Children Under Three
Children under the age of three are not eligible for funding through school districts. In the state of New Hampshire, funding for services for children 0 - 2 is handled through Family Centered Early Supports and Services.
Process:
- Contact the Intake Coordinator of the New Hampshire Region in which you live and request an assessment of your child.
- An intake and multidisciplinary assessment will be arranged for you through the Intake Coordinator
- Following the assessment, an Individual Family Service Plan (IFSP) will be developed for your child and family. This plan will be composed of goals and objectives for your child based on the results of the multidisciplinary assessment. Once goals and objectives have been identified, the services necessary to meet those goals and objectives will be determined. Services contained in IFSP's are funded through Family Centered Early Supports and Services.
It is important to understand that your child will only receive funding for ABA therapy through Family Centered Early Supports and Services if it is included in your child's IFSP. If you have questions or concerns about the services offered in the IFSP, you should gain the advice of a private ABA professional or Parent Advocate to assist you in ascertaining the appropriateness of services and service providers offered.
If you are unable to receive ABA services through your child's IFSP, you may be able to receive funding through Medical Insurance.
TOP
Children Three and Older
Children between the ages of 3 and 21 are entitled to receive a Free and Appropriate Public Education (FAPE) under both state and federal law. Funding for all services necessary to deliver FAPE is the responsibility of the Local Education Agency (LEA). ABA therapy may be included as a component of a child's Individualized Education Program (IEP) if the child requires the service to make adequate progress and receive FAPE.
In order to receive funding for ABA services through the school district, your child must be identified as a child in need of special education services and must have an IEP. If your child does not have an IEP, you will need to refer your child for a special education evaluation to your school district.
Process:
- Contact the Child Find Team in your school district and state that you are referring your child for special education services. To find the Child Find Coordinator, call the office of the School Administrative Unit (SAU) in which you live. Provide the Child Find Team with a written statement of all of your areas of concern (i.e. areas in which your child seems delayed) and include any supporting documentation (from physicians, therapists, school personnel, etc.)
- Within 15 days of your referral, you should receive a written response from the Child Find Team. This response may indicate that further evaluations need to take place. If further evaluations are required, the Team will request your permission to perform assessments on your child. Alternatively, the Child Find Team's response may indicate that your child's needs can be met by services already available to all students within the school district. If you receive this response, you have the right to request Alternative Dispute Resolution if you disagree.
- After all necessary evaluations have been completed, an IEP Team Meeting will take place to review evaluations, as well as any additional information available (school records, independent reports, information from parents, etc.). The IEP Team (including the parents) will determine whether the child is a child with a disability requiring special education services based on the available evidence.
- If a child is determined to have an educational disability, the IEP Team will create an Individualized Education Plan designed to meet the child's individualized needs and provide FAPE to the child. Measurable goals and objectives will be developed and the services to meet those goals and objectives will be decided upon. Finally, the Team will determine the most appropriate placement for the child based on the required services and the child's needs.
You may want to contact a Parent Advocate for advice on how to initiate and navigate this process.
If your child has a current IEP, your child's IEP Team must determine that ABA therapy is required in order for your child to make adequate progress in IEP goals and objectives (i.e. receive FAPE) to receive funding from the school district.
If your child's IEP Team agrees that ABA services are appropriate, there are a wide variety of services they might offer, ranging from services provided by classroom aides to contracting with a private ABA provider. If you have questions or concerns about the ABA services offered, you should gain the advice of a private ABA professional or Parent Advocate to assist you in ascertaining the appropriateness of services and service providers offered.
If you are unable to receive ABA services through your child's IEP, you may be able to receive funding through Medical Insurance.
TOP
Medical Insurance
Autism Bridges has in network status with United Behavioral Health and Harvard Pilgrim.
Depending on your specific plan, you may be eligible for coverage for ABA services or may be limited to coverage required under Connor's Law (See below). Out-of-pocket expenses (copays, deductibles, etc.) also vary from plan to plan.
If you do not have coverage through United Behavioral Health and Harvard Pilgrim you may still be able to gain funding for ABA services through your medical insurance policy. In New Hampshire, ABA services are specifically addressed through "Connor's Law" (RSA 417-E:2) enacted January 1, 2011.
Connor's Law provides a state mandate that private* insurance companies operating in New Hampshire must follow.
*ERISA ("self-funded") medical insurance plans are subject to federal regulation and are not subject to Connor's Law.
You may be informed that only in-network providers are covered by your insurance carrier. If this is the case, you should request that your carrier give you a list of in-network ABA Therapy providers who are professionally certified by the national Behavior Analyst Certification Board (BACB). Under Connor's Law, ABA Therapy is eligible for health insurance coverage only if it is provided by (or performed under the supervision of) a person professionally certified by the BACB. The person must be a Board Certified Behavior Analyst (B.C.B.A). If your insurance carrier does not have in-network providers with a B.C.B.A certification, you should request that your carrier authorize payment for an out-of-network provider who meets the Connor's Law criteria. You may need to send a copy of RSA 417-E to your health insurance carrier to demonstrate the need for out-of-network services.
Process:
- Schedule an Intake with the ABA provider. The ABA provider will contact your insurance carrier to obtain authorization for an intake evaluation. Some carriers (such as Optimum) provide preauthorization while others will require you to send your invoices or claims after the intake to seek reimbursement.
- Once an intake report has been prepared, the ABA provider will request authorization for the recommended services from your insurance company based on Health Codes or CPT (Current Procedural Terminology) Codes depending on the insurance carrier.
- Codes may differ among carriers. You should contact your insurance carrier to see what codes are accepted and provide this information to the ABA provider.
- At this time, Autism Bridges will fill out specific claim forms for insurance carriers and attach invoices to the claims for parents to submit.
If the ABA provider is unable to secure authorization from your insurance carrier or if your claims for reimbursement are denied, you will be held responsible for all costs associated with treatment.
Depending on your individual insurance carrier and policy, you may have to work assertiely with your insurer to obtain authorization for your child’s treatment. The following steps are adapted from ABA via Insurance by Beverly Chase:
- Ask your child's primary care physician or other care provider (developmental pediatrician, neuropsychologist, etc.) to write a letter requesting ABA services on your child's behalf with your child’s diagnosis with diagnosis code. It may be helpful to provide a template. Make certain that the letter is written on professional letterhead and is signed and dated. Ask the provider to send the letter to you (rather than the insurance company). You may request letters from more than one provider
- While waiting for the letter(s) from your health provider(s), contact your insurance carrier and request that a case manager be assigned to your child. It will be helpful for you to have a single individual to contact on an ongoing basis. You may need to make this request in writing and/or request to speak to a supervisor.
- Once you have a case manager, inform this individual that you have a child with an Autism Spectrum Disorder and that your child's physician has prescribed ABA therapy with associated CPT codes or Health Codes for your child. Ask what steps you need to take to receive authorization from the insurer. Follow the steps given (one of which will almost certainly be sending a letter from a health provider).
- If the case manager states that ABA is not covered by your health insurance or indicates in some other way that obtaining coverage may be difficult, inform the individual that you have a copy of RSA 417-E as well as a physician's order for medical treatment. Ask the individual for his/her mailing address and inform him/her you will be sending the information.
- Write a cover letter stating your request for coverage of medically necessary ABA services for your child. Attach a copy of RSA 417-E, a copy of the intake evaluation from your ABA provider, and a copy/copies of provider letter(s) to your cover letter. In the cover letter, request that you be contacted immediately for a response to your request. Send the letter certified mail, return receipt requested. Make sure to keep copies of all communication.
- Make sure to follow up with the case manager 1-2 weeks after mailing the information.
- If your insurance carrier denies coverage or rejects claims, you have the right to appeal. The appeals procedure is outlined in your benefits handbook, or GSA (Group Service Agreement).
TOP
|
