Re: NOW WAIVER AND ABA THERAPY

[Guest guest]

Hi - I was at the same meeting and heard the same thing you did. My question to you is -- why do you believe that your support coordinator is giving you the correct information? There is a lot of misinformation coming from a lot of sources about the changes in the waiver. Where did your support coordinator get her information?

Do all of you who have been waiting for a Natural Supports Waiver, now being converted to the new Options Waiver, realize that it will not cover ABA therapy for school age children?  My child's ABA is being terminated on his upcoming birthday according to our support coordinator.  Apparently, the government thinks it is a duplication of services even though it is usually hard to get any one-on-one ABA through the school system.  I know parents who have waited for years in hopes of gettting ABA therapy paid for through an MRWP waiver and now many of them won't get it ever.  This directly contradicts what Darlene Meador, one of Steve Hall's underlings, told me at the new waiver meeting at the Holday Inn in Decatur in November of 2007.  She said before a packed house that you just could not use ABA therapy in lieu of the school system. In other words, you could not take $12,000.00 and home school your child in lieu of the school system.  She led everyone to believe you could still do ABA on the side.  I have learned one thing. Never believe a word that comes out of the mouth of someone who works in disabilties for the State of Georgia.

She lied to me.

**************Play online games for FREE at Games.com! All of your favorites, no registration required and great graphics – check it out! (http://pr.atwola.com/promoclk/100000075x1211202682x1200689022/aol?redir=

http://www.games.com?ncid=emlcntusgame00000001)

[Guest guest]

- I had the opportunity to speak with Darlene Meador and Steve Hall about the change to the NOW waiver on November 1 and how that will effect Natural Support Enhancement Services and, more specifically, ABA therapy.

I asked them whether a child who receives ABA in a school setting could also receive ABA through the waiver. The answer was yes, the child can receive ABA in school and receive ABA paid by the waiver in another setting. The waiver will NOT pay for ABA in the school setting as that is the responsibility of the school system. (This is true of all waiver services)

The NOW waiver uses different names for ABA and does set cap amounts for the services. The $2450.24 cap for Behavioral Supports Consultation has caused alot of confusion and worry for families. Families need to understand that this is not a cap on all "ABA" services that the individual can receive. It is a cap on the consultative services that come from a professional who might, for example, design and set-up a program and therefore charge a high rate for their services. These services are provided by a psychiatrist, psychologist, Licensed Professional Counselor or Licensed Clinical Social Worker. The actual ABA program would be provided by a therapist whose services could be billed under community access services, community living support services, adult therapy, or natural support training services - depending on the individuals needs. The reimbursement rate for these services is lower than the Behavioral Supports Consultation rate so the $ will go further and the individual will be able to receive more hours. One issue for families is that these ABA therapists need to be Medicaid providers - so, it is possible that your current ABA therapist will have to jump through the Medicaid hoops to become a Medicaid provider or you will have to sign on with a new one. This is a Medicaid rule - not within the scope or power of the Office of DD to control. This explains why families will no longer be reimbursed for ABA therapy that they have paid out of pocket for. This is a big Medicaid no-no and something they will no longer allow - in fact, they should never have allowed it to happen in the first place.

I hope this helps answer some of the questions directly related to ABA. The Office of DD is personally

contacting families receiving NSE services to explain the changes. They have also mailed a letter to clarify the changes that take effect on November 1. These changes effect rates and services - but it is important to understand that individuals are not losing $$$ on November 1. New ISPs will be written at the time of the individual's birthday and at that time $$$ amounts MAY go up or down according to individual needs.

The NOW and COMP Waiver manuals are now online at the georgia health portal.

You can ask me questions. I'll try to answer . . . if I don't know, I'll try to get the answers.

In a message dated 10/25/08 9:20:00 PM, mrdavidmeyer@n a message dated

Do all of you who have been waiting for a Natural Supports Waiver, now being converted to the new Options Waiver, realize that it will not cover ABA therapy for school age children?  My child's ABA is being terminated on his upcoming birthday according to our support coordinator.  Apparently, the government thinks it is a duplication of services even though it is usually hard to get any one-on-one ABA through the school system.  I know parents who have waited for years in hopes of gettting ABA therapy paid for through an MRWP waiver and now many of them won't get it ever.  This directly contradicts what Darlene Meador, one of Steve Hall's underlings, told me at the new waiver meeting at the Holday Inn in Decatur in November of 2007.  She said before a packed house that you just could not use ABA therapy in lieu of the school system. In other words, you could not take $12,000.00 and home school your child in lieu of the school system.  She led everyone to believe you could still do ABA on the side.  I have learned one thing. Never believe a word that comes out of the mouth of someone who works in disabilties for the State of Georgia.

She lied to me.

**************Play online games for FREE at Games.com! All of your favorites, no registration required and great graphics – check it out! (http://pr.atwola.com/promoclk/100000075x1211202682x1200689022/aol?redir=

http://www.games.com?ncid=emlcntusgame00000001)

[Guest guest]

, Thanks for the information. We have an ABA consultant who designs my son's programs and have been using college students to do the actual therapy after they have gone through training. I see this will no longer work as they are not Medicaid providers. My consultant also runs an autism center that provides ABA therapy. I will see if she is a Medicaid provider. If so, maybe we can work out something with her. I really appreciate you sending me this information. MeyerKAddams@... wrote: - I had the opportunity to speak with Darlene Meador and Steve Hall about the change to the NOW waiver on November 1 and how that will effect Natural Support Enhancement Services and, more specifically, ABA therapy. I asked them whether a child who receives ABA in a school setting could also receive ABA through the waiver. The answer was yes, the child can receive ABA in school and receive ABA paid by the waiver in another setting. The waiver will NOT pay for ABA in the school setting as that is the responsibility of the school system. (This is true of all waiver services)The NOW waiver uses different names for ABA and does set cap amounts for the services. The $2450.24 cap for Behavioral Supports Consultation has caused alot of confusion and worry for families. Families need to understand that this is not a cap on all "ABA" services

that the individual can receive. It is a cap on the consultative services that come from a professional who might, for example, design and set-up a program and therefore charge a high rate for their services. These services are provided by a psychiatrist, psychologist, Licensed Professional Counselor or Licensed Clinical Social Worker. The actual ABA program would be provided by a therapist whose services could be billed under community access services, community living support services, adult therapy, or natural support training services - depending on the individuals needs. The reimbursement rate for these services is lower than the Behavioral Supports Consultation rate so the $ will go further and the individual will be able to receive more hours. One issue for families is that these ABA therapists need to be Medicaid providers - so, it is possible that your current ABA therapist will have to jump through the Medicaid hoops to become a Medicaid provider or you will have

to sign on with a new one. This is a Medicaid rule - not within the scope or power of the Office of DD to control. This explains why families will no longer be reimbursed for ABA therapy that they have paid out of pocket for. This is a big Medicaid no-no and something they will no longer allow - in fact, they should never have allowed it to happen in the first place.I hope this helps answer some of the questions directly related to ABA. The Office of DD is personally contacting families receiving NSE services to explain the changes. They have also mailed a letter to clarify the changes that take effect on November 1. These changes effect rates and services - but it is important to understand that individuals are not losing $$$ on November 1. New ISPs will be written at the time of the individual's birthday and at that time $$$ amounts MAY go up or down according to individual needs.The NOW and COMP Waiver manuals are now online at the

georgia health portal. You can ask me questions. I'll try to answer . . . if I don't know, I'll try to get the answers. In a message dated 10/25/08 9:20:00 PM, mrdavidmeyer@n a message dated Do all of you who have been waiting for a Natural Supports Waiver, now being converted to the new Options Waiver, realize that it will not cover ABA therapy for school age children?  My child's ABA is being terminated on his upcoming birthday according to our support coordinator. Apparently, the government thinks it is a duplication of services even though it is usually hard

to get any one-on-one ABA through the school system. I know parents who have waited for years in hopes of gettting ABA therapy paid for through an MRWP waiver and now many of them won't get it ever. This directly contradicts what Darlene Meador, one of Steve Hall's underlings, told me at the new waiver meeting at the Holday Inn in Decatur in November of 2007. She said before a packed house that you just could not use ABA therapy in lieu of the school system. In other words, you could not take $12,000.00 and home school your child in lieu of the school system. She led everyone to believe you could still do ABA on the side. I have learned one thing. Never believe a word that comes out of the mouth of someone who works in disabilties for the State of Georgia.She lied to me.**************Play online games for FREE at Games.com! All of your favorites, no registration required and great graphics – check it out! (http://pr.atwola.com/promoclk/100000075x1211202682x1200689022/aol?redir= http://www.games.com?ncid=emlcntusgame00000001)

[Guest guest]

I wouldn't think any ABA consultant would be set up for billing Medicaid in Georgia. These are usually BCBAs, not psychologists or other state licensed providers (although they could be). There are currently no licences required in this state for ABA. The only board for these that I am aware of is the Behavior Analysis Certification Board which is international.

In the past, Medicaid has not covered ABA in Georgia at all. I don't understand how this could work.

From: autism-georgia [mailto:autism-georgia ] On Behalf Of MeyerSent: Tuesday, October 28, 2008 10:49 PMTo: autism-georgia Subject: Re: NOW WAIVER AND ABA THERAPY

,

Thanks for the information. We have an ABA consultant who designs my son's programs and have been using college students to do the actual therapy after they have gone through training. I see this will no longer work as they are not Medicaid providers.

My consultant also runs an autism center that provides ABA therapy. I will see if she is a Medicaid provider. If so, maybe we can work out something with her. I really appreciate you sending me this information.

MeyerKAddamsaol wrote:

- I had the opportunity to speak with Darlene Meador and Steve Hall about the change to the NOW waiver on November 1 and how that will effect Natural Support Enhancement Services and, more specifically, ABA therapy. I asked them whether a child who receives ABA in a school setting could also receive ABA through the waiver. The answer was yes, the child can receive ABA in school and receive ABA paid by the waiver in another setting. The waiver will NOT pay for ABA in the school setting as that is the responsibility of the school system. (This is true of all waiver services)The NOW waiver uses different names for ABA and does set cap amounts for the services. The $2450.24 cap for Behavioral Supports Consultation has caused alot of confusion and worry for families. Families need to understand that this is not a cap on all "ABA" services that the individual can receive. It is a cap on the consultative services that come from a professional who might, for example, design and set-up a program and therefore charge a high rate for their services. These services are provided by a psychiatrist, psychologist, Licensed Professional Counselor or Licensed Clinical Social Worker. The actual ABA program would be provided by a therapist whose services could be billed under community access services, community living support services, adult therapy, or natural support training services - depending on the individuals needs. The reimbursement rate for these services is lower than the Behavioral Supports Consultation rate so the $ will go further and the individual will be able to receive more hours. One issue for families is that these ABA therapists need to be Medicaid providers - so, it is possible that your current ABA therapist will have to jump through the Medicaid hoops to become a Medicaid provider or you will have to sign on with a new one. This is a Medicaid rule - not within the scope or power of the Office of DD to control. This explains why families will no longer be reimbursed for ABA therapy that they have paid out of pocket for. This is a big Medicaid no-no and something they will no longer allow - in fact, they should never have allowed it to happen in the first place.I hope this helps answer some of the questions directly related to ABA. The Office of DD is personally contacting families receiving NSE services to explain the changes. They have also mailed a letter to clarify the changes that take effect on November 1. These changes effect rates and services - but it is important to understand that individuals are not losing $$$ on November 1. New ISPs will be written at the time of the individual's birthday and at that time $$$ amounts MAY go up or down according to individual needs.The NOW and COMP Waiver manuals are now online at the georgia health portal. You can ask me questions. I'll try to answer . . . if I don't know, I'll try to get the answers. In a message dated 10/25/08 9:20:00 PM, mrdavidmeyer@n a message dated

Do all of you who have been waiting for a Natural Supports Waiver, now being converted to the new Options Waiver, realize that it will not cover ABA therapy for school age children?  My child's ABA is being terminated on his upcoming birthday according to our support coordinator. Apparently, the government thinks it is a duplication of services even though it is usually hard to get any one-on-one ABA through the school system. I know parents who have waited for years in hopes of gettting ABA therapy paid for through an MRWP waiver and now many of them won't get it ever. This directly contradicts what Darlene Meador, one of Steve Hall's underlings, told me at the new waiver meeting at the Holday Inn in Decatur in November of 2007. She said before a packed house that you just could not use ABA therapy in lieu of the school system. In other words, you could not take $12,000.00 and home school your child in lieu of the school system. She led everyone to believe you could still do ABA on the side. I have learned one thing. Never believe a word that comes out of the mouth of someone who works in disabilties for the State of Georgia.She lied to me.**************Play online games for FREE at Games.com! All of your favorites, no registration required and great graphics – check it out! (http://pr.atwola.com/promoclk/100000075x1211202682x1200689022/aol?redir= http://www.games.com?ncid=emlcntusgame00000001)

Internal Virus Database is out-of-date.Checked by AVG.Version: 7.5.524 / Virus Database: 270.8.1/1728 - Release Date: 10/16/2008 7:38 AM

Internal Virus Database is out-of-date.

Checked by AVG.

Version: 7.5.524 / Virus Database: 270.8.1/1728 - Release Date: 10/16/2008 7:38 AM

[Guest guest]

I wouldn't think any ABA consultant would be set up for billing Medicaid in Georgia.  These are usually BCBAs, not psychologists or other state licensed providers (although they could be).  There are currently no licences required in this state for ABA.  The only board for these that I am aware of is the Behavior Analysis Certification Board which is international.

 

In the past, Medicaid has not covered ABA in Georgia at all.   I don't understand how this could work.

My understanding is that there is a way to be a Medicaid provider of these services for individuals on the NOW Waiver. Medicaid will ONLY pay if the individual has a waiver. **************Play online games for FREE at Games.com! All of your favorites, no registration required and great graphics – check it out! (http://pr.atwola.com/promoclk/100000075x1211202682x1200689022/aol?redir=

http://www.games.com?ncid=emlcntusgame00000001)

[Guest guest]

Great information. However, I was told again today that services would end on 11/1 not on my daughter's bday in Sept. If they would change it on the bdays it would give time to come up with the new wording and make it happen. I have no way of getting things changed for next week so therefore looks like she will have to go without services in November.

[Guest guest]

i'm not but

I was told that the waiver would not pay for therapy - any kind

by my planning list administrator - he works for DHR.

I think it is clear that for years the state has been trying to

reduce what it will pay for and this is just the latest way.

There may be a lots of misinformation, as you put it, but there is

very little information out there on this subject. It seems that

only a very small group of people know what is going on with this

program, if that. I don't think it should work this way.

Currently I'm in my second week of waiting to get blank copies of the

forms I need to complete for the next step in getting the waiver.

Actually, there is alot of information it is just difficult to decipher . . . the best place to start is with the manuals for the new waivers. They are available at https://www.ghp.georgia.gov Go to provider information and then all provider manuals - then choose either the COMP or NOW manuals.

You will see in the manuals that the waivers CAN pay for therapy - there are restrictions, though.

First, the waiver can not pay for anything that is included in the state Medicaid plan. Simply put, if Medicaid should pay for it, then the waiver $$$ will not pay for it. That means that OT, PT and Speech for children (0-21) cannot be paid for by the waiver. Even if Medicaid denies these therapies to a child (for whatever reason), the waiver will not pay for it. The waiver can be used to pay for OT, PT and Speech for an adult (over 21). This is because Medicaid will not pay for these therapies for an adult - it is not part of the state Medicaid plan.

Second, In both the NOW and COMP waiver manuals you will find that certain other type of therapies can be services that an individual receives. The waiver language that is used does not refer to these services as "ABA" or "Life Skills Training" but that might be what it looks like when implemented. For example: Go the NOW Waiver manual, page XIX-9, Section 1906. This section refers to covered services under Community Living Supports.

5. Implementation of the behavioral support plan of a

participant to reduce inappropriate and/or maladaptive

behaviors and to acquire alternative adaptive skills and

behaviors.

Isn't this ABA?

The third confusion is the school therapy vs outside school therapy which comes from language also found in the manuals. (This is what referred to in the original post). On page XVII-14, Section 1706, Non Covered Services:

Non-Covered Services

1. Educational services otherwise available through a program funded

under 20 USC Chapter 3, section 1400 of the Individuals with

Disabilities Education Act (IDEA), including private school

tuition, Applied Behavior Analysis (ABA) in schools, school

supplies, and tutors.

All this means is that the waiver will not pay for things that the school should be paying for. For example, things that are in the IEP, things that happen at school or things that are specifically to help with school. The waiver is intended to support individuals at home and in the community. So the ISP would not have a behavior support plan intended to reduce inappropriate and/or maladaptive behaviors at school - it would be for everywhere but school (park, church, home, gro store, neighbor's home, etc.)

I urge all of you to read these manuals and to carefully look at the language that is used. Question what the support coordinator, planning list administrator. provider, etc are telling you. Ask them where specifically it says that absolutely has to be done or absolutely CANNOT be done.

**************Plan your next getaway with AOL Travel. Check out Today's Hot 5 Travel Deals! (http://pr.atwola.com/promoclk/100000075x1212416248x1200771803/aol?redir=http://travel.aol.com/discount-travel?ncid=emlcntustrav00000001)

[Guest guest]

Did the support coordinator tell you the reason WHY they would be stopped.

Is is because there is not a prior authorization that will cover it? (As said in an earlier email, that will be corrected within a few days).

Is it because the ISP needs to be changed? From what I understand, this is not the problem. The goals will simply be applied to the correct service.

Most likely it is because the provider is no longer allowed to reimburse you for the ABA services. This is a big Medicaid no-no and Medicaid absolutely will no longer allow it. Your provider has no choice.

So, my understanding of what is happening is that the NSE providers do not have a way to bill Medicaid for these services. (actually, I don't know if they don't have a way, they don't know the way, or they don't want to) But, anyway . . . I believe that some ABA (Behavior Support) providers may be able to directly bill Medicaid for these NOW/COMP services. Once again, if you go to the manuals you can see what the requirements are for being a provider of these services. So . . . can your team do one of the following: a) subcontract with your provider, become a Behavior Support provider, c) subcontract with an existing Medicaid Behavior Support provider. Has your support coordinator spoken with them

Your support coordinator needs to help you find a solution. It is unacceptable for her to just tell you they will be ending without any more information. (Although, in her defense she is probably just making you aware that your NSE provider will not reimburse you for services after today - so that you don't get stuck with out-of-pocket expenses - thanks, but daughter still needs the therapy)

Great information.  However, I was told again today that services would end on 11/1 not on my daughter's bday in Sept.  If they would change it on the bdays it would give time to come up with the new wording and make it happen.  I have no way of getting things changed for next week so therefore looks like she will have to go without services in November.

**************Plan your next getaway with AOL Travel. Check out Today's Hot 5 Travel Deals! (http://pr.atwola.com/promoclk/100000075x1212416248x1200771803/aol?redir=http://travel.aol.com/discount-travel?ncid=emlcntustrav00000001)

[Guest guest]

i'm not but

I was told that the waiver would not pay for therapy - any kind

by my planning list administrator - he works for DHR.

I think it is clear that for years the state has been trying to

reduce what it will pay for and this is just the latest way.

There may be a lots of misinformation, as you put it, but there is

very little information out there on this subject. It seems that

only a very small group of people know what is going on with this

program, if that. I don't think it should work this way.

Currently I'm in my second week of waiting to get blank copies of the

forms I need to complete for the next step in getting the waiver.

>

> Hi - I was at the same meeting and heard the same thing you

did. My

> question to you is -- why do you believe that your support

coordinator is giving

> you the correct information? There is a lot of misinformation

coming from a

> lot of sources about the changes in the waiver. Where did your

support

> coordinator get her information?

>

>

>

>

>

>

> > Do all of you who have been waiting for a Natural Supports

Waiver, now

> > being converted to the new Options Waiver, realize that it will

not cover

> > ABA therapy for school age children?  My child's ABA is being

terminated on his

> > upcoming birthday according to our support coordinator. 

Apparently, the

> > government thinks it is a duplication of services even though it

is usually hard to

> > get any one-on-one ABA through the school system.  I know

parents who have

> > waited for years in hopes of gettting ABA therapy paid for

through an MRWP

> > waiver and now many of them won't get it ever.  This directly

contradicts what

> > Darlene Meador, one of Steve Hall's underlings, told me at the

new waiver

> > meeting at the Holday Inn in Decatur in November of 2007.  She

said before a packed

> > house that you just could not use ABA therapy in lieu of the

> > school system. In other words, you could not take $12,000.00

and home school your child in

> > lieu of the school system.  She led everyone to believe you

could still do ABA

> > on the side.  I have learned one thing. Never believe a word

that comes out

> > of the mouth of someone who works in disabilties for the State of

Georgia.

> > She lied to me.

> >

> >

>

>

>

>

> **************

> Play online games for FREE at Games.com! All of your favorites,

> no registration required and great graphics †" check it out!

> (http://pr.atwola.com/promoclk/100000075x1211202682x1200689022/aol?

redir=

> http://www.games.com?ncid=emlcntusgame00000001)

>

[Guest guest]

- I am confused about ABA therapists being covered under medicaid. To my knowledge they have never been covered under Medicaid which is why we had to get the waiver in the first place. I don't use the waiver for OT and PT which are covered under Medicaid. I have used the waiver to pay for things that are not covered (ABA and Developmental Pediatrician) Does that make sense?

[Guest guest]

Awww! My head is spinning! It does seem like it can be paid for through Community Living (although at a much reduced rate). I will check with the person that sets up our program to see if she has signed up as a Behavioral Consult. They already subcontract with GCSS so that shouldn't be a problem. I think the best thing for us at this point is to go self directed. I don't know how quickly that can happen. Is it me or does it seem crazy that we are having to do this on such short notice. For our SC to get the PA today or tomorrow and somehow implement all the codes, etc, so services can be billed on Monday just doesn't seem very doable! Anyway, how do I contact Acumen to get the ball rolling? How long does it take for our support team to get signed up to be paid through Acumen?