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Review finds need for improvement in access to services
Idahohas found itsMedicaid waiver program for Home- and Community-Based Services comes up short in complyingwithnew federal guidelinesand is inviting public reaction. The state Department of Health and Welfare examined Idaho's 352 residential assisted living facilities and 2,212 certified family homes and found gaps in their compliance with the new federal rules which prohibit services that "isolate" residents from the general community or fail to provide the same level of access.
Individuals with autism and their caregivers who receive or want Medicaid waiver funding can comment on the review through November 2. Feedback can be submitted by:
Written comments sent to:
Division of Medicaid, Attn. Transition Plan
PO Box 83720
Boise, ID 83720-0009
(208) 332-7286 (please include: Attention HCBS)
Calling toll free to leave a voicemail message:
1 (855) 249-5024
What's the issue?
Early this year, the federal government issued new guidelines that may affect how you as an individual with autism or a caregiver will receive services through Medicaid.Idaho has reviewedhow its Medicaid program complies with the new regulations, which can affect services such as in-home or out-of-home residential support, day activities like supported employment or day habilitation, and other services like respite and family support. For more information about these rules, check out this replay from Autism Speaks' live chat.What can you do about it?
Idahois now required to seek public input. This is your opportunity as an individual with autism or a caregiver to affect how these changes take place in your state.
The new rules were published in early 2014 by the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administering the Medicaid program. The regulations outlined criteria for certain Home and Community-based Services (HCBS) programs operated under specific Medicaid waiver programs. (These rules do not apply to intermediate care facility or other Medicaid services – these rules apply only to Medicaid HCBS programs, including HCBS waivers.)
Medicaid HCBS programs provide a variety of services and supports that individuals with autism need to live in the community. These programs offer an alternative to institutional services for people with disabilities who need ongoing support to meet their functional needs. All states operate HCBS programs that serve individuals with developmental disabilities, like autism, but these programs vary widely from state to state in terms of eligibility requirements and available services. More information about Medicaid HCBS is available online.What do the new rules mean?
The rules require all Medicaid HCBS programs to allow individuals to be able to choose their services and have access to the community. In particular, states are prohibited from using HCBS funding for settings that isolate individuals from the broader community. This is an important new protection that could help individuals with autism live in settings that are more integrated with the community.
However, in implementing this new requirement, each state Medicaid office has significant discretion in determining whether a given setting results in “isolation.” As a result of the rules, states are beginning to 1) identify the type of settings that may no longer be in compliance with the new rules, and 2) develop plans on how they will change their HCBS programs.
CMS developed these rules over a number of years, and Autism Speaks has long been involved in helping ensure that the needs of the autism community were represented in the development of these new standards. Now that the rules are final, states are beginning to implement the necessary changes to their programs including identifying the type of settings that may no longer be in compliance with the new rule, and to develop plans that outline any changes they will make to their HCBS programs as a result.What is Autism Speaks doing and what can autism families do?
During this process, states are required to obtain input from advocates and Autism Speaks urges each state to seek and incorporate stakeholders' views on what constitutes isolating settings and how best to integrate individuals into the broader community. For more information on Autism Speaks' position on Housing and Residential supports, view our position statement here. Individuals with autism and their family know firsthand the barriers to true community integration and are the most appropriate individuals to help define isolating settings.Not sure what to say?
Medicaid policy can be very confusing and the state documents that describe programs aren't written in a way that most people can understand. But that shouldn't stop advocates from expressing their opinion. CMS has published a set of exploratory questions that advocates can use to help them think about their experiences and create their message to state officials.
If you are in a waiver program already, use these questions to tell about your experience. For example:
- What was your experience planning your waiver services? Were you able to choose the services you wanted and get them where and how often you wanted?
- Does the place where you get your services reflect your needs and preferences? Did you have options to choose from?
If you are not yet receiving waiver services (because you are on a waitlist or otherwise) but expect to be using waiver services in the future, use these questions to talk about what services will be important to you in the future. For example:
- Do you want to be able to work? If not, what type of meaningful non-work activities would you like to be involved in?
- Would you like to have roommates or live on your own? How often would you like to have visitors? What types of supports are necessary for you to live as independently as possible?
New program would have cut ABA provider rates in half
WASHINGTON, DC (October 9, 2014) --The Department of Defense has announced it will delay a planned cut in what it pays providers through TRICARE to deliver applied behavior analysis (ABA) treatment to military kids with autism.
The new demonstration program allows coverage of BCBA/BCBA-D direct services and the tiered-service delivery model, which includes BCaBAs and Behavior Technicians, by consolidating existing programs under one uniform benefit for all TRICARE beneficiaries with autism.
The cut in reimbursement was among a series of changes included in TRICARE's new consolidated ABA benefit for beneficiaries that is scheduled to take effect October 20.
In a statement, a Department of Defense spokesperson confirmed thatTRICARE will delay any ABA reimbursement rate changes until April 20, 2015.
"The Department understands the concerns caused by the rate change," the DoD said. "In order to address these concerns, the Department has commissioned an independent review of the Demonstration."
Autism Speaks responded to the announcement as a positive sign.
"We are encouraged to see the DoD respond to the concerns of families and providers and look forward to working with the Department to ensure the final policies meet the needs of families, align with best practices, and provides for timely and affordable services," said Karen Driscoll, Autism Speaks' associate director for federal government affairs & military relations.
Autism-specific steps included in plan announced by Governor
(October 10, 2014) -- Connecticut Gov. Dannel Malloy has announced a comprensive overhaul of the state's emergency and lonterm behavioral health care system, includingfour steps specific to upgrading treatment for children with autism. The reforms were required by legislation enacted after the 2012 mass shooting tragedy inNewtown.
“No child in mental health crisis should have to wait days to get access to the treatment they need," Malloy said. "That is why I am announcing a series of strategies that...can be implemented immediately."
The Connecticut plan calls for short-term improvements toemergency care services which, in line with national trends, have experienced increasing admissions of youths with acute behavioral health issues and delays in discharges. Malloy's plan calls for immediate increases in emergencycare capacity with specific accommodations for the autism community.
The longer term changes were developed bythe state Department of Children and Families (DCF) as required under Public Act 13-178, legislation enacted following the Newtown tragedy.
In a review of emergency care services required by children in HUSKY, the state's Medicaid program, nearly half the children with autism enrolled in the programneededto visit anemergency roomover an 18-month period. Nearly half of those visits were because of behavioral, rather than medical, reasons, versus just 7 percent for the overall HUSKY population.
In response, four steps were outlined specific to the autism community:
- Connecticut will implement the federal government's July 7 directive to provide medically necessary treatment through its Medicaid program forchildren with autism up to age 21. An outline of services is expected October 22.
- The state will invest up to $1 million to create up tothreeteams of specially trained practitioners to address the unique needs of children with autismreceiving care in Psychiatric Residential Treatment Facilities and other settings to recommend a successful out-placement.The transition plans may includeevidence-based interventionscovered byprivate insurance or Medicaid,work with children in hospitals orin their homes who are at risk for hospitalization.
- An in-home care program will be created todivert children with autism aged13-21from inpatient and other residential settings.A $300,000 pilot program will serve 10 children with severely challenging behaviors. "This in-home support pilot will assist adolescents who have autism and who are exhibiting severely challenging behaviors to remain in the community and live successfully at home with their families."
- Threespecialized inpatient hospital beds will be providedfor individuals experiencing the most acute and complex autismand co-occurring psychiatric disorders. A small number ofindividualsrequire hospitalization because of intense behavior challenges, but Connecticut has been ill-equipped to handle them.
DCF estimates that 156,000Connecticut children may have behavioral health symptoms that would benefit from treatment.
"Families experience a number of barriers to treatment including a highly fragmented system in which access varies according to such factors as insurance status, involvement in child welfare or juvenile justice, race and ethnicity, language, and geographic location," the Department concluded. "In addition, the array of services lacks sufficient inclusion of supports for all children and families that promote nurturing relationships and environments that foster social, emotional, and behavioral wellness. A comprehensive plan is required to guide the efforts of multiple stakeholders in developing a children's behavioral health system that builds on existing strengths and addresses the many challenges that exist."
The Governor's immediate action plan is HERE.
The DCF longterm plan is HERE.