AUGUST2015 spectrum

The Spectrum
The Spectrum is a monthly electronic publication of the Autism Support
Center. This newsletter is published to inform parents and professionals
of resource information, upcoming events, and other autism-related
topics. ASC is funded primarily by the Mass. Dept. of Developmental
INFORMED. EMPOWERED. CONNECTED.
Services. The views expressed do not necessarily reflect those of the funding source. ASC
does not endorse any product, service or theory referred to in this newsletter. Articles, resources and announcements are included for information only.
Anyone wishing to contribute information for this newsletter should send
it to asc@ne-arc.org or to our mailing address Parent contributions are
encouraged. Announcements are included as space is available.
The Autism
Support Center
is celebrating
23 years of
supporting and
empowering
families in
northeastern
Massachusetts.
VOLUME 24 The Spectrum
Update: NEW MassHealth
Coverage for ABA Therapy
ASC AT 978-777-9135
Contact us:
FOR MORE INFORMATION.
SUSAN GILROY
CO-DIRECTOR
978-624-2302
GLORIA RICARDI CASTILLO
CO-DIRECTOR
978-624-2301
6 SOUTHSIDE ROAD, DANVERS MA 01923
AUGUST 2015
The Autism Support Center
PLEASE CONTACT
OR VISIT HTTP://NE-ARC.ORG/SERVICES/AUTISM-SERVICES/
ISSUE 2 WHITNEY RYAN POSADA
SENIOR COORDINATOR/BROKER
978-624-2305
ALLIE KEOUGH
COORDINATOR/BROKER
978-624-3721
STACEY CRUWYS
COORDINATOR/BROKER
978-624-2347
INSIDE:
3rd Annual Family
Harvest Festival!!!
The following information is from Massachusetts Advocates for Children’s Autism
Center and Massachusetts Law Reform Institute (July 27, 2015)
A new state law requires MassHealth to cover medically necessary ABA services for children with autism under age 21.
•
ABA services are now available to MassHealth members. The FAQs below explain how to get coverage now and after October (when the process will
change) for members who have MassHealth either as their primary or secondary
insurance.
FAMILIES:
Q. What types of MassHealth insurance covers ABA services?
A. Children under the age of 21 who have been diagnosed with autism and are covered by
MassHealth Standard and CommonHealth1 are entitled to medically necessary ABA services. Coverage is also available to members who have MassHealth as secondary insurance.
Q. MassHealth is my primary insurance. How can I get ABA services for my child
now (until October)?
A. MassHealth members should locate an ABA provider and have the provider contact
MassHealth to request prior authorization for ABA. Providers need to enroll with
MassHealth and request prior authorization to evaluate your child and also to approve an
ABA treatment plan. Your provider must receive this authorization from MassHealth before
he or she can provide any services. If you already have an ABA provider, he or she must
also enroll with MassHealth and request prior authorization to begin providing covered
ABA services.
Q. How do I find an ABA provider?
A. The Autism Insurance Resource Center maintains a list of ABA providers that can be
used to help locate a provider.
Q. What will happen in October 2015 if MassHealth is my primary insurance?
A: Starting in October, children enrolled in managed care plans will access medically necessary ABA services through their managed care plans (Boston Medical Center Health
Net Plan, Fallon Community Health Plan, Health New England, Neighborhood Health
Plan, Tufts Health Plan - Network Health, or the Massachusetts Behavioral Health Partnership).
•
Continued inside!
IT’S A FACT:
Autism is the fastest growing serious
developmental disability in the United States.
46th Annual Golf
Tournament
46th Annual Mike Frangos
Commodore
Invitational Golf Tournament
September 21st at 11:30 am to 8:00 pm
Myopia Hunt Club
435 Bay Road
South Hamilton
Join us for the longest-running continuously held charitable golf tournament in the nation!
11:30 am lunch
12:30 pm shotgun start
Bramble format
Dinner reception immediately following
Raffles, auction, and awards
Contact us for sponsorship information
Pam Silva 978-624-2403
ABA ISN’T JUST FOR KIDS
Save the date!
8:30 am to 1 pm on Friday, September 18
Autism Support Center Mini-Conference
ABA Isn’t Just For Kids with Autism!
Let’s work on those skills and abilities that will enable adolescents and young
adults to meet standards of personal independence.
Mercier Center, Lowell; $25 per person
More information to come soon.
SUPPORT GROUPS
Acton
ASC Sponsored; Target Group: Mandarin-speaking parents.
Acton Memorial Library, 486 Main St (Rt. 27) Acton; bimonthly meetings TBA; Parent facilitator: Wen Li
Contact ASC 978-777-9135 or asc@ne-arc.org for info.
Danvers
AANE/ASC sponsored; Adults with Asperger’s
Pizza and Game Night
6 Southside Road, Danvers, 1st Thursday, 6-8 pm
$12 for pizza, salad, dessert, beverage. Prior registration
required.
Facilitator: Gail Kastorf 617-393-3824
Danvers
AANE/ASC sponsored; Target Group: Parents of adults
with Asperger’s
6 Southside Rd, Danvers; 2nd Thursdays, 6:30 to 8pm
Facilitator: Gail Kastorf 617-393-3824
Fee: $90 for 6 sessions, $45 for 2nd parent of same
adult
Danvers
ASC sponsored; Target group: Parents of children with
Intensive Needs
6 Southside Rd, Danvers; 3rd Wednesday, 10
-11:30 am
Contact: Susan Gilroy at
978-624-2302 or sgilroy@ne-arc.org
Danvers
ASC sponsored; Target
Group: Parents of children
Danvers
ASC/AANE sponsored; Target Group: Adults (18+) with
Asperger’s syndrome
6 Southside Road, Danvers; 3rd Thursdays, 6:45 to
8:00pm. Contact facilitator Gail Kastorf at 617-393-3824
or gail.kastorf@aane.org
Lawrence
ASC sponsored; Target Group: Spanishspeaking parents of
children with disabilities
Community Action
Program, 112 East
Haverhill St., Lawrence; 2nd Friday,
9:30-11:30am
Contact facilitator
Gloria Castillo 978624-2301 or gcastillo@ne-arc.org
Lynn
Family Resource Center sponsored;
Target group: Spanish-speaking parents of children with disabilities
Contact: Aymee Lucifora 978-624-2381
Newburyport No August meeting!!!
ASC sponsored; Target Group: Parents of children with ASD
Newburyport 5 Cents Savings Bank, State St, Newburyport; 2nd Thurs., 7 p.m. Parent facilitator: Nancy Lucier. Contact: Susan Gilroy at 978-624-2302 or sgilroy@nearc.org
Reading
ASC sponsored; Target: parents of children with ASD
6 Southside Road, Dan- Reading Senior Center, 49 Pleasant St, Reading;
vers; 3rd Thursday, 5:30- Date: TBA
7pm
Parent facilitator: Kim Gargano
Contact: Allie Keough at RSVP kimgargs@yahoo.com or call 1-781-526-9171
978-624-3721
under age 5
IT’S A FACT:
Summer Fair
Chelmsford
Autism is the fastest growing serious
developmental disability in the United States.
MassHealth Update
Summer Fair For Kids With Disabilities
When: August 9, 2015
Contact: 978- 692-6866
Chelmsford, August 9th, 2015,
9:30 to 11:30 a.m.
Free to Kids with disabilities and their families.
Games, crafts, parachutes and prizes.
Fair location is The Paul Center for Learning
and Recreation, Inc., 39 Concord Road, in
Chelmsford. Sponsored and run by the Knights
of Columbus Chelmsford/Westford/Littleton,
MA. For more information visit
http://www.kofc9275.org/
Register to: 978- 692-6866 or
kgdesigned@gmail.com
BOWLING LEAGUES
Cape Ann Lanes, Gloucester
North Shore Bowling League
Ages 22+
Ages 13+
Wednesdays, 6:30-8 pm
Sunnyside Lanes, Danvers
$10/week
Mondays 6-7:30 pm
$10/week
Heritage Bowling League
Beverly Bowl-O-Mat
Ages 13+
(continued from page 1)
Contact the Rec Department for details
978-624-2308
Metro Bowl, Peabody
Thursdays, 3-4:30 pm
Wednesdays, 4-5:30 pm
Ages 22+
$10/week
$10/week
Q. Will ABA providers still need to request prior authorization for ABA Services in October 2015?
A. Yes. After managed care plans add ABA as a covered service,
which is expected in October 2015, your child’s ABA provider will
need to request authorization for coverage from your child’s
MassHealth managed care plan.
Q. Will my child continue to receive services in October,
without interruption, when the managed care plans become
responsible for provision of ABA services?
A. MassHealth intends for managed care plans to provide continuing ABA services for 90 days after Sept 30th to allow time for
ABA to be re-authorized by your managed care plan. MassHealth
is negotiating new contract terms with the managed care plans,
which will be effective October 1st. These new contract terms will
ensure continuity of care, requiring the managed care plans to
cover the same level of previously authorized ABA services
through out-of-network providers for 90 days.
MASSHEALTH AS SECONDAY INSURANCE:
Co-pays and Deductibles:
Q. What if my child has MassHealth as secondary insurance
coverage?
A. The Massachusetts Behavioral Health Partnership (MBHP) is
now covering copays and deductibles for children with autism
under age 21 who receive ABA services through private insurance (Employer Sponsored Plan or Qualified Health Plan) and
have MassHealth as secondary insurance and are enrolled with
MBHP.
Q What does my child’s ABA provider need to do so that my
co-pays and deductibles are
covered?
A. Providers need to call MBHP to be authorized (this is separate
from MassHealth ABA enrollment) and submit an Explanation of
Benefits showing that cost sharing is due. This MBHP authorization process is easier and more expeditious than the MassHealth
ABA approval process. Providers can call community relations for
information 1-800-495-0086.
Q: Will coverage of co-pays and deductibles change in October?
A: MBHP will continue to cover co-pays and deductibles after
October 1.
Q: Can I get reimbursed for cost-sharing that I have already
paid out this year?
A: MBHP is processing provider claims for cost-sharing for dates
of service back to May 18, 2015. Your provider should be willing
to reimburse you for the cost-sharing you have paid since then,
and bill MBHP.
PROVIDERS:
Q.
I’m an ABA provider, what do I need to do to
provide services to children with MassHealth
primary insurance (or MassHealth secondary
to
a policy that does not cover ABA) from now
until October?
A. Providers must be approved by MassHealth as an ABA provider (even if they are already enrolled in another capacity). Providers can call 617-847-3786 for assistance and guidance. Before
providing any services, including an initial evaluation, providers
must submit a request for prior authorization (PA) to
MassHealth that includes documentation of medical
necessity for ABA.
The PA-1 Request Form is online at http://
www.mass.gov/masshealth (click on Provider forms).
The documentation submitted with the standard prior
authorization request form should be similar to what is required
by commercial insurers to authorize ABA services.
Q. What is acceptable evidence of medical necessity for ABA
services?
A. Evidence of medical necessity will most likely include an evaluation from a qualified specialist (e.g., developmental pediatrician, pediatric neurologist, psychologist with developmental or child/adolescent expertise, psychiatrist
or other licensed physician experienced in the diagnosis and treatment of autism) that incorporates a
formal diagnostic and/or functional assessment, includes a comprehensive
medical evaluation to rule out an underlying medical etiology, establishes a
DSM-V diagnosis of autism, and supports the need for ABA services.
Q. Must a provider be MassHealth approved before submitting prior authorization for services?
A. Providers can simultaneously submit an application for approval as a MassHealth provider of ABA
services, and submit prior authorization requests for
a BCBA evaluation or ABA treatment.
Q. What if a child is already receiving ABA services and has
a recent BCBA evaluation,
(e.g., as part of Early Intervention or by an Autism Waiver
provider)?
A. If an evaluation by a BCBA has recently been conducted, you
should check with MassHealth at 617-847-3786 to see if the evaluation can be submitted rather than conducting a new evaluation.
An evaluation/treatment plan conducted within the last two
months should be acceptable.
Q. Will Early Intervention ABA providers be approved as
MassHealth ABA providers?
What about ABA providers in the Autism Waiver program?
A. These ABA providers are encouraged to apply as MassHealth
approved providers. This is particularly important to help ensure
that children who are aging out of EI and the Autism Waiver can
continue to receive necessary ABA services.
Q. I’m an ABA provider, what do I need to do to be paid for
cost sharing for children with private insurance that covers
IT’S A FACT:
Autism is the fastest growing serious
developmental disability in the United States.
Ask the
Advocate
Ask the Advocate! August
Fathers Needed for Study
Question: “Can you have an IEP meeting in the summer?”
Answer: Yes
The rules don’t change over the summer. If necessary you can request a meeting although the entire team
may not be available to meet and the parents would need to
excuse those team members. The meeting can consist of the
parent and administrator if the issue does not require the full
team.
Sometimes for an amendment to the IEP a meeting
is not necessary. A direct request in writing with your ideas
to special education administration may be appropriate. The
school has a “reasonable” amount of time to respond. Ask
that the school responds on a notice form (N1, N2).
If you need an advocate, please call our Advocacy Intake
Coordinator at: 1-978-762-8352
NORTHEAST ARC DANCES!
August 21, 6:30 to 8:30
Knights of Columbus
96 Main Street, Peabody
Open to all
Join us at our new site, KoC banquet hall
in Peabody. Dress to impress! Dance to
your favorite songs played by the one
and only, DJ Dave. $15 per person.
August 25, 6:30 to 8:30
Knights of Columbus
177 Lynnfield Street, Lynn
22+ years
This dance is open to adults 22 years and
older. We dance and have a lot of fun.
Drinks are provided for everyone in the
downstairs reception room, and we provide the snacks.
$10 per person (support staff free).
Contact the Rec Dept for more info
978-624-2308.
AANE CONFERENCE ON ANXIETY
Accepting the Challenge:
Practical and Effective Strategies for Students with Anxiety
IT’S A FACT:
Northeast Arc is the fourth largest Arc in the coun-
Sensory friendly
movies at AMC
theatres
Join AMC Theatres and the Autism Society special showings of
the following movies. Movies will be shown at 10 a.m. local time in
participating theatres nationwide.
MOTHERS’ RETREAT
All shows are at 10:00 am local time. Dates and films are subject to change.
Saturday, July 18, 2015 - MINIONS
Saturday, Aug, 2015 - TBD
Saturday, Sep 26, 2015 - HOTEL TRANSYLVANIA
Saturday, Oct 17, 2015 - THE JUNGLE BOOK
Saturday, Nov 14, 2015 - THE PEANUTS MOVIE
Saturday, Dec 5, 2015 - THE GOOD DINOSAUR
Local theatres:
AMC Burlington, 20 South Ave, Burlington
AMC Braintree, 12 Grandview Road, Braintree
AMC Framingham 15, 22 Flutie Pass, Framingham, Mass. 17014
AMC Tyngsboro 12, 440 Middlesex Road Tyngsboro, Mass. 01879
AMC Loews Methuen 20, 90 Pleasant Valley St. Methuen, Mass.
01844
AMC Theatres (AMC) and the Autism Society have teamed up to
bring families affected by autism and other disabilities a special opportunity to enjoy their favorite films in a safe and accepting environment on a monthly basis with the "Sensory Friendly Films" program.
MASSHEALTH UPDATE
(CONTINUED FROM PAGE 3)
ABA and MassHealth secondary coverage?
A. Almost all children and youth under age 21 with MassHealth secondary are enrolled with MBHP. Providers need to call
MBHP to be authorized (this is separate from MassHealth ABA enrollment). This MBHP authorization process is easier and
more expeditious than the MassHealth ABA approval process. For information about this authorization, ABA providers can email Garland.Russell@valueoptions.com. Once authorized, providers can call community relations for information on submitting an Explanation of Benefits showing that cost sharing is due: 1-800-495-0086. This process is not expected to change on
October 1, 2015.
Q. Is MBHP covering co-pays for ABA services that providers have already delivered this year?
A. Yes. MBHP is processing provider claims for cost-sharing for dates of service back to May 18, 2015. Since MBHP will not reimburse members, families may contact providers for reimbursement paid since then. Providers should be prepared to reimburse
members for cost-sharing that they can now receive from MBHP.
Q. How does the process for providing ABA services change after October 1, 2015?
A. After October 1, 2015, MassHealth Managed Care plans are expected to assume responsibility for covering ABA services for
children and youth under age 21 who are enrolled in MassHealth Standard, CommonHealth or Family Assistance. Starting in early August, providers should contact the Managed Care plans about each plan’s procedure for joining the plan’s network and obtaining authorization for ABA services for its members. The plans will be required to continue paying claims for services authorized prior to October 1, 2015 from out-of-network providers for a 90-day period to avoid interruption in covered services for their
members.
1 Children who are covered by Family Assistance will also be entitled to medically necessary ABA services in October. Additional
information will be provided as process and procedures are clarified by MassHealth.
Massachusetts Advocates for Children, 617.357.8431 www.massadvocates.org
During a
IT’S A FACT:
SIBSHOPS
Autism is the fastest growing serious
developmental disability in the United States.
Family Meet & Greet
Sibshops Sibling Support
Group for Youth Ages 12-15
BY ADAM QUINN, DIRECTOR
Fridays
6:30—8:00
August 28, 2015—Ice Cream Social—6
Southside Rd, Danvers
Cost: $15 per event
Come To One To One or Come To Them
All!
Space is limited! To register, please contact
Virginia Flister 978-624-2380 or Vfllister@nearc.org
Group Topics Include:
♦
♦
♦
♦
♦
Getting to know the group
Sharing and relating to one another
Learning about your sibling’s strengths and challenges
Coping with stress and strong emotions
Responding to questions about your sibling
ADVOCACY BOOTCAMP
MASS. FAMILIES ORGANIZING FOR CHANGE
Life for your family not what you expected?
Still adjusting to your child’s needs?
Want time to rejuvenate while preparing for the future?
Need a reminder that possibilities for your child are endless?
Join others raising young children with developmental disabilities and chronic illnesses for an exciting training where you’ll learn how to utilize your strengths to
make you child’s world bigger and his or her future brighter.
ADVOCACY BOOTCAMP
Saturdays, 9am-12pm
Lexington
September 19, 26, October 3, 17, 24, 31
Applications can be found online and are due August 19. www.mfofc.org
Questions? Contact Sophia Johansson at o.sophia.johansson@gmail.com
Limited funds for respite care may be available.
It is hard to believe that it has already been six months since I
Thanks!
Adam Quinn
Director of Recreation and Leisure
Northeast Arc
(978) 624-2308
AQuinn@ne-arc.org
IT’S A FACT:
Autism is the fastest growing serious
developmental disability in the United States.
Where’s Your
Center?
The Department of Developmental Services (DDS) provides funding for family support programs and services across the state
designed to provide information, assistance, and an array of supportive services to families with children and adults with disabilities who are living at home.
Family Support Centers across the state provide a local presence
and act as a hub for offering a wide range of general family support services and activities to families of children and adults who
are eligible for DDS services.
In addition, DDS funds Autism Support Centers, specialty programs serving families living with autism. A family may receive
services from both Centers.
Dealing With Your Escape Artist
CONTRIBUTED BY THE NORTHEAST ARC BEHAVIORAL HEALTH TEAM
We’ve heard a lot lately about raising “free range” kids, given them plenty of unstructured time and opportunity to explore their own interests and world. For families with
children with “elopement” behavior (running away, wandering off, bolting off) the
phrase “free range” may instill panic or seem out of the question for their child. Trips to
the park, soccer practice, the walk from the house to the car, even unsupervised time
in a friend’s house could result in elopement behavior. Here are some steps that may
help:
Find your local Family Support Center below, and give them a
call! You may be surprised at the array of programs and services
they offer.
Take necessary safety precautions:
This can mean notifying the police and fire departments of your child’s needs and information, securing exit point in your home and yard, installing bells or chimes. Investing in identification bracelets, teaching your child his or her name, address, and telephone number, and considering a GPS device. When you go to a new place, talk to
people ahead of time and ask questions so you can feel more comfortable and prepared.
DDS REGION 3 FAMILY
SUPPORT CENTERS
Merrimack Valley Area
Fidelity House Human Services
Merrimack Valley Family Support Center
One Parker Street, Lawrence, MA 01843
(978) 685-9471 (x157)
Sue Lunn slunn@fidelityhhs.org; www.fidelityhhs.org
Metro North Area
The Arc of East Middlesex
The Arc of East Middlesex Family Resource Center.
26 Princess Street, Wakefield, MA 01880
(781) 587-2314
Judy Santamaria judysantamaria@theemarc.org
www.theemarc.org
North Shore Area
Northeast Arc
Northeast Arc Family Resources
6 Southside Road, Danvers, MA 01923
(978) 624-2381
Aymee Lucifora alucifora@ne-arc.org www.ne-arc.org
Central Middlesex Area
Riverside Community Care
Riverside Family Support Center
300 West Cummings Park, Suite 354, Woburn, MA 01801
(781) 801-5247
Kristen D’AndreaKdandrea@riversidecc.org
www.riversidefamilysupport.org
Lowell Area
LifeLinks, Inc.
LifeLinks Family Support Center
258 Mill Road, Chelmsford, MA 01824
(978) 349-3040
Rachel Ward-Sullivan rwardsullivan@lifelinksinc.net
Amy Young ayoung@lifelinksinc.net www.lifelinksinc.net
Cambodian Mutual Assistance Association of Greater
Lowell
Cultural/Linguistic-Specific Family Support Center
Monorom Family Support Program
120 Cross Street, Lowell, MA 01854
(978) 454-6200 ext.1026
Brian Chen bchen@cmaalowell.org www.cmaalowell.org
Specific Ethnic/Linguistic Group:
Cambodian families
Teach skills:
Understanding the drive behind the bolting can help us in teaching a replacement skill.
Is your child looking back and laughing, thinking running a game? Teaching the child
to request “chase” or “tag” and the appropriate places, then giving them plenty of opportunity to do so when appropriate, may help. Does your child bolt to escape an unpleasant trip or loud sound? Knowing the triggers can help you be prepared beforehand to provide a warning, gain physical proximity so you can intervene, and prompt your child to request to leave, so you can help him or her exit safety. Does your child bolt towards favorite toys? Prompting for communication before the bolt or keeping a preferred item close by so that he or she doesn’t
need to run may help. Does your child just love to run? Finding ways to channel that energy into appropriate, safe activities (sports
activities, swimming) may reduce the impulse to engage in the behavior whenever an opportunity presents.
•
•
•
Set yourself up for success:
Review Expectations: Just before moving to a space where bolting is possible, review expected behaviors and have the child
practice. Give yourself plenty of time to do this so it doesn’t feel rushed for you or the child.
Bring Back Up: Invite extra people who you can trust to help support you and your family so you have more energy to enjoy the
experience.
Be Realistic: Choose activities that you think you can be successful with. An 8-hour day at the beach with three young kids and
one adult may not be it. A picnic to a park with a fence and the babysitter may be smaller scale, but ultimately more fun.
It’s summer, and as adults we all know
the feeling of just wanting to take off,
get away, and explore new things. Planning for safety and teaching communication can help shape that impulse and
nurture healthy curiosity we can all appreciate.
Northeast Arc Behavioral Health Services Director, Stacey Villani, can be
reached at 978-624-2340.