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New Health insurance options coming to NH's Healthcare Exchange in 2015

08/21/2014

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Recent news releases from the NH Department of Insurance as well as others have announced several new options that have been recommend to CMS for next year's NH Healthcare Exchange.  The link below announces Assurant Health specifically but others that were just confirmed with the DOI are Anthem BCBS NH, Harvard Pilgrim, Minute Men, Assurant Health and Maine Community Health.  They are awaiting confirmation from CMS Federally for inclusion.   I've seen announcements from Anthem that service limits for ABA Therapy have been removed but have not yet been able to access details surrounding the other plans.  I wrote to our Insurance Commissioner recently regarding Harvard Pilgrim's current dollar cap for ABA but was unable to identify the details of the plan that has already been recommended for inclusion.  You can see a copy of my letter below.  Note that Dan Unumb of Autism Speaks has been a great help in these efforts so be sure to get out on September 28th for the Northern New England Walk NOW for Autism at SNHU in Manchester.  Without their help we probably would not have seen the dramatic shift towards support for ABA in NH this year. ~Tim Heald http://www.nh.gov/insurance/media/pr/2014/documents/060214-2.pdf 

Recent Updates on Autism Advocacy in NH

08/14/2014

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As part of my role in Constellations, I have taken on the responsibility of pushing forward awareness, understanding and support for those affected by autism.  NH had a wonderful group of dedicated parents and advocates who pushed through Connor’s Law (2010 HB 569) but we have seen a drop-off in advocacy efforts since then.  That said, I’m proud to say that the torch has been once again picked up and there is again a solid group of advocates that are steadfastly pushing for stronger support and knowledge throughout the State’s support system and beyond.  This year alone has seen some dramatic developments with insurance reform at the state level.  I’ve bulleted out some of the highlights below and will continue to fight for funding and support for evidenced-based education and ABA therapy.  If you’d like to help or know of a contact or effort that I may not be aware, please contact me at tim@constellationsbehavioral.com . ·         Anthem BCBS NH was able to convert Connor’s Law’s $36,000 limit on ABA Therapy to a mere 360 hours for 2013 and the first half of 2014.  I’m excited to say that they have announced that annual caps on ABA will be eliminated for small group plans on 7/1/14 and on individual plans as of 1/1/15.  This is a monumental shift for them and we look forward to further improvements in their policies towards ABA and ABA providers. Read the notice to providers at: http://www.anthem.com/provider/nh/f5/s1/t0/pw_e218354.pdf?refer=ahpprovider&state=nh  ·         Harvard Pilgrim appears to still be issuing plans in 2014 with the annual cap to ABA benefits as prescribed by Connor’s Law but may not be in line with ACA.  An effort is currently underway to explore whether this is justified or not. ·         NH Medicaid is currently evaluating how to add ABA as a covered benefit for their members per advice from CMS at the Federal level to all states.  A working group has formed and is meeting soon to begin the discussions of this vitally important effort. http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-07-07-14.pdf The NH Disabilities Rights Council (DRC) has asked that families with Medicaid who have been denied coverage for ABA be aware of their rights of appeal as they are entitled to these benefits now.  If you have questions or would like assistance in the appeal process, you can reach the DRC at www.drcnh.org. ·         Mainecare has very recently opened up another Section of Medicaid (Section 32) which among other things provides for additional funds for consult, including consult by a BCBA.  The program will be limited to 40 families for this year.  Details of the selection process are not yet available. ·         Tricare announced in July that the three programs they had developed for active duty and non-active duty military families are being consolidated into one streamlined program, TRICARE Autism Care Demo (ACD).  There will not be an annual cap on the program.  Families currently enrolled in one of the existing programs will be converted to the new plan by 1/1/15.  You can read more on this at www.tricare.mil/ABAPilot072314. ·         ABA International (ABAI) proposed standardized billing codes for ABA Therapy to the American Medical Association (AMA) this year.  The AMA has published CPT codes specific to ABA providers thereby validating the service as medically necessary and negating the argument that ABA is an “experimental” therapy.  These new codes are considered temporary while the ABA field and insurance companies process the implications.  The main benefit to having standardized codes would be to eliminate the confusion and delay in forming new relationships with insurance companies and establishing pre-authorization for clients.  I am not aware of a NH insurance company that has adopted these codes but look forward to future developments. As you can see, it’s been a very dynamic and positive year for the field of Behavior Analysis.  Many elements are still being evaluated but the conversation has shifted from “What’s best for children with autism?” to “How do we add ABA to our network quickly?”  I look forward to next year’s developments with great optimism but it is important to remember that awareness and implementation of ABA Therapy programs in NH continues to be vitally important.  Our state and local officials need to hear from you regarding your concerns and needs.  They use the complaint and appeal processes to determine what needs attention so without complaints begin filed with the Department of Insurance and appeals being sent to your NH Medicaid Managed Care Organization (Wellsense/ NH Healthy Families) their thought is that there are no problems.  Reach out and make your voice be heard.  ~Tim Heald “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” ~ Margaret Mead

Preparing for Back to School: Ideas to help ease your child (and you!) into the new school year

08/12/2014

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Governor Maggie Hassan recently proclaimed August 4th-8th as ‘Back to School Preparedness Week’ in the state of New Hampshire.  In hearing this, the team at Constellations began to wonder;  “What is the best advice we could give parents for preparing their child with special needs for the upcoming school year?” One of the most important things to consider is avoiding ‘guilt by association’.  In the world of Applied Behavior Analysis, we refer to this as ‘stimulus-stimulus pairing’.  This is when two stimuli (changes, events, items, actions) are presented at the same time- typically for repeated trials or presentations.  The end result is that one stimulus will typically acquire the function of the other stimulus.  For a relevant example, think about your child on his or her first day of school.  All summer, you have been allowing him/her to wake up naturally, play or watch cartoons while you make breakfast.  Perhaps he or she is even able to lounge in their jammies for a while before getting dressed to go play outside.  Structure and routine have not been your priority this summer and it feels so nice!  Before you know it, the morning of the first day of school arrives.  This morning feels different.  Your child is woken up by an alarm you set for him or her or perhaps by you, your spouse or even a rushed sibling.  You prompt your child to sit at the table and eat their breakfast- no time for TV or playing.  Breakfast is cold cereal- not the yummy pancakes you have been whipping up!  Now it is time to get dressed, out the door and onto the bus!  What a hectic, potentially stressful morning for your child!  (Stimulus number one).  Your child then arrives at school and is held to a routine and expectations which he or she was not prepared for.  There a lot of people, bright lights, loud noises, funny smells, and other sensory experiences that could also add to what your child now thinks of as ‘school’.  (Stimulus number two).  This occurs over and over.   A few weeks into school, you find yourself telling a friend that mornings in your house have become so tense and that your child is extremely difficult to get out of bed and to the breakfast table.  You wish you knew what to do. To avoid this sort of scenario in your home and to promote a smoother transition for everyone involved, here are some things you can do ahead of time to make that first day of school more comfortable and perhaps even associated with familiar and fun things.  1)         Begin practicing your morning routine now.  This does not have to be done all at once, but could be introduced gradually.  If your child has been eating the same breakfast every morning but you know it will not be an option on rushed mornings, introduce other things from time to time.  If you are going to require your child to be dressed before coming out of their room in the morning, help them by laying out their clothes at night.  If waking up much earlier is a concern, begin introducing the alarm you plan to use but at the time your child has been waking up naturally.  You can then slowly set the alarm for earlier and earlier times over the course of a week or two until you have helped your child adjust to waking at an earlier time.  2)        Visit the school.  Part of your child’s comfort level in their new classroom could be directly related to a great experience you have with them there.  Contact your school to find out when it would be a good time for you and your child to go see their classroom.  Allow your child to look around and perhaps even help you take some pictures!  (These could be used later for a social story.)  If your child’s teacher is available, remember the pairing we talked about!  Ask the teacher if he or she would be willing to read a favorite book or even share a favorite snack with your child when they come in. 3)      Plan your routines.  Help your child feel more comfortable by providing predictable routines to the extent possible for the times right before and after school.  If your child benefits from picture activity schedules, written lists or calendars, provide those and help him or her use those tools until they become more independent and/or comfortable with the routine.  4)      Organize and involve your child.  Your child will have an easier time finding things in their backpack and knowing where to put things away if you involve him or her in this process.  Have your child help you pack their backpack for school, now he or she will know what they have and where they can find it!  5)      Brush up on the IEP.  Be familiar with your childs IEP so that you can be mindful and observant of their progress and/or any difficulty they might have.  Be sure to bring any questions to the team and communicate often.  Remember that you can call an IEP meeting at any time to discuss progress, ask questions, etc.  Here are a few helpful links for preparing for school and communicating your childs needs with the school team: http://featsacramento.org/Portals/0/Document%20Library/Teacher%20HandBook%20Downloadable%20Documents/2009TeacherHandbook.pdf  A handbook for teachers which parents can print and fill out for their own reference as well as to send to school ahead of time to provide additional information to the teacher about their child. http://specialchildren.about.com/od/specialeducation/ht/teacherpacket.htm Step by step tips and resources for creating a back to school packet to send to your child’s teacher and team ahead of time.