ABA Medi-Cal Funding: An Update

By Ronald Moreno, M.A., BCBA

Background

In 2011, Senate Bill 946 mandated that all health insurers in the State of California provide coverage for Behavioral Health Treatment (BHT) services, such as Applied Behavior Analysis (ABA), for all individuals with an Autism Spectrum Disorder (ASD) diagnosis regardless of age.  ABA was finally recognized as a medically necessary treatment for individuals with ASD!

  In July 2014, the Department of Health Care Services (DHCS) received federal approval to provide BHT services as a Medi-Cal benefit for individuals under the age of 21 with an ASD diagnosis.

Four years later, the Centers for Medicare and Medicaid Services (CMS) came out with a statement that Medi-Cal must cover medically necessary BHT services for all individuals between the ages of 3-21.  That is, if BHT services have been deemed medically necessary, all individuals regardless of diagnosis should be eligible for BHT services if they have Medi-Cal.  These changes took effect less than a week ago, on July 1, 2018.  This is another big win! 



 

How Does This Affect Current ABA Services?

Outcomes vary and health coverage may not be available due to individual circumstances.  And as with any recent change in the law, implementation may be imperfect.  So let’s consider a hypothetical example:

Meet Jane.  She has a non-autism diagnosis (e.g., Intellectual Disability, ADHD, Cerebral Palsy, etc.), is currently receiving ABA services funded by a Regional Center, and also has Medi-Cal benefits.  Under the new rules, Jane will be transitioned to a Medi-Cal managed care plan, such as Inland Empire Health Plan (IEHP), L.A. Care, Molina, CalOptima, Medi-Cal Anthem Blue Cross, or Kaiser Medi-Cal.

However, if Jane does not have a managed care plan, but has what they call “straight” or “fee-for-service” Medi-Cal, Regional Center funding for ABA services continues.  In addition, if Jane only has private insurance, Regional Center funding for ABA services remains.

If Jane currently has an ABA provider, she does not need to do anything to transition funding to her managed care plan. Regional Centers are working behind the scenes with managed care plans to transition services smoothly.  Each Regional Center has its own plan about when to transition services.  Please contact your Regional Center and/or ABA provider for more information about whether and when services will be transitioned. 



 

Starting Service Without Current Regional Center Funding

If you don’t have Regional Center funding for ABA services, here are some steps which might help you get coverage and start service:

  • First, visit a primary care physician, licensed psychologist, or licensed psychiatrist and tell them any current concerns with development, behavior problems, etc.

  • Second, ask a medical doctor or licensed psychologist to prescribe ABA services.

  • After getting that prescription, call the managed care plan and request ABA services.  This can usually be done by calling the member services number on the back of the insurance card.

  • The managed care plan may direct callers to an ABA provider that is in-network or redirect them to the provider directory to research different ABA providers and make a selection.

  • Contact one or more ABA providers.  See if they are currently accepting new clients or if there is a waiting list.  Ask about the program.
  • After finding an ABA provider, they may offer assistance in getting services started.  Be ready to send them a copy of the insurance card, the client’s date of birth, and the prescription for ABA services.  Please make sure you have verified they are a legitimate ABA agency.  You do not want to send your child’s personal information to the wrong person.
  • If an ABA agency intends to provide service, they will likely request a Functional Behavior Assessment (FBA) from your managed care plan prior to the onset of intervention. This is intended to assess the current level of development and observe any reported behavior problems.

If you have other questions and are a CBS client (or are considering our services), please feel free to email BT@centerforbehavioralsciencesinc.com and someone from CBS will be happy to provide you with additional information.

 


Disclaimer: This article is for general information only and not for the purpose of providing legal or medical advice.  You should contact your health care provider or attorney to obtain advice regarding any particular issue or problem.  The opinions expressed at or through this post are the opinions of the individual author and may not reflect the opinions of CBS.

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Making Sense of Autism

Making Sense of Autism — A Personal Perspective

By Astrid Liddel

My name is Astrid Liddel, and I have autism. You probably have lots of ideas about what I might be like, just by seeing the word ‘autism’ in conjunction with my name. Some of those ideas might have some truth to them, while others might not. So I will tell you about myself so you can see what I am actually like. Hopefully, this will inspire you to see autistic people in a different light.

My autism is probably what you would call ‘high-functioning’. A word of advice about this — some autistic people do not like the ‘high-functioning’ and ‘low-functioning’ classifications, because they feel these labels only lead to discrimination and unfounded assumptions about how autistic people behave. So, even though there are vast differences of functionality on the autistic spectrum, I wouldn’t recommend putting autistic people into categories based on how they behave.

Another thing that might be relevant is that I also have anxiety and depression, which can affect how I function. These additional mental illnesses make it hard for me to simply get up and be productive, so I often struggle to fill my day with activities. I struggle with internet addiction, so as a result a lot of my day winds up being filled by random internet browsing or watching YouTube videos because I am bored. I do go out and volunteer, but at this point my schedule is very empty and very much a work in progress.

In addition, it is difficult for me to read people’s expressions. I know when a cat is angry or hungry because I spend a lot of time around them — I have two cats who provide a lot of emotional support for me — but when I look at people’s faces, they look totally blank to me. I can’t read emotions unless they are extreme, and since most emotions are subtle, that means that most of the time, I have to take wild guesses as to what people are thinking. Imagine being surrounded by faceless robots who you can’t understand, yet you are expected to read like a book. That’s how I feel most of the time.

Social stuff in general is often a total mystery to me. I feel like the only two vocal tones I can recognize are neutral and angry. This makes it often feel like people are upset with me when it turns out that they were not. This also means I have trouble using an appropriate tone of voice when talking to others. I tend to scream when I’m angry, because to me that is the only way that I can convey the intensity of what I am feeling. Because I cannot understand tone or utilize tones properly, this can make me very difficult to communicate with.

I also often take out my anger or frustration on the people around me. This makes it easier for me to end friendships than to start them. Since starting friendships is about as easy as learning a new language, this means I do not have a lot of friends and often spend my time feeling lonely. Lately, it seems that it’s easier for me to have online friends or primarily communicate with real-life friends over text, because then I can monitor what I say and I am less likely to have an outburst and wind up alienating my friends. These online friendships have been incredibly meaningful and supportive, but I often feel pressure to make ‘real’ friends and that something is wrong with me because I don’t have large friend groups like others my age might.

By now, you are probably wondering how to communicate with autistic people in such a way that they can understand you and won’t be intimidated by you. Here is some advice that hopefully will make your relationships with autistic people easier:

  • Above all, treat them like normal people. It’s okay to ask about why they might do certain behaviors, but don’t mock them or tease them, even if you think you are only joking. They might not get your tone and feel upset.
  • Be very straightforward with them. Explain things that might otherwise seem obvious to you. As an autistic person, a lot of subtleties can slip by me and I am sure other autistic people would want everything told to them exactly how it is, even if it means saying something you think they should be able to pick up on without your help.
  • Don’t raise your voice or yell. Some autistic people, including yours truly, are very sensitive to noise, and sudden loud noises can upset or scare them.
  • Don’t assume that they won’t get your sense of humor. Autism and a good sense of humor are not mutually exclusive. That said, if they ask you to explain a joke, please do so.

These tips are just the beginning of learning to understand and communicate successfully with autistic people. The most important thing you can do is listen, clarify, and be willing to adapt your behavior to make your conversations easier. By following this advice, you will find out in no time that autistic people are so much more than stereotypes make them out to be.

 


Astrid Liddel is a CBS staff member and blogger publishing under a pseudonym.

 

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CBS, Inc. at the CalABA 36th Annual Western Regional Conference

        

On March 9, 2018, CBS’ Director Dr. Joyce Tu, along with CBS’ Assistant Director Ronald Moreno, Clinical Manager Alex Silva, and behavior consultant Angie Montero presented two original behavior analytic research studies in a poster session, as part of the California Association for Applied Behavior Analysis 36th Annual Western Regional Conference in Santa Clara. The studies are entitled “Teaching Metaphorical Tacts to Individuals Diagnosed with Autism,” and “Teaching Autoclitic Responses to Children Diagnosed with Autism.” CBS is proud of its ongoing contributions to the field of applied behavior analysis, and we are grateful to all study participants.

CalABA is the primary clearinghouse for research and training in behavior analysis in the Western Region of the United States. Dr. Tu is a past president of the CalABA Board of Directors.

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Help Your Child Sleep through the Night Using these Simple ABA Techniques

We’ve posted our tips on tackling toilet troubles. Another common issue for parents and caretakers of children with developmental disabilities is their child’s interrupted or irregular sleep pattern. Below, Dr. Joyce Tu, Ed.D, BCBA-D shares systematic shaping and fading strategies, designed to help regulate your child’s bedtime routine.  Please note that this program is best suited to children with chronic sleeping issues (such as sleeping only 2-4 hours daily for a prolonged period). It is not intended for children who may have experienced only a few sleepless nights.

Before you begin, limit your child’s sugar and caffeine intake before bedtime. Your child should not eat foods that contain sugar or caffeine at least four hours before bedtime.  Implement at least ½ hour of daily exercise in conjunction with this sleeping program.

On the first night, begin with a 12:00 a.m. bedtime. Prompt your child to perform “getting ready for bed” tasks such as brushing her teeth, using the restroom, changing into pajamas, getting into her own bed, and listening to a bedtime story.

Keeping your child awake until 12:00 a.m. might be the most difficult part of the program. Parents who complete this program successfully often report that they engage their children with activities such as taking walks, playing games, etc., to keep the children awake during the first few weeks.  If your child gets up between 12:00 a.m. and 6:00 a.m., prompt her to return to bed with no additional verbal interactions. In other words, do not scold or acknowledge the behavior excessively.

When your child can stay in bed from 12:00 a.m. to 6:00 a.m. for one week:  Move her bedtime to 11:30 p.m. the next night. Then, when she can stay in bed from this time, move bedtime to 11:00 p.m., then to 10:30 p.m., then 9:00 p.m.  Following these procedures, gradually shape your child’s bedtime to suit your household schedule.

 


Disclaimer: The recommendations provided are general. For specific recommendations for you and/or your child please consult with a behavior analyst.

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Toilet Training Made Easy

Introduction

Caring for a child, potty accidents come with the territory, especially for those with developmental disabilities such as autism. As common these issues are, the good news is that they are also highly manageable. Our step-by-step guide below aims to tackle even the trickiest of toilet troubles. Let’s dive right in!

The goals here are two-fold.  First, we’ll aim for seven days in a row with no more than one accident.  The long-term goal is for your child to use the toilet for every elimination with no assistance.  This program requires that your child be able to walk, sit for approximately 2-3 minutes, and grasp with her hands.  You will also need the following:

  • Training pants (preferably regular underwear).
  • Simple clothing: no pants/elastic waistband pants, or short shirts for girls.
  • A child-size toilet seat, or child’s potty chair if your child is uncomfortable on the adult toilet. (If you use a potty chair, keep it in the bathroom at all times.)
  • A variety of your child’s favorite drinks.
  • A variety of small food treats that your child likes. (Note: be sure to only make these food treats available as a reward for dry pants! Do not use these treats for anything else.)

  • A variety of your child’s favorite toys and activities.
  • Two or three days of free time with minimal disruption for training.

Understanding the Two Basic Procedures

Procedure 1: Toileting

Using the toilet is a chain of many small steps. Your child must be taught each of the following steps to help her learn these habits effectively:

a.  Come up with a signal for your child to use to tell you she needs to go to the toilet:

Ask, “where do you go potty?” and vocally prompt the answer “toilet” or “bathroom.” Have your child imitate “toilet” or “bathroom” aloud if necessary. Praise your child for answering “toilet” or “bathroom.” If your child cannot talk, have her use a gesture or a picture.

b.  Have your child walk to the bathroom in front of you. Physically prompt your child to do so if necessary.

c.  Have your child take down her pants and sit on the toilet.

d.  Give your child 2-3 minutes to use the bathroom. Encourage her to do so by stating “go potty.”

If your child eliminates, praise her and provide food treats (or other reinforcers of their choice). If your child does not eliminate, ignore it. Do not scold or express disappointment. Go to the next step.

e.  Flush the toilet (or empty the portable potty) only if your child eliminates.

f.  Say “Get down” and have your child pull up her pants.

g.  If this was performed during a wet version of the “dry pants check” (Procedure 2 below), have your child walk back to the place she wet herself and change to dry pants

h.  Continue with the toileting schedule.

Procedure 2: Dry Pants Check

This is a way to teach your child that you want her pants to be dry all the time.  The procedure is as follows:

a.  Ask your child “Are you dry?” Help your child place her hand on the crotch area of her pants so that she can feel for wetness.

b.  If your child is dry:

Praise her for being dry (e.g., “Nice dry pants”), and give her lots of social reinforcers (e.g., hugs, kisses). Then give your child a small piece of the food treat or a sip of a drink.

c.  If your child is wet:

Tell her “No wet pants.” Take her immediately to the toilet (using Procedure 1 above). Have your child do as many of the steps as possible and use hand-over-hand prompting for those steps your child does not know.

d.  For the steps your child can partially perform:

*Pair every step in this procedure with the actual instruction (e.g., “walk to the bathroom”).

*Do not talk to or praise your child during this procedure; only give those verbal instructions to complete the step(s) involved. Your voice should be calm but firm.

*Do not scold or reinforce behavior (such as with a drink or affection) during this procedure.

Day One

Step 1. Change & Drink:

After a small breakfast (no starches) change your child’s diaper to training pants. At breakfast have your child drink at least 1 ½ cups (6 oz.) of her favorite drink.

Step 2. Perform Procedures 1 & 2:

Five minutes after breakfast perform a dry pants check (Procedure 2).

If your child is dry, praise her and give her a small piece of her food treat. Then ask, “What do you need to do?” Verbally prompt your child to state, “Go potty.” Proceed to performing toileting (Procedure 1). If your child eliminates, give her lots of praise and a reinforcer of her choice. If your child does not eliminate, say “nice try” and continue with the toileting schedule below.

Step 3. Toileting Schedule One:

After performing the above procedures, repeat the following cycles:

a.  Every 10 minutes: Dry pants check (Procedure 2).

b.  Every 20 minutes: Toileting (Procedure 1). Do this approximately 10 minutes before your child has a bowel movement (BM).  The BM schedule is based on what you recorded on the original toileting data sheet prior to training. Record whether your child was dry, wet, and/or had a BM.

c.  Every 1 hour:  Have your child drink a ½ to 1 cup of her favorite drink.

Step 4. Toileting Schedule Two:

When your child is eliminating in the toilet with no accidents for at least three hours:

a.  Every 15 minutes: Dry pants check (Procedure 2).

b.  Every 30 minutes: Toileting (Procedure 1).

c.  Every 90 minutes: Have your child drink a glass of liquid.

If your child has four or more accidents in a row, have your child repeat the toileting procedure after each accident two times and decrease consumption of the drink to a ½ cup.

Final Steps:

For every three-hour interval your child goes without any accidents:

  • Increase the intervals between dry pants checks and toileting procedures by 5 to 10 minutes.
  • Increase the intervals between liquid consumption by 30 minutes.

Diapers should only be worn when your child is asleep.  Eating schedules should be kept the same, but prepare lighter meals with fewer starches.

Day Two and Beyond

Continue with the same toileting schedule you ended with on Day 1. When your child is eliminating every two to three hours, stop giving liquids on a scheduled basis and slowly thin out (decrease) reinforcers for eliminating in the toilet.  By continuing to follow this procedure, you and your child will be on the way to success!

 


Adapted from Toilet Training in Less Than a Day by Nathan H. Azrin and Richard M. Foxx

Disclaimer: The recommendations provided are general. For specific recommendations for you and/or your child please consult with a behavior analyst.

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CBS Presents Its Research at the Bucharest International ABA Conference

In April, 2017, Dr. Joyce Tu, Ed.D, BCBA-D traveled to Romania on behalf of Center for Behavioral Sciences, along with other invited speakers from all over the world for the Bucharest International ABA Conference.  Ten international lectors attended from Great Britain, the United States, Norway, and Spain to present the newest theories and practices in Applied Behavior Analysis. Dr. Tu presented CBS’ original research on the following topics: “The Role of Joint Control in Manded Selection Responses and Generative Responding,” and “Teaching Social Verbal and Non-Verbal Behavior to Children with Autism.”

The Bucharest ABA International Conference is Romania’s main event dedicated to research and theory in Applied Behavior Analysis. The conference is accredited at the international level by Behavior Analyst Certification Board, and at the national level by the Romanian College of Psychologists and College of Physicians.

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3rd Conference Speaker

CBS Presents Research and ABA Training in India

On December 8 and 9, 2012, Dr. Joyce Tu, Ed.D, BCBA-D attended the third annual conference of the Association for Behavior Analysis-India, in Kolkata, along with other eminent professionals from overseas and from India.  The program was attended by over 200 participants, including special educators, mental health experts, psychiatrists, academics, and parents of children with autism and other learning disabilities.  Dr. Tu and CBS presented two original studies regarding joint control; as well as an intensive workshop on behavior analytic strategies to develop age-appropriate social skills.

The Association for Behavior Analysis-India is an affiliate of the Association for Behavior Analysis International (ABAI) in the United States.  ABA-India’s mission is to advance the science of behavior analysis, encourage its application for changing socially relevant behaviors, to advocate ethical practices, and to provide leadership in the practice of the science in diverse fields like education, developmental disabilities, autism, mental health, organizational behavior management and research.

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