News from the Edge

Staff newsletter for Behavior Matters March 2015

Professional Development Days

Behavior Matters Eagle River will close the clinic to clients from 8:30am-12:00pm three times a year for professional development and team planning. They will occur the first week of May, August and December. Future dates will be planned for Behavior Matters Nebraska.

Stimulus List and Instructional Plan

Every goal/program should have a stimulus list (list of stimuli to teach i.e title of books, sight word list, specific tasks) and a detailed instructional plan written by the supervising BCBA. If you do not have these for each active program, please let me know and I will work with your supervisor to provide you with this information.

Training Opportunities

Direct Line Staff please talk with your supervisor about additional training. Every technician is hired with the goal of teaching you to use our science effectively so that you may have a positive impact of those we serve.

It is also the mission of Behavior Matters to train future competent, professional BCBA/ BCaBA's. This is accomplished by offering our staff the highest quality of training.

We have online line training, training video's, reference books, and hands on sessions. the supervision team is also available to provide some additional training through shadowing sessions.

Looking for the "Just Right" Space

As our Eagle River based clinic and school continues to grow, we find that we need more space. I am actively looking for another commercial building or house that can be zoned commercial, If you have any suggestions (within ER), please let me know.


AK Team Round Up

Administrative Team

Rebeka- CEO

Antonina- Clinical Director

Laura- Business Manager

Heidie - Intake Coordinator and Bookkeeper

TBA- Administrator Assistant

Pearl- Receptionist

Spencer- Office Assistant

Clinical Staff:

BCBA/ BCaBA Team: Rex , Maya, Consuelo, Liza (Juneau), Dale , Becky P, Kelly

BCBA/ BCaBA Trainee: Melodie, Daisy, Wendy, Kate, Julie

Behavior Technician Team: Angela, Krystle, Christy, Angela, Amanda, David, Michelle, Sadiku, Kelly (Juneau), Kate (Juneau), Jenna (Juneau)

We currently have 2 openings for FT positions for Behavior Tech & BCBA/ BCaBA open to current staff. Please send a letter of intent if interested.

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NE Team Round Up

Administrative Team

Rebeka- CEO, BCBA

Laura- Business Manager

Heidie- Intake Coordinator and Bookkeeper

Alisha & Teresa- Office Assistant

Clinical Staff:

BCBA/ BCaBA Team: Jenna, Corey, Phil, Emily

SLP: Brittany

BCaBA Trainee: Aaron, Aspen

Behavior Technician Team: Amanda, Adan, Nora, Heather, Aleisha, Melissa, MaDonna, Teresa

We currently have 2 openings for FT positions for Behavior Tech & BCBA/ BCaBA open to current staff. Please send a letter of intent if interested.

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S.T.A.G.E.S. of Learning Center Team Round Up

Administrative Team

Antonina- Center Director

Beth- Program Manager

Heidie- Bookkeeper

Clinical Staff:

BCBA: Antonina

Teacher: Amy

BCaBA Trainee: Wendy

Behavior Technician Team: Olivia, Terri, Dawn

Behavior Support: John

Florida Team Round Up

CEO: Rebeka

Assistant: Kaitie Hamme

Tricare Autism Care Demonstration (Info for Parents)

Tricare Autism Care Demonstration

The TRICARE Comprehensive Autism Care Demonstration (Autism Care Demo) covers applied behavior analysis (ABA) for all TRICARE beneficiaries diagnosed with an autism spectrum disorder.

· The demonstration started on July 25, 2014.

· It will end on December 31, 2018.

Is your sponsor on active duty? You must register in the Extended Care Health Option (ECHO) to qualify for the Autism Care Demo.

Step 1: Get Diagnosed

Your child must by diagnosed by an approved diagnosing provider, which includes: Primary Care Physicians with the following specialties: Family Practice, Internal Medicine, Pediatrics.

We require testing Using the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) within one year to confirm the ASD diagnosis.

Specialized Diagnosing Providers who are board certified or board eligible in:

· Behavioral Developmental Pediatrics

· Neurodevelopmental Pediatrics

· Pediatric Neurology

· Adult or Child Psychiatry

· Licensed Clinical Psychology, doctoral level

We don’t require more testing to confirm the ASD diagnosis.

Step 2: Get a Referral and Authorization

· This is required for everyone in all TRICARE plans

· Your diagnosing provider will ask for a referral and authorization from your regional contractor or US Family Health Plan provider

· You’ll get an authorization letter for ABA for one year.

· A new referral and authorization is required each year

Step 3: Schedule an Appointment

You can schedule your appointment with the Board Certified Behavior Analyst (BCBA) listed in the authorization letter as soon as you get the letter.

If you’d like to see a different BCBA than the one listed on your authorization letter, please contact your regional contractor.

Your behavior analyst will:

· Complete an ABA evaluation

· Develop an individual treatment plan

· Work one-on-one with your child

· Help parents and caregivers

· Supervise services provided by Board Certified Assistant Behavior Analysts (BCaBAs) or

Behavioral Technicians

· Re-evaluate your child as needed

Your child’s individual treatment plan will say how much ABA they’ll get each week. The hours may be changed during re-evaluation.

Questions & Answers

How much ABA my child can get?

· No age limits

· No duration limits

· Care is authorized for one year at a time

What can we expect during the course of treatment

· Periodically: Re-evaluation and changes to the treatment plan

· Every Six Months: Progress report

· Every Year: New referral and authorization

· Every Two Years: Medical Review to see if treatment is working

How much will we pay per appointment?

· There’s no annual or lifetime dollar limit to the amount of ABA TRICARE may cover, if appropriate.

· Your plan and type of provider determine how much you’ll pay.

If you see a BCBA with a Master’s degree or higher, you’ll pay the copayment or cost share for your plan:

· Active duty family members with Prime: $0

· Active duty family members with Standard/Extra (and TRICARE Reserve Select):

o 15% in network

o 20% out of network

· Retired family members with Prime: $12

· Retired family members with Standard/Extra (and TRICARE Retired Reserve):

o 20% in network

o 25% out of network

· These amounts will apply to your annual catastrophic cap

If you see a BCaBA or a Behavior Technician:

· You’ll pay a 10% cost share** for supervised ABA

· This amount doesn’t count toward your annual catastrophic cap

**The monthly ECHO fees will satisfy the cost share for supervised ABA for active duty family members.

Costs and Coverage Limits

There are no enrollment fees, but you must pay part of the monthly expenses for authorized ECHO benefits. The monthly cost share is based on the sponsor's pay grade as shown in the chart below. The monthly cost share is only one fee per sponsor, not per ECHO beneficiary. You only pay the cost share if you use ECHO benefits during that calendar month.

Monthly Cost Share

E-1 to E-5 $25

E-6 $30

E-7, O-1 $35

E-8, O-2 $40

E-9, W-1, W-2, O-3 $45

W-3, W-4, O-4 $50

W-5, O-5 $65

O-6 $75

O-7 $100

O-8 $150

O-9 $200

O-10 $250

Coverage Limits

The total TRICARE cost share for all ECHO benefits combined, excluding the ECHO Home Health Care (EHHC) benefit, is $36,000 per fiscal year. Coverage for the EHHC benefit is capped on an annual basis. The cap is limited to the maximum fiscal year amount TRICARE would pay if the beneficiary resided in a skilled nursing facility. This amount is based on the beneficiary's geographic location.

Costs cannot be "shared" between family members. For example, if an ECHO beneficiary in the household has used only $20,000 toward the $36,000 limit, the $16,000 difference cannot be used or credited to another ECHO beneficiary in the same family.

Questions & Answers

How long has TRICARE covered applied behavior analysis (ABA)?

· We’ve covered ABA for active duty family members since 2005 through the Extended Care Health Option (ECHO), and before that, through the Program for Persons with Disabilities.

· The ECHO Autism Demonstration began in March 2008. This demo increased access to supervised services from BCaBA and ABA tutors (now called Behavior Technicians).

· In August 2012, we expanded coverage to non-active duty family members through the basic program and the ABA Pilot.

· On December 31, 2014, all beneficiaries using the ECHO Autism Demonstration or the ABA Pilot were fully transitioned into the Autism Care Demo.

What’s the difference between the sole provider model and the tiered model, and do I have to choose one option?

· You don’t have to choose between the sole provider model and the tiered model.

· Your child can get ABA services from either or both.

· Whichever model you choose depends on the patient’s individual needs and provider availability.

In a sole provider model, your child gets all applied behavior analysis services from just one provider (BCBA with a Master’s degree or higher).

In a tiered model, your child gets ABA services from a team of providers lead by a supervisory BCBA. Here’s an example of the tiered model:

· Your child can see both types of providers for different services:

· BCBA for applied behavior analysis assessments, treatment plans and help for parents

· BCaBA or Behavior Technician for direct one-on-one ABA

· In this scenario, the supervisory BCBA submits the bill.

Can we see more than one BCBA?

Yes. Short term consultation with a second BCBA may be needed at times when the primary provider lacks expertise in a specialized area. But, only the primary BCBA can bill for services.

Can ABA end against parents’ wishes?

Parents should work with the provider to make decisions together.

· You must follow authorization guidelines and get your care reauthorized every year.

· Adjustments may be made to the treatment plan.

· Failure to follow the Autism Care Demo requirements could result in denial of claims.

We care about what is best for each child. We will work closely with families and providers in situations where continued coverage becomes an issue.

What happens if my sponsor transitions from Prime to Standard, or vice-versa?

Your coverage and testing requirements are the same no matter what TRICARE plan you use. Only your costs vary by plan.

What if my sponsor retires from active duty?

Your Autism Care Demo coverage is the same. Only your costs will change.

Is the Autism Care Demo available overseas?

The Autism Care Demo is only available in the United States and District of Columbia. However, we may cover applied behavior analysis overseas if provided by a BCBA with Master’s degree or higher. We don’t cover services overseas from supervised BCaBA or Behavior Technicians.

How do our out-or-pocket costs (cost shares and copayments) for applied behavior analysis apply towards our catastrophic cap?

Cost shares and copayments are required by law. They vary depending on your TRICARE plan and if you have other health insurance. The catastrophic cap is the most your family pays out-of-pocket each year for TRICARE-covered services.

Catastrophic caps are:

· $1000 for active duty and TRICARE Reserve Select families

· $3,000 for retiree families

Under the demo, costs from:

· BCBAs count towards the cap

· Supervised BCaBA and Behavior Technicians don’t count towards the cap

Once you reach your catastrophic cap, TRICARE covers 100% of the charges from authorized BCBA.

Can I still file claims for care received before I transitioned into the Autism Care Demo?

Yes. All claims must be filed within one year in the U.S. and three years in all overseas areas. If you paid costs before you transitioned that are more than the demo costs, you may be eligible for reimbursement.