opinion, that Tricare is misusing the PDDBI.

I can only speculate as to the motives of their misuse, but I would say it is due to financial reasons. Either Tricare is purposefully misusing it or they are grossly incompetent; either way, it is being misused. What's more worrying is that ABA is only funded through Dec. 31, 2023. Jan. 01, 2024, if it is not extended, all services will be terminated. Families will loose ABA services for their children.

If you're interested in helping, you can sign this petition from Autism Services for Kids (https://bit.ly/2YdntT0) which goes into greater detail about both the professional opinions of those responding to Tricare's reports as well as how you can take action. If you're having difficulty downloading the actual response from Dr. Ira Cohen, here is a second link: https://saveautismservices.org/uploads/NCAASCohenExecutiveSummary_FINAL_1-7-21.pdf.

Qualifications to provide ABA

12/05/19

ABA is the science of behavior. As a science, it needs thorough study and experience to be able to understand its concepts and to utilize its principles effectively and ethically. So, how do you know if someone is qualified to provide services for your child?

The Behavior Analyst Certification Board (BACB) is the only organization that provides accredited credentials for top and mid-tier providers. From the BACB's website,

"The BCBA®, BCaBA®, and RBT® certification programs are accredited by the National Commission for Certifying Agencies (NCCA), the accreditation body of the Institute for Credentialing Excellence. The NCCA’s Standards for the Accreditation of Certification Programs were the first standards developed for professional certification programs to help ensure the health, welfare, and safety of the public. NCCA Standards highlight the essential elements of a high-quality program."

The top-tier provider is known as a Board Certified Behavior Analyst (BCBA). To become a BCBA, you must meet educational, experiential, and testing requirements. A BCBA is someone with at least a master's degree. There is a doctoral level BCBA-D, however that is more to designate a doctorate program in psychology or ABA with specific education. A BCBA is an independent practitioner and fully capable of running cases. In addition to the master's degree, a BCBA must meet specific educational requirements in ABA. These classes are known as the verified course sequence. This verified course sequence must also be accredited through the Association for Behavior Analysis International (ABAI) starting January 2022.

The experiential portion of the certification is comprised of 1500 hours across the content task list. In 2022, the requirements will increase to 2000 hours. Those hours require a minimum of 5% supervision from a BCBA to establish competency.

After the educational, experiential, and supervision requirements are met, the person is allowed to test for the credential. The test is 160 questions, and uses a modified Angoff method for establishing passing scores. According to the board, "t he modified Angoff method is a criterion-referenced method that relies on the judgment of a panel of subject matter experts who hold BACB credentials and approval from the BACB Board of Directors."

The mid-level provider, Board Certified Assistant Behavior Analyst (BCaBA), is similar in many ways to the BCBA credential except that it requires a minimum of a bacherlor's degree and a verified course sequence, 1000 hours of experience, and the test is 140 questions. BCaBAs require 2% monthly supervision from a BCBA after they acquire the credential.

Finally, the Registered Behavior Technician (RBT) credential is the third-tier provider. The RBT credential requires a high school diploma or GED as well as 40 hours of classroom training on behavior analytic principles. The person must then pass a competency assessment provided by a BCBA or BCaBA. The test is 85 questions long. It also requires 5% supervision from a BCBA and/or BCaBA afteracquiring the credential.

But certification is just the beginning of the journey, not the end. After certification, every two years, behavior analysts are required to get continuing education. BCBAs must get 32 hours every two years with 4 hours in ethics and 3 hours in supervision. BCaBAs must get 20 hours of continuing education with 4 hours in ethics.

What behavior analysts do requires a lot of training and experience. This is important because what we do when we're working with your child impacts him or her for a lifetime. Improper use of ABA can at best lead to little to no progress and at worst, cause lasting harm both physically and developmentally. That's why many states require a license to practice, and part of their license laws require someone to hold either a BCBA or BCaBA credential. The BACB really is the gold standard for ABA. So when someone comes to provide services, ask questions! Ask where they went to school and about the courses they took, ask about their training, their continuing education, and their credentials. A good behavior analyst is someone who is happy to tell you all about how they are qualified to provide services for your child!

Behavior Analyst Certification Board. (2019). ABOUT THE BACB - Behavior Analyst Certification Board. [online] Available at: https://www.bacb.com/about/#Accreditation [Accessed 5 Dec. 2019].

We're Moving!

12/31/20

We're moving! It's time to pack up. Our new location for center based therapy is 108 Featherstone Drive, Warner Robins, GA 31088. I'm so excited to be taking this next big step to serve our community. A center will allow us to provide more opportunities for social skills and skill acquisition. Center based services will begin in 2021! Check back soon for more updates.

Where to turn after a diagnosis?

11/10/19

When your child first receives an Autism Diagnosis or if your child has had the diagnosis for some time, one thing parents have is questions. Often people will recommend verified therapies (ABA, SLP, OT) and sometimes people recommend something they heard helped their friend's cousin's ex's child who has Autism. I am often asked if I've heard of music therapy or equine therapy, and if it's any good. One place that I regularly refer parents to is The Association for Science in Autism Treatment ( https://asatonline.org/ ). You can search for treatments and read about the evidence behind them. I strongly recommend parents and caregivers bookmark this website and review it regularly for best practices. You should even look up ABA on here before starting any treatment!

Some other resources include:

https://iancommunity.org/cs/newly_diagnosed

https://www.cdc.gov/ncbddd/autism/facts.html

https://www.bacb.com/wp-content/uploads/2017/09/ABA_Guidelines_for_ASD.pdf

Problem behavior and what to do.

09/12/19

When I talk to parents, they're often frustrated with tantrums and aggression. This frustration is the exacerbated by knowing their child is upset a lot and not being able to help. So what do behavior analysts do to help children with problem behavior?

The first thing a behavior analyst will do is complete an assessment. A functional behavior assessment is often completed by talking with the parent and asking questions about what happens right before the behavior and then right after. Another form of assessment is completing a MAS or FAST. The MAS (Motivation Assessment Scale) or the FAST (Functional Analysis Screening Tool) ask a variety of questions that try to then predict the what the function of the behavior is. Think about the function of a behavior as what the person is getting as a result of the behavior. So, what are the functions of behavior?

In ABA all behavior has a function. It may be difficult to figure out what that function is for some learners, but there is always, 100%, a function. Once you know what that function is, that's when you can start treating. It can also get really complicated when the behavior is under multiple stimulus control which is the behavior way of saying the learner uses the behavior for more than one function. The four functions of behavior are: Access, Escape/Avoidance, Attention, and Automatic.

Access: If a behavior is maintained by access, that means the person engaging in the behavior is getting some sort of item as a result of the behavior. An example is when a baby cries because she is hungry and the parent goes over to the baby to offer food. Since that behavior got the baby the food she wanted, she is more likely in the future to cry to get food.

Escape: Imagine you're at the movie theater waiting to to watch something. Suddenly the speakers let out a loud, sharp squeal that just keeps on going! I probably won't take long for you to decide to get on out of there. You're going to "escape" something in your environment that you don't like.

Avoidance: Avoidance is very similar to escape which is why they're put together. Imagine you're afraid of escalators. One day you're at the mall and want to go to a store on the second floor. You look around and see the escalators. You still want to go upstairs so you'll have to find another way. After looking around, you find the elevators. Bingo! You've just avoided that thing you don't like!

Attention: Have you ever heard of a class clown in school? This is usually attention maintained behavior. The class clown makes jokes or comments to get everyone laughing and looking at him/her. (This is one of those sneaky situations where the function might also be escape/avoidance because if the class clown is disrupting class, the teacher can't teach or the class clown is avoiding doing a worksheet or other work.)

Automatic: This is behaviors a person does just because they like doing the behavior. It's sometimes called sensory, but that's not really the best description of why the behavior occurs. Think of your favorite food. Eating it just makes you feel good. Maybe it's a rich, dark chocolate or a smooth milk chocolate.... my favorite iscrème brulee because I love to take my spoon and crack the sugar crust for no other reason than because I like to do it.

So what does this all mean for you and your child? Well, whatever your child is doing, s/he's doing it because that behavior is getting him/her something. The best intervention is to provide a functionally equivalent replacement behavior (FERB). This means that we teach the child to do a different, easier, effective behavior than the problem behavior. One really great way to do that is to provide functional communication training (FCT). With FCT, a person is taught how to appropriately ask for the item he or she wants or ask for a break from a difficult task. So instead of throwing a temper tantrum, we'll teach your child to use words, signs, or even a communication device to ask for juice, ball, blocks, etc. that he or she wants.

There are lots of different ways to handle problem behavior and the above is just one place your child's behavior analyst may start. The best advice is to get a BCBA (Board Certified Behavior Analyst) ASAP to get this started. Hopefully this will help you understand why your child is behaving the way s/he does!

How to get started with ABA services pt. 2

10/20/19

So now that you have a diagnosis, the next step is getting a referral. The hoops you have to jump through differ depending on the insurance.

Tricare: For Tricare, you must be in the Exceptional Family Member Program (EFMP). You can contact Renee McFeeters on RAFB's EFMP office to get the paperwork started. Once you're in the EFMP program, you can ask for a referral if your diagnosing provider has not provided one. You can request ABA Unlimited, LLC or have them pick one if you're not sure. You're not locked in with whichever company you are assigned or choose. All you need to do is call to get the authorization switched if you're unhappy. To switch to a particular company, you just need the name and the address. Ours is ABA Unlimited, LLC, 108 Featherstone Drive, Warner Robins, GA 31088

Medicaid: Medicaid is a little be trickier. You must provide the following documentation to your provider: A prescription/letter of medical necessity for ABA and a copy of the diagnosing report from the doctor's office (see below for a list of doctors in Middle GA that can diagnose children with ASD). This also goes for Medicaid's CMOs (WellCare, PeachState, Care Source, and Amerigroup).

Unfortunately, every private insurance may have a different set of requirements to get a prior authorization. You'll have to contact your insurance company to ask what documentation it will need.