Autism Deserves Equal Coverage

03/26/2020

Are you worried that you won’t be able to get your BHT/ABA therapy during the Coronavirus shutdown?

Please join our Tele Town Hall TODAY Thursday March 26 at 7pm.

Please Share widely - links fixed

Confirmed Speakers: Director Nancy Bargmann (CA DDS) and Dr. Clarissa Kripke (UCSF)

CALIFORNIA Focused - Information presented will only be relevant to Californians

Dear Families, Therapists, Advocates, Providers, Health Plans, and Insurers, We are hosting a Zoom Tele Town Hall on Thursday, March 26 at 7 pm PST to address the delivery of BHT/ABA in light of Coronavirus and its spread throughout California.

03/19/2020

UCSF virtual rounds on COVID-19 for anyone interested. Primarily meant for my health care provider contacts but anyone welcome. I got the notification from my cousin.

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03/19/2020

Group Brainstorm - let’s assume all ABA services need to continue, even in lock down. What do we need to do it safely!! Even if you done think it’s possible - put it down and we (at least I) will ask.

Hi all - I’m in the Bay Area in lock down “shelter in place.” Most providers in. CA are still providing services but some other are stopping them altogether or stopping them in “shelter in place” areas, and others are talking about laying off workers to avoid paying sick leave (not by choice but they think for survival). Short term survival may mean long term decimation. We are working tirelessly, asking for, and/or getting emergency exemptions, regulations, and emergency funding for the industry, but we also need to be figuring out how to keep these urgent healthcare services provided to as many kids as possible.

ABA for many/most/all kids is essential, not discretionary healthcare. Our lockdown Counties have deemed it essential healthcare and exempt from the lock down, but providers are not having an easy time navigating. Telehealth works for BCBAs but not direct care.

Pretty soon I predict all areas will be on lockdown. We need a discussion about it, all ideas are good ideas. Think way outside the box.

If the assumption is we continue providing telehealth for BCBAs when possible and Direct therapy for BTs and RBTs who are willing (with telehealth where appropriate), how can we do it safely? What do we need? Combat pay? Risk pay? masks? Gloves? How to make the kids not scared of the protective gear? Let’s make a list and then ask for it.

I’m CA we are asking for stuff and getting it. LA Unified closed schools and suspended all IEPs, (before the feds did), and we mobilized and asked and the Governor ordered IEPs continued.
My provider temporarily discontinued services because they weren’t sure they were essential health services, we asked and got our county to clarify in writing that they were (by 7am after a 2am email from me). I’m not saying all areas will be able to get stuff, but there amazing flexibility even at the federal level. They are moving fast and writing stuff that makes big strides, maybe causes unintended consequences, and then try to fix it.

Let’s assume everyone wants to do the right thing and continue services, what do we need to ask for. The ski is the limit. Don’t be constrained by whether you think you can get it. I’ll also post this on the FB page. Please only positive ideas, constructively point out problems and maybe someone else will solve them.

This is the smartest most amazing group of people I know. And we have individually and as a group gotten many things people never thought we could. What do we need???? We sure can’t get it if we don’t ask for it. We need your help in CA now and then you can use the info and model when it comes to your state.

GO!!!
Sent from Yahoo Mail for iPhone

03/18/2020

Considerations for ABA Providers about what the responsibility is to continue services in the Covid-19 crisis even in areas with shelter in place orders and the flexibility needed to do so safely.

Please do remember that we (the ABA community, families and ABA providers) got what we all wanted, we/you are healthcare providers and held to higher standards and expected to take some reasonable risks. It's not easy to balance all the competing things but I urge you to think how can services be provided safely so they can continue, what do we need to do that. Front line healthcare workers are getting extra supplies and safety precautions. You are front line healthcare workers and should be getting them too. Figure out what you need and ask for it. If they say not let me know and I'll help you get it - or let Sarah Trautman know and ask for it.

During disasters, which this clearly is, there is additional flexibility. You have already seen it for Telehealth. You have seen it with DDS paying even for cancellations, and CDE too. There will be more coming. There can be increase pay for increased risk, there can be increased pay to cover extra health supplies, and much much more. Please please try to start thinking about what you need to keep these essential services going, and again then ask me to help you get it. Think way outside the box.

And if cash flow is an issue, let's try to think that through too. DDS and CDE are paying for cancelled services - and if your local LEA is saying they won't, let your leaders know. But also know that it is already approved on the statewide level - so another important thing is to send in those invoices even if your district is giving you a hard time. Send them in anyway so when we do get the attention of the state leaders the LEA's cant say, well no one sent any invoices. To protect yourselves, make sure to mark the invoices with a prominent notice - COVID-19 emergency - services not rendered due to COVID-19. Then when we can fix the back end to have them pay for what they agreed to, your invoice is in the cue.

You could even consider doing that for insurance services - submit with a note - cancelled due to Cover-19, requesting special consideration to pay invoice anyway so we can stay afloat and survive the crisis. All they can do is not pay. But you never know because it sure won't look for them not to step up.

CAVEAT - this is my opinion and not level advice or business advice. Is it an educated opinion from a parent and advocate who is working her tail off to keep services coming to patients and keep this exceptional profession and all the expertise and skilled healthcare workers in existence throughout and after this crisis.

03/18/2020

Flexibility in delivering ABA services during Covid-19

There will likely be flexibility for increased fees to payers to cover these supplies. This is certainly the case for CMS Medicare and Medicaid services. It is listed on their standard disaster relief flexibility page on their Covid-19 page. I haven’t looked it up but it was mentioned on an all state call done by CMS today. Figure out what you need and ask the payers for it, whether it’s DDS, Medicaid LEA’s, and hopefully insurers will follow suit.

There is flexibility for anything paid for by CMS to pay more to get providers if their current providers can’t continue (eg a group home has an infected patient) or having to hire higher credentialed workers or any number of reasons. The underlying reason is the states are absolutely required to deliver the services - and are given substantial leeway and flexibility to figure out how, including additional payments for multiple aspects. ASK!! Especially Medicaid/Medi-Cal.

03/18/2020

Here is confirmation ABA/Autism Services are Healthcare Operations and exempt from the "Shelter in Place" orders (meaning they are allowed to continue.)
Please read down this thread - in the Bay Area there was some question for a period of time by at least some providers about whether ABA was Healthcare Operations and therefore exempt from the "Shelter in Place" ordinances in the 7 Bay Area Counties that went into effect today. Many of you interpreted it as essential but others weren't sure and some have suspended services. Below is an analysis from San Mateo County Supervisor Dave Pine (who is also an attorney) with a confirmation of the analysis by the San Mateo County Legal Counsel. They are working to get a letter up on their website but have asked for patience. They were unbelievably responsive already. In the interim, if there is anyone with any lingering question whether ABA is an exempt service, the analysis is below.
David Silberman
To:Kristin Jacobson
Cc:Dave Pine
Tue, Mar 17 at 3:06 PM
I am confirming Supervisor Pine’s analysis. It is clearly correct.
From: Kristin Jacobson
Sent: Tuesday, March 17, 2020 9:57 AM
To: Dave Pine
Cc: John Beiers
Subject: Re: URGENT please read - Hundreds of Bay Area families to lose life saving healthcare service (ABA) Tuesday morning Fw: Update on ###XX Services
Hi Dave,
Thank you for your prompt and thorough response. I really appreciate your willingness to share your opinion and stating it so strongly. I forwarded it to my provider. If time permits, I will wait for John Beiers to confirm your analysis before sharing widely. As you know better than most, we are in uncharted territory and we need to get the information out ASAP before hundreds or even thousands of Bay Area kids lose these critical services.
Thank you again for your leadership. What a critical time to show the importance and effectiveness of strong local government.

Kristin
Sent from Yahoo Mail for iPhone
On Tuesday, March 17, 2020, 9:04 AM, Dave Pine wrote:
Kristin,Thank you for contacting me about this.I think there is no question that ABA/autism services are exempt from the “Shelter in Place” Order because they fall within the definition of “Healthcare Operations.”
Section 10b of the Order (attached) addresses “Healthcare Operations”:“For purposes of this Order, individuals may leave their residence to work for or obtain services at any “Healthcare Operations” including hospitals, clinics, dentists, pharmacies, pharmaceutical and biotechnology companies, other healthcare facilities, healthcare suppliers, home healthcare services providers, mental health providers, or any related and/or ancillary healthcare services. “Healthcare Operations” also includes veterinary care and all healthcare services provided to animals. This exemption shall be construed broadly to avoid any impacts to the delivery of healthcare, broadly defined. “Healthcare Operations” does not include fitness and exercise gyms and similar facilities.”
Note the language above that states: “This exemption shall be construed broadly to avoid any impacts to the delivery of healthcare, broadly defined.”
By way of this email, I am asking San Mateo County Counsel John Beiers to confirm my analysis.
Let me know how this works out.All the best to you and your family during these trying times.Dave
Dave Pine
Supervisor, District 1
San Mateo County Board of Supervisors
400 County Center, 1st Floor
Redwood City, CA 94063