These resources are a list of links and websites for you to explore further. Social Skills Playhouse does not endorse or suggest a particular company, link or website, or third party website that links to information shared below. Social Skills Playhouse will not be held liable for unintentional misinterpretations or incorrect statements provided by these resources. Social Skills Playhouse explicitly disclaims any responsibility for the accuracy, content, or availability of information found on the sites that link to or from our site from third parties not associated with us. Information provided here is never substitute for the advice provided by your own physician or other medical professional.

Autism and ABA

First 100 Days Kit 

http://www.asatonline.org/

Applied Behavior Analysis – ABA

https://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba

Resources inTexas:

Autism Society of Collin County (Texas)
Autism Society of Greater Tarrant County (Fort Worth)
The Denton County Autism Society
Families for Early Autism Treatment (FEAT) Houston
FEAT – North Texas (Dallas/Fort Worth)
Texas Gulf Coast ASA Chapter

Financial Resources

Social Security Income (SSI)

Supplemental Security Income (SSI) is a Federal income supplement program funded by general tax revenues (not Social Security taxes): it is designed to help people with severe disabilities who have little or no income pay for food clothing and shelter. For an applicant under 18 years old, the entire family’s income is considered in determining eligibility. For an adult, only the applicant’s income is considered. For more information, go to http://www.socialsecurity.gov/ssi//  

Financial Assistance from the State of Texas

If you have a child with autism, you should get on the very long “interest” (waiting) lists to apply for financial aid from the State of Texas. In Austin, call the Texas Department of Aging and Disability Services (DADS) at 1-877-438-5658 to get on the list for CLASS (Community Living Assistance and Support Services). All it takes to get on the list is your child’s name, address, and telephone number.

Also, call your Local Authority to get on the interest list for HCS (Home and Community-based Services) and/or MDCP (Medically Dependent Children’s Program). You can schedule an intake interview or do it by mail. You may also qualify for other services from the agency that are available now. Go to http://www.dads.state.tx.us/contact/DADSServicesByCounty.html to find the right office.

When your name comes to the top of the CLASS and HCS lists in a number of years (the waiting list for HCS is over 10 years long), then you actually apply. These funds can be used for a variety of treatments and supports, and eligibility is not based on the income of the family. But you need to get on the lists as soon as possible.

Another state program is the Texas Health Insurance Premium Payment (HIPP) program. If someone in your family is on Medicaid and someone else in your family is eligible for health insurance through his/her job, the HIPP program might help you. For more information, call

1-800-440-0493 or go to http://www.gethipptexas.org/index.html or http://gethipptexas.com

DARS Autism Program

The DARS (Department of Assistive and Rehabilitative Services) Autism Program serves children with autism through contracts with community organizations in and around these cities: Austin, Corpus Christi, Dallas, El Paso, Ft. Worth, Houston, San Antonio.

The Autism Program serves children who are three through fifteen years of age; have a diagnosis on the autism spectrum; and are Texas residents. Services include applied behavioral analysis (ABA) and other positive behavior support strategies in both individual and group settings.

http://www.dars.state.tx.us/stakeholders/autism/

The Center for Autism Related Disorders (CARD), an ABA Clinic in Austin, receives funding through the DARS Autism Program to serve children in Travis, Williamson, Bastrop, Hayes, Blanco, and Burnet Counties. Contact CARD for more information (512-330-9520); cardaustin@centerforautism.com; www.centerforautism.com).   The Autism Treatment Center in San Antonio is the contracting agency for children in Bexar and surrounding counties. Contact Lauren Alvarado (210-599-7733).  

Texas Education Agency Noneducational Community-Based Support Services

The 74th Texas Legislative appropriated funds to provide noneducational community-based support services for certain students with disabilities and their families to help them care for their children with severe disabilities, and to enable them to better cope with having an individual with a disability at home. Students with autism can only be approved for respite care or attendant care. For more information about the funds and the application process, go to

http://www.tea.state.tx.us/index2.aspx?id=2147497817

Talk About Curing Autism (TACA)

Since 2006, TACA has provided medical scholarships to families living with autism. These scholarships help families pay for physician-prescribed services, and include stop gap medical treatments, independent assessments, and other necessary crisis funding. TACA continues to work hard to find scholarship opportunities that will help eligible families speed up the cycle time from the autism diagnosis to effective treatments.

The TACA Family Scholarship Program is available nationwide to help with limited financial assistance for treatment by a Defeat Autism Now (DAN) or Medical Academy of Pediatric Special Needs (MAPS) doctor.

http://www.tacanow.org/about-taca/taca-scholarships/

National Autism Association (NAA)

NAA’s Helping Hand Program provides families with financial assistance in getting necessary medical treatments, lab testing, physician-recommended supplements and therapies for their child with autism. This program does not provide funding for iPads, camp tuition, respite care, fencing, trampolines, swingsets, trips to Disney World, etc. Funding is extremely limited.  This program is intended ONLY for parents in DIRE financial need. Do not apply if your annual net income exceeds $50,000.  Helping Hand grants are one-time grants.

http://nationalautismassociation.org/family-support/programs/helping-hand/

Generation Rescue

Generations Rescue’s Rescue Family grants are designed to provide support for individuals and families affected by Autism Spectrum Disorders. Each grant recipient will receive 2-doctor visits with a specially trained physician who treats autism, vitamins, minerals and supplements for 90 days, a Generation Rescue Parent Mentor, and dietary intervention training.

This grant is only available to families who have not done biomedical treatment, with the exception of the GF/CF Diet. https://www.generationrescue.org/member-log-in/join-grant/

Johnson Center for Child Health and Development

The Johnson Center (www.johnson-center.org) is a medical clinic for the treatment of autism in Austin. The Johnson Center has some scholarship money available. To apply, contact the Johnson Center at (512) 732-8400. http://www.johnson-center.org//

The Optometry Center for Vision Therapy

OCVT is located in Austin, Texas. Dr. Briana Larson, its founder, provides free initial consultations. In addition, OCVT has a grant program which provides free services to children from low-income families. See www.ocvt.info or call (512) 401-0400.

Imagine A Way Foundation

Imagine A Way Foundation provides financial support for therapy, and also delivers a network of resources, to help families with children diagnosed with autism. Their focus is on young children. To qualify, the child must be between the ages of 2 and 6 and have an autism diagnosis from a neurologist or pediatrician. Family income must be above the current qualifying amount for children’s Medicaid in Texas (See http://www.chipmedicaid.org/en/Can-I-Get-It). Applications may be submitted through their website (www.imagineawayfoundation.org), or call 512-220-4324 to have an application mailed to you.

UnitedHealthcare Children’s Foundation, Inc.

The UnitedHealthcare Children’s Foundation is a 501(c)(3) non-profit charity dedicated to facilitating access to medical-related services that have the potential to significantly enhance either the clinical condition or the quality of life of the child and that are not fully covered by the available commercial health benefit plan. This “support” is in the form of a medical grant to be used for medical services not covered or not completely covered by commercial health benefit plans. For more information, see www.uhccf.org.

Children’s Special Needs Network

The Children’s Special Needs Network (CSNN) is a non-profit organization based in Belton, Texas that assists families and professionals in providing services for children in Central Texas who are diagnosed with physical or psychological special needs. CSNN provides a wide range of direct services and connects families with medical, educational, and social service resources in their communities. It also serves as a conduit, advocating on behalf of children in need and calling on churches, health care providers, schools, and others to rally around some of the most needy members of our Central Texas communities. See www.kevinswebdesign.com/Special/about.

ACT Today

ACT Today! Is a national nonprofit 501(c)(3) organization whose mission is to raise awareness and provide treatment services and support to families to help their children with autism achieve their full potential.  

http://www.act-today.org/act-today-grant-program.php

Autism Cares Financial Support Awards

Financial Support Awards provide financial relief up to $1,000 for individuals with ASD and their families to help cover costs associated with critical living expenses such as housing, utilities, car repair, funeral expenses, and other essential items on a case-by-case basis.   www.autismcares.org

Turtle Wing Foundation

Small educational grants for families in Fayette, Lavaca, Colorado, Victoria, Gonzales, Lee, Washington, Austin, Ft. Bend and Dewitt counties in Texas.

www.turtlewingfoundation.org

Variety of Texas’ Heart of Variety Fund

Direct financial assistance program designed to assist families in need. Families are selected based upon a self-completed application and internal Variety review.

http://www.varietytexas.org/programs/

Zach’s Voice

Zach’s Voice brings the gift of communication into the homes and classrooms of children unable to vocalize their needs and thoughts. They accept donations of used iPads, then distribute them to children in Central Texas with an autism diagnosis or a diagnosis of an early speech/language delay with suspicion of autism, who have a verified communication deficit that may be aided with the iPad and a communication app. See www.zachsvoice.org.

The Different Needz Foundation

The Different Needz Foundation awards grants to developmentally disabled individuals and the organizations that support them for medical services and equipment. Grant applications are made in January of each year and grant awards are announced in May.

http://www.differentneedzfoundation.org/grants/

Bright Steps Forward

Bright Steps Forward, Inc. is a 501c3 nonprofit organization that provides funding for intensive pediatric therapy to financially disadvantaged children with neurological disorders such as cerebral palsy, disabilities of prematurity, autism and other congenital or acquired conditions that affect their physical functioning.

Intensive pediatric therapy uses state-of-the-art therapy techniques, such as the Suit Therapy MethodA form fitting suit consisting of a cap, vest, shorts, kneepads, and specially adapted shoes, all connected to each other through a system of adjustable straps and elastic bands and Hyperbaric Oxygen Therapy. Hyperbaric oxygen therapy is a form of medical treatment that employs the use of 100% oxygen, generally inside a specialized chamber. Hyperbaric oxygen allows nonfunctional brain cells to revive and ultimately to be used in restoring function to areas of the body used in speech, cognition, movement and coordination, along with more traditional physical therapy methods to achieve rapid strides in physical strength and coordination.

Bright Steps Forward, Inc. accepts grant applications (the registration form) from individuals, regardless of their geographic location, race, gender or sexual orientation. Those found to qualify for and who receive a grant (based on financial need and documentation of illness) may attend any of the forty or so clinics nationwide that offer this type of therapy.

Small Steps in Speech

Small Steps in Speech assists children with speech and language disorders by funding supplemental therapies and treatments for individuals as well as grants to charitable organizations who serve children with communicative disorders. The organization does NOT fund iPads or ABA therapy.

http://www.smallstepsinspeech.org/

Covering the Costs of ABA

Insurance Coverage Information

Courtesy of: Families for Effective Autism Treatment (FEAT)-Houston

Retrieved from http://www.feathouston.org/resources/how-do-i-access-aba/insurance/

State Laws

            Tex. Insurance Code § 1355.015 (2007 Tex. Gen. Laws, Chap. 877; HB 1919 of 2007:, Fiscal Note)

Texas requires a health benefit plan to provide coverage for all generally recognized services prescribed in relation to autism spectrum disorder by the enrollee’s primary care physician in the treatment plan recommended by the physician. The law defines “generally recognized services” to include applied behavior analysis; speech, occupational and physical therapy; medications or nutritional supplements; and other treatments. This coverage may be subject to annual deductibles, copayments and coinsurance that are consistent with annual deductibles, copayments and coinsurance required for other coverage under the health benefit plan.  2009 Tex. Gen. Laws, Chap. 1107 (House Bill 451) amended the law to specify that a health benefit plan must provide coverage to an enrollee who is diagnosed with autism spectrum disorder from the date of diagnosis until the enrollee completes nine years of age (the law previously required coverage to an enrollee older than two years of age and younger than six years of age). If an enrollee who is being treated for autism spectrum disorder becomes 10 years of age or older and continues to need treatment, this does not preclude coverage of treatment and services. 

Where do I begin?

Getting your health insurance to reimburse/cover ABA therapy can range from as easy as submitting a claim or as hard as taking your insurance company to court.  There are many variables that affect how much your particular health plan will cover in your child’s particular case:  type of plan, child’s diagnosis, type of provider, etc..  However, take heart in that there are more people getting reimbursement for ABA therapy every day.  Filing claims with the insurance company can become overwhelming—especially if you have several young children at home.  You may wish to hire a claims specialist.  This is someone who can file the claims on your behalf and charges you a fee.  There are two national organizations through which you can find a professional who may help you.

Alliance of Claims Assistance Professional http://www.claims.org/

Medical Billing Advocates of America http://www.billadvocates.com/.

 

  • First your child must have a diagnosis from doctor, and the doctor must prescribe Applied Behavior Analysis and specify that ABA is “medically necessary”.

  • Next you need to know what type of health plan you have:  fully funded, self-funded, individual, etc.  Knowing the name of your insurance company does not tell you what kind of plan you have.  Blue Cross Blue Shield, for example, can administer a self-funded plan for one company and offer fully funded plans to another.  (NOTE:  You cannot compare the benefits that your insurance company, say Blue Cross Blue Shield, offers you to the benefits of another person at another company that uses Blue Cross Blue Shield.  Each employer buys a unique set of benefits to offer their employees based on the cost of the benefits to the company.)

  • Use your employer’s HR department as a resource to learn what coverage your child has access to.   Ask to see the Summary Plan Document for your company’s insurance program.

  • You may want to request a case manager from the insurance company so that you are not speaking with a new person each time you contact them.

  • Keep a log of your conversations with the insurance company.  Try to get as much in writing as possible.

Self-Funded Plans

About half the people in Texas are insured through self-funded plans.  This term describes plans in which the company directly pays for the health care costs and contracts with an insurance company, like Aetna or Blue Cross Blue Shield,  to administer its health plan, keeping track of the claims and paying them, for example.  The good news is that your company is the one who decides which benefits to include or exclude in the contract that they sign with the administering insurance company. The first health plans that reimbursed for ABA programs were self-funded plans.  They did this after employees advocated to secure reimbursement for ABA programs.  The amount of advocacy required has varied significantly from company to company—from a written request to the human resources department (HR) of the company to years of appeals within the company to a full blown lawsuit– but it has been done.  If your self-funded plan does not currently cover ABA, you, as an employee, can appeal directly to those decision makers within your company.  You may wish to download the PowerPoint presentation available at www.autismvotes.org under Resources that helps educate companies with self-funded plans about autism and its treatment.

This link will provide you with detailed information about self-funded plans including what the appeal process looks like: http://www.dol.gov/dol/topic/health-plans/

Another bright spot is that in 2008, as a part of the economic bailout package, the “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008” was passed to close the previously existing loopholes in mental health coverage that allowed limitations on the number of visits and dollar amounts for therapy.  The number of therapy visits has been one of the largest barriers for getting coverage of ABA because ABA differs significantly in intensity and duration from other mental health therapy models for other conditions.   If a company offers a mental health benefit, the benefits, copays and financial limits must match those offered under the plan’s medical/surgical coverages.

Fully Funded Plans

Fully funded plans are regulated by the Texas Department of Insurance (TDI)   http://www.tdi.state.tx.us/.  As of January 1, 2010, state funded plans were mandated to provide coverage to children up to age 10 years old with autism in Texas.  The legislation in the 2009 session and the 2007 sessions of the Texas Legislature:

  • redefined autism as a medical, neurobiological disorder

  • mandated that if a physician prescribes evaluations and assessments, ABA, speech, behavior training and management,  occupational therapy, physical therapy, medications or nutritional supplements for a child with autism ages 3 – 10, they must be paid for out of surgical and medical benefits rather than mental health benefits.

  • provided definitions or criteria that allow board certified behavior analysts and board certified associate behavior analysts to be considered approved providers for reimbursement.

  • included language that the mandated age range cannot be used as an excuse to stop benefits just because a child turns 11 years old.

FEAT-Houston lauds the work that Sen. Eddie Lucio Jr., Rep. John Davis, Rep. Juan Garcia, and Rep. Todd Smith have done to obtain better insurance coverage for children with autism in Texas.  The bills that accomplished this passed only as the result of grassroots advocacy throughout the state of Texas.  It is one of a series of mandate bills that have been passed in various states.  For a complete up-to-date list on state initiative throughout the country please go to http://www.autismvotes.org/site/c.frKNI3PCImE/b.3909861/k.B9DF/State_Initiatives.htm .

Clearly, more work needs to be done so that all persons with autism spectrum disorder can have appropriate services reimbursed through their insurance plan as well.

Please note that plans that are fully funded by the company or organization providing them (self-funded plans) are NOT governed by ERISA, and so are NOT affected by the passage of the “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008”

If you find yourself in a dispute with your insurance company, please contact TDI http://www.tdi.state.tx.us/.  It is also wise to “cc” all your correspondence with your state representative and state senator as well so that your case can be resolved quickly.  You can find out who represents you here: http://www.fyi.legis.state.tx.us/.

Medicaid/CHIP

Federal Medicaid requires that all reimbursable services be provided by a “licensed practitioner of the healing arts”.  At this time, there are only a few states in the US which offer licensure for board certified behavior analysts (BCBAs). Texas is not one of them, and therefore does not cover ABA therapy. Most states do not have income or asset tests for Medicaid eligibility for children who have disabilities. However, a check for services called “Behavioral Health Rehabilitation Services” is recommended. Medicaid Waivers may also be available under the “Katie Beckett Waiver”.  A child with special needs often qualifies when the parents’ income exceeds normal Medicaid guidelines. The following link has more information: http://www.tash.org/mdnewdirections/medicaid.htm

Other Funding Resources

Behavioral services may be accessed in a variety of ways. Behavioral services can be paid for with funds available through insurance, grants, federal and state agencies, and through private means. In addition, behavioral services can be provided by school, Early Childhood Intervention services, and local Service and MHMR centers.

Early Intervention Services: Birth to 3

For children under the age of 3, each state provides services under the Individuals with Disabilities Education Improvement Act (IDEIA). Each state must assess your child to determine if your child meets the eligibility criteria. In most states, the child must have an identified disability such as Down syndrome or they must qualify based on a developmental delay.

If your child is eligible, then you and the specialists will develop an Individualized Family Service Plan (IFSP). That plan will determine what services your child needs and how often they are needed. In most states, these services are free. However, in some states, the services are provided on a sliding scale. Further information about Early Intervention can be found at NICHY.org (http://www.nichcy.org/babies/Pages/Default.aspx) and at NECTAC (http://www.nectac.org/default.asp).

If you think your child has a behavioral need, contact your provider to request an assessment. In Texas call 1-866-581-9328.

Public School Provision of Behavioral Services; Students Age Three to 21

For children who are 3 years up to age 21, behavioral services are provided by the school district. If you think your child has a behavioral need, you will need to request an assessment from the district to determine if your child has a disability or if special behavioral supports are needed.

If your child has an Individualized Education Program (IEP), then you will need to request additional services for your child’s IEP. Usually a request for a functional behavioral assessment will be sufficient to start the process. Further information about behavioral service provision and public schools can be found at the US Department of Education (http://idea.ed.gov/). For information on schools, discipline and behavior, Wrightslaw carries a number of relevant articles and links (http://www.wrightslaw.com/info/discipl.index.htm).

Individuals with Disabilities Over 21

Behavioral services and supports are provided by a state agency. In Texas, the services are provided by the Department of Aging and Disabilities. In Connecticut they are provided by the Department of Developmental Services. You will need to complete various applications to be approved for funding.

In Texas: Contact the Department of Aging and Disability Services (webpage: www.dads.state.tx.us)

In Connecticut, the Department of Disability Services (webpage: www.ct.gov/dds)

United Healthcare Children’s Foundation

See: http://www.uhccf.org/

What are the grants?   The grants provide financial relief for families who have children with medical needs not covered or not fully covered by their commercial health benefit plan. The Foundation aims to fill the gap between what medical services/items your child needs and what your commercial health benefit plan will pay for.

How does the grant work?  If a grant is approved by the Regional Board of Directors for your child, the grant will help pay for approved medical services/items after your commercial health benefit plan submits payment, if any. The grant funds are not paid to you or the child outright – you work with the Foundation on submitting invoices/bills for approved medical services/items after your commercial health benefit plan submits initial payment (if any) to the health care provider.

USA armed services

“TRICARE”, the military insurance, is authorizing ABA as an educational benefit to be cost-shared under the Program for Persons With Disabilities (PFPWD). Families in the military should contact their local Tricare office to obtain a case manager under the PFPWD.” (Benefits may be limited to $1000/month.)

Health and Behavioral Health Insurance

Many states now have mandated health insurance coverage for ABA services for children with autism. However, these laws apply to certain insurance companies. Self-funded insurance companies do not have to abide by these laws. These laws only pertain to children with autism and do not include ABA services for children with other types of disabilities. (See Richard Saffran’s webpage on Autism:  http://rsaffran.tripod.com/aba.html. It has a lot of very helpful information.)

Services in Texas Only

DARS grant programs

See: http://www.dars.state.tx.us/stakeholders/autism/autismaprilaug/program-providers.html

Autism spectrum disorder (ASD) is the fastest-growing serious developmental disability in the United States, affecting an estimated 1 percent of children.1  It incorporates diagnoses of Autistic Disorder, Pervasive Developmental Disorder – Not Otherwise Specified,  Rett’s Disorder, Asperger’s Disorder, and Childhood Disintegrative Disorder. In 2008, there were approximately 50,100 Texas children under age 21 with ASD.2  With this number growing at a significant rate, there continues to be an unmet need for services. The DARS Autism Program was developed as an attempt to mitigate this need.

In August 2007, the Legislative Budget Board, in conjunction with the Office of the Governor,  instructed the Health and Human Services Commission to transfer $5 million in general revenue for the biennium to DARS to fund services, such as applied behavior  analysis (ABA), for children ages three through eight with an autism spectrum disorder. Current providers listed below:

  1. Child Study Center, Ft. Worth, TX
  2. Easter Seals-North Texas, Carrollton, TX
  3. MHMRA-Harris County, UH-CL, Houston, TX
  4. Texana Center, Rosenberg (Houston), TX
  5. Any Baby Can + TSU, San Antonio, TX
  6. Center for Autism and Related Disorders (CARD), Austin, TX