Summary of Legislation• Final draft signed onApril 2nd, 2012– Applies to statemandated plans• PEIA• CHIP• BCBS– Does not include…• Self-funded plans• Medicaid/Medicare• Small businesses
Coverage for ABA Services• Annual Maximum Benefit $30,000– First 3 years of services– Reduced to $2,000 a month thereafter• Services must be provided by or supervised byBCBA– WWW.TRAINWV.ORG– WWW.BACB.COM
How to Qualify• Treatments that are medically necessary– Prescribed by licensed physician or a licensedpsychologist• Age limitations– 18 mos – 18 yrs– By age 8
Continuation of Services• Progress reports– Condition is improving in response to treatment– Maximum improvement has not be attained– Anticipated improvement is attainable in agenerally reasonable amount of time.
TRAIN WVTraining and Resources for Autism Insurance NavigationOur goal is to increase access toeffective, empirically validatedservices to individuals withautism across the mountain state.
TRAINWV: A Brief Background• Training and Resources for Autism InsuranceNavigation– Grant funded project– identify implementation issues– Work with stakeholders to find solutions– Disseminate information– Run a demonstration and training facility
Highlights Over the Past Year• Resources– WWW.TRAINWV.ORG• Connect with providers• Discussion board• Additional Resources– Slideshows– Copy of legislation– FAQ about autisminsurance reform law
Highlights Continued• Newsletter– Cover current issues– FAQ– Share providerinformation• Brochure• Find us on FB!
Highlights Continued– Raising Awareness• Light it up blue!• Walk A Mile in Our Shoes• Media– Public Access– WBOY• 4 part series• Major Projects (Current)– PEIA policy– Pediatrics packet– Provider database
Lessons Learned• Limited coverage– Percent of eligible population• Limited resources– 4,300 children– 44 registered BCBAs• Limited education– Insurance plans that follow a medical model– Parents unaware of rights– Providers• Bill issues• Lack of connection with community
Suggested Next Steps• MOTIVATE and EMPOWER– Change in self-funded policies• Continue to train and educate next generationof BCBAs– (# students)– Undergraduate course sequence• TRAIN as a platform for communication