News from the Edge
Staff Newsletter October 2015
Behavior Matters Mission Statement
Behavior Matters LLC is an organization committed to the treatment of children using empirically validated methods and strategies in order to assist each child in reaching his or her greatest potential and improving their quality of life. At Behavior Matters, we cherish every child as an individual.
In addition to behavioral and educational programming, we focus on the needs of the family and its fundamental role in the success of our behavioral and educational programming. We are dedicated to providing each family with customized support and training using the principles and techniques of applied behavior analysis (ABA) while following the ethical guidelines set forth by the Behavior Analysis Certification Board (BACB), the Association of Behavior Analysis International (ABAI) and the Association of Professional Behavior Analyst (APBA).
One of our goals is to manage the care and service of our clients by improving our communication, quality face-to-face time, and reducing telephone tag and misinformation through a second and third hand messages
Our families expect Professionalism first and foremost. All of our staff needs to conduct all interactions with honesty and integrity, to deliver on request and manage expectations upfront, without compromising our companies or the BACB's values. My expectation for the Behavior Matters/ S.T.A.G.E.S. of Learning Center staff is to exhibit humility, dependability, & confidentiality, while genuinely caring for our clients and the other professional's on our team, no matter what the situation, to advance the professionalism of Behavior Analyst and Behavior Matters/ S.T.A.G.E.S. of Learning Center.
We all have our moments when we know internally that we have handled something… well… less than professionally. Perhaps we texted an important scheduling change, rather than picked up the phone to call; or lacked patience with another team member; or failed to follow through on a promise made to you as a family; or simply did not focus on what was most important in goal setting for your family. In the end, we may have compromised our value of professionalism and likely disappointed someone.
It takes a conscious effort to take more time to train our staff, reread / rewrite that email before pushing send, connect with the parent when entering the home to understand what happened in school today, or to connect with co-workers. Professionalism is a responsibility of all of us.
Words used to describe Professionalism:
Reliable, dependable, dedicated, trustworthy, steadfast, responsible , Patient, tolerant,
understanding, persevering, determined , Versatile, open-minded, flexible, adaptable,
resilient, easygoing, cooperative, spontaneous , Meticulous, prudent, conscientious,
level-headed, introspective, considerate, kind, compassionate, accommodating , Amiable,
agreeable, affable, gregarious, ebullient, exuberant, buoyant, vivacious , Empathetic,
sympathetic, sensitive, caring, encouraging.
Supervision Team Tricare Tx Plan Changes.....
Supervision Team: Attached is the newest version of the treatment plan, based on changes to the TOM (Tricare Operation Manual) on Oct 1, 2015. I also included the newest timesheet.
- The most recent IEP will need to be submitted to United Healthcare, so to be sure to send the office the most recent IEP for every child.
- ***Any child that has more than 50 hours per week combined (school/ABA/outside ST/OT etc...) the plan has to go to clinical/medical review. Basically, all of our tx plans will go under clinical review, if a child is going to school 40 hours and we are asking for more than 10 hours per week for any ABA services. They also count that new 0368/0369T code in their count. That's why they ask for the number of hours a child is in school/therapy and ABA.
- Every goal needs baseline. Tricare case managers have been asking for baseline from the first plan, if it is not available, please submit copies of graphs. ABLLS-R, VB-MAPP, AFLS seem to be the easiest to show progress, please use when applicable.
- When updating plan, if the clients has missed too many session to show adequate progress, please explain in the background section. i.e. Rebeka has missed 75% of scheduled sessions due to the following factors: Her family was on vacation from May 30- August 15, 2015. Her family also cancelled 48 of 80 scheduled session Jan1-May 29, 2015 for various reasons from illness to school events.
- Caregiver meeting should occur every month.
- Please track cancellations on your timesheet.
- CPT Codes: Adaptive Behavior Treatment by Protocol (General Supervision) 0364/65 Adaptive Behavior Treatment by Protocol Modification (Supervision to teach new programs, extra supervision) code: 0368/69
- Tech's need to become RBT's (by BACB) or an ABAT (by QABA) by Dec 1, 2015 (as per BXM).
- BLS (basic life support) is required for all staff. Needed by Dec 1, 2015
- All BCBA must have the 8 hour supervision course. (available through Relias).
- TRICARE requires all supervision, to include the two face-to-face synchronous contacts, to be direct supervision whereby the BCBA/ BCABA to provide supervision to the BT and directly observes the BT providing the face to face, one-on-one ABA interventions to one beneficiary at a time. Supervision does not necessarily need to be the same beneficiary for both of the two required face-to-face synchronous contacts. Each TRICARE beneficiary under the ACD must receive a minimum of one direct supervision contact per 30 calendar day period per BT.
More on Tricare Supervision.....
From the Tricare website: New Autism Care Demonstration Updates 10/2/2015
In an effort to continually improve the benefit, the Comprehensive Autism Care Demonstration (ACD) was recently updated to reduce the potential financial burden of applied behavior analysis (ABA) services for non-active duty families.
As of October 1, 2015, all ACD cost-shares will match TRICARE Prime and Standard cost-shares for all ABA services provided by authorized ABA supervisors, assistant behavior analysts, and behavior technicians. This change will allow cost-shares to contribute to the annual catastrophic cap for families and eliminates the 10 percent cost-share for assistant behavior analyst and behavior technician services, also known as “tiered” services, significantly reducing the potential financial burden of ABA services for our non-active duty families.
Revisions were also made to enhance the quality and safety of ABA services. All ABA providers will become trained in Basic Life Support (BLS) by December 31, 2015. Many beneficiaries diagnosed with autism spectrum disorder (ASD) typically have other medical conditions, and in the rare event that BLS would be needed to save a life, all ABA providers will be trained. All behavior technicians (BT) are also now required to obtain BT certification from an accredited organization. BT certification ensures these providers are consistently well-trained in ABA services.
The TRICARE ACD covers all TRICARE eligible beneficiaries diagnosed with ASD under a single benefit. There are currently almost 13,000 beneficiaries receiving ABA through the ACD which runs through December 31, 2018.
For more information about the changes to this benefit, visit the Autism Care Demonstration page on the TRICARE website.
Your authorized ABA supervisor 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 assistant behavior analysts and behavior technicians
- Re-evaluate your child as needed
Questions & Answers
How much ABA my child can get?
- No age limits
- No duration limits
- Care is authorized for six months at a time
What can we expect during the course of treatment?
- Periodically: Re-evaluation and changes to the treatment plan
- Every Six Months: New referral and authorization
- Every Two Years: Clinical necessity review to see if treatment is working
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.
Initial Treatment Plans, TP updates every six months that include documentation of progress using either graphic representation or objective measurement (using the same tool as baseline) of data from direct, objective observation, and measurement of treatment targets at baseline and throughout treatment using standard ABA methods. Those data may be supplemented by results of assessments using instruments with published and accepted validity and reliability for evaluating adaptive functioning in individuals with ASD of the same age and functioning level as the beneficiary, conducted at baseline and semi-annually. Examples of such instruments are the Vineland Adaptive Behavior Scale - 2nd edition, the ABLLS-R and the VB-MAPP. The diagnosing evaluation must also be included. In addition, for services to be provided in the school, an IEP, when available, (unless the child is home schooled) must accompany the referral and authorization request and the ABA TP must demonstrate that the ABA services provided under TRICARE are not the same ABA services provided under the IEP and therefore are not educational services.
8.2 ABA Assessments and TPs shall include:
8.2.1 The beneficiary’s name, date of birth, date the initial ABA assessment and initial ABA TP was completed, the beneficiary’s DoD Benefit Number (DBN) or other patient identifiers, name of the referring provider, background and history (to include number of hours enrolled in school,the IEP, and number of hours receiving other support services such as OT, PT, and SLP, and how long the child has been receiving ABA), objectives and goals, and ABA recommendations. The ABA assessment shall include results of the assessments conducted to identify specific treatment targets and the ABA intervention procedures to address each target.
8.2.2 Background and history shall include information that clearly demonstrates the beneficiary’s condition, diagnoses, medical co-morbidities, family history, and how long the beneficiary has been receiving ABA.
8.2.3 The initial ABA assessment must identify objectively measured behavioral deficits that impede the beneficiary’s safe, healthy, and independent functioning in all domains (social, communication, and adaptive skills).
8.2.4 The initial ABA assessment must state that the beneficiary is able to actively
8.2.5 The initial ABA TP shall include clearly defined, measurable target behaviors in all DSM-5 symptom domains as identified in the initial assessment, and objectives and goals individualized to the strengths, needs, and preferences of the beneficiary and his/her family members.
8.2.6 The initial ABA TP and all TP updates shall also include all measurable objectives and goals for parent/caregiver treatment guidance on implementation of selected treatment protocols with the beneficiary at home and in multiple other settings. The protocols shall be selected jointly by the authorized ABA supervisor and the parent(s)/caregiver(s). If
parent(s)/caregiver(s) treatment guidance is not possible, the TP shall document why not.
8.2.7 Documentation on the initial ABA TP shall also include the authorized ABA supervisor’s recommendation for the number of weekly hours of ABA under the Autism Care Demonstration to include the recommended number of weekly hours for ABA interventions provided by BTs. TPs are individualized and treatment goals and hours of ABA services are determined by theDSM-5 symptom domains and severity levels, needs of the parent/caregiver, and capability of the beneficiary to participate actively and productively in ABA services. Recommendations for hours shall take into account whether the child is attending school, the time available in the beneficiary’s schedule for ABA, and individual beneficiary needs. CPT Assistant, June 2014 states: “The typical Early Intensive Behavior Intervention patient initially has 15 or more treatment targets per week and requires 25 hours of treatment per week during a defined treatment period. Older patients typically have fewer targets and require considerably fewer treatment units per week.”
8.2.8 Semi-annual ABA reassessments and TP updates shall document the evaluation of progress for each behavior target identified on the initial ABA TP and prior TP updates. Documentation of the semi-annual ABA reassessment and TP update shall include all of the following:
• Date and time the semi-annual reassessment and TP update was completed.
• ABA provider conducting the reassessment and TP update.
• Evaluation of progress on each treatment target using graphic representations of data from direct, objective observation and measurement of treatment targets at baseline and throughout treatment using standard ABA methods. The evaluation of progress data may be supplemented, but shall not be replaced, by results of assessments using instruments with published and accepted validity and reliability for evaluating adaptive functioning in individuals with ASD of the same age as the beneficiary (e.g., the Vineland Adaptive Behavior Scale - 2nd edition; the ABLLS-R and VB-MAPP).
Revisions to the ABA TP to include identification of new behavior targets, objectives, and goals.
• Recommendation for continued ABA to include a recommendation for the number of weekly hours of one-on-one ABA, including documentation of clinical necessity of additional hours needed, under the Autism Care Demonstration.
• A projected duration of ABA.
• A periodic ABA program review to include a referral to a step down level of care to which the beneficiary will be referred once the ABA TP target goals are attained.
• The semi-annual reassessments and TP updates are required to be conducted every six months and must be dated as being conducted during that time frame. The semiannual reassessments and TP updates may be submitted as early as 60 days prior to the 6 month reassessment due date. Reassessments must be completed and submitted by the sixth month for review for continued reauthorization. Any delay in submission of the ABA reassessment and TP updates may delay or terminate continued authorization for ABA services.
6.3 Behavior Technicians (BTs)
6.3.1 Para-professionals who meet the educational requirements established herein by the
DoD. A BT may not conduct the ABA assessment, or establish a child’s ABA TP. Claims for
BTs who are not properly supervised in accordance with Autism Care Demonstration requirements will be denied.
6.3.2 Qualifications To Become a BT Under TRICARE
The following eligibility requirements must be met:
• Completed a minimum of 12 semester hours of college coursework in psychology, education, social work, Behavior Sciences, human development or related fields, such as counseling, OT, SLP, and be currently enrolled in a course of study leading to an associates or bachelor’s degree by an accredited college or university; or
• Completed a minimum of 48 semester hours of college courses in an accredited college or university; or• Obtained a High School diploma or General Education Development (GED) equivalent and have completed 500 hours of employment providing supervised ABA therapy as verified by the ACSP, or authorized ABA supervisor.
6.3.3 Training Requirements
Prior to BTs being allowed to provide supervised one-on-one ABA interventions, completion of training provided by an authorized ABA supervisor or supervised assistant behavior analysttrainer in accordance with the current BACB Guidelines for “Applied Behavior AnalysisTreatment of Autism Spectrum Disorder: Practice Guidelines for Healthcare Funders and Managers” and the BACB Guidelines for Responsible Conduct for Behavior Analysts (http://www.bacb.com) and all current applicable BACB and/or QABA rules and regulations (or those of another certification body that is approved by Director, DHA, for TRICARE purposes), must be documented and maintained by the authorized ABA supervisor and the BT.
184.108.40.206 The following training is required:
• BLS, as demonstrated by BLS certification
• Forty (40) hours of training which includes the following content
• Crisis Behavior Management
• Mandated reporting
• Problem solving
• Conflict Management
• Principles of Behavior Analysis:
• Developmental milestones
• Data collection (measurement)
• Basic ABA procedures such as reinforcement, shaping, prompting, etc.
• Ethics and Confidentiality
220.127.116.11 Documentation of the 40 hours of required training must include:
• Dates and times of training sessions;
• A course description to include course objectives, a syllabus outlining course content,
and an evaluation process to measure successful completion; and
• Signed and dated acknowledgment
18.104.22.168 The authorized ABA supervisor and the BT shall each keep a copy of the training
documentation on file. The authorized ABA supervisor shall submit a copy of the certificate of completion to the contractor upon request.
6.3.4 The BACB has offered a RBT competency and registration credential since August 2014. The QABA certification board developed another behavior technician level credential, the ABATcertification. Either the RBT or the ABAT will satisfy the 40 hour training requirement. After December 31, 2014, all new hire ABA BTs must have the RBT by the BACB or the ABAT by the QABA (or certification of another certification body that is approved by Director DHA, for TRICARE purposes) and have until December 31, 2015 to complete this requirement. All previously grandfathered BTs (i.e., those employed prior to the ACD transition under the legacy programs), will have until December 31, 2016 to obtain and provide documentation of either the RBT or ABAT. After December 31, 2016, all BTs must have either the RBT credential or the ABAT certification (or certification of another certification body that is approved by Director, DHA, for TRICARE purposes).
6.3.5 BTs must obtain ongoing supervision for a minimum of 5% of the hours spent providing one-on-one ABA per 30 calendar day period per beneficiary. Supervision of every BT must include at least two face-to-face, synchronous contacts per 30 calendar day period during which the supervisor observes the BT providing services in accordance with the BACB practice requirements of the RBT credential (at http://www.bacb.com) or the QABA practice requirements of the ABAT certification (http://www.qababoard.com) (or practice requirements of another certification body that is approved by Director, DHA, for TRICARE purposes). TRICARE requires all supervision, to include the two face-to-face synchronous contacts, to be direct supervision whereby the authorized ABA supervisor or the assistant behavior analyst delegated to provide supervision to the BT and directly observes the BT providing the face to face, one-on-one ABA interventions to one beneficiary at a time. Supervision does not necessarily need to be the same beneficiary for both of the two required face-to-face synchronous contacts. Each TRICARE beneficiary under the ACD must receive a minimum of one direct supervision contact per 30 calendar day period per BT.
Remote supervision through the use of real time methods is also authorized. For the purpose of this paragraph, “real-time” is defined as the simultaneous “live” audio and video interaction between the authorized ABA Supervisor and the BT by electronic means such that the occurrence is the same as if the individuals were in the physical presence of each other. Such is usually done by electronic transmission over the Internet through a secured HIPAA compliant program.
Behavior Matters Alaska and Nebraska
S.T.A.G.E.S. of Learning Center
16935 North Eagle River Loop Rd
Eagle River, AK 99577
907-726-5330 BXM office
907-726-3350 STAGES cell
907-726-5366 office fax
7200 S. 84th St
LaVista, NE 68128