An article in the Volume 22, No. 1, Spring 2010 issue of Behavior Analysis Digest International describes a service delivery model in which the hiring of Board Certified Behavior Analysts® as full-time employees of school districts, rather than on a contract basis for the equivalent services, resulted in substantial cost savings. The article is reprinted in its entirety, and any changes are purely for typesetting purposes.
" School districts Hire Behavior Analysts, Save Money - Lots of Money.
Eric Burkholder, Dublin Unified School District; Chelsea J. Wilhite, University of Nevada, Reno; Rebecca Peck, Livermore Unified School District; Carla A. Epps, and Julia H. Fiebig, San Ramon Valley Unified School District; Lorien Quirk and Joel Vidovic, Mount Diablo Unified School District.
San Francisco - In the current financial climate, states are cutting funding to public school districts. Districts are investigating service delivery models in attempts to determine cost-effective ways to provide services to students, including those eligible for special education. School districts' critical examination of costs extends to services historically provided by behaviorally-oriented, non-public agencies. Now some California districts have hired board certified behavior analysts to provide behavior analytic services as full-time district employees, rather than contracting the same service, and money is being saved.
The addition of a full-time behavior analyst as a school district employee can have many impacts on the service delivery system within a school district. The impact of having an in-house behavior analyst may increase staff ability to manage students' behaviors, increase capacity to serve students with autism and other disorders and allow better service delivery of services using scientifically validated techniques and it saves cash. Three school districts in California have found that the addition of full-time behavior analysts is a cost effective approach to delivering these services.
The three suburban school districts are located in California's San Francisco Bay Area. Dublin United States School District, Mount Diablo Unified School District and San Ramon Valley Unified School District. All three, prior to hiring behavior analysts, had significant expenditures for behavioral consultants and behavioral non-public agencies that serve special education students. The services took several forms, including individualized consultation services written into students' IEPs, class-wide consultation as part of ongoing service delivery, individual educational evaluations and staff training. As part of cost control and quality control all three schools decided to hire board certified behavior analysts (BCBA's) full-time.
All three school districts reported an average reduction in costs compared to when they had contracted behavioral services: $244,108 per behavior analyst hired! "
Prefacing note: While this report is being shared as a "news item of interest" as a public event in progress, it seems relevant at this time to state that this report is not taking an editorial position on the legal aspects or allegations of this case nor the specific claimants, nor does this constitute legal interpretation. Please see the court documents for relevant specifics.
"...does Kaiser's health plan contract exclude from coverage Applied Behavior Analysis therapy or speech therapy for autism spectrum disorders on the grounds that such therapies are “non-health care services,” “academic or educational interventions,” or “custodial care”? Second, assuming that the therapies are excluded from coverage by the health plan contract, does the Mental Health Parity Act allow Kaiser to categorically apply such exclusions on the basis that the therapies are not health care services, or are provided by persons not licensed or certified by the state?..."
An amended reconciliation bill H.R. 4872 passed in the U.S. House Thursday night, March 25, 2010 by a vote of 220 to 207 on the motion to concur with the Senate amendments after its return from the Senate earlier in the day. In the Senate, the vote was 56 to 42. The vote split approximately down political party lines, with Republicans in both chambers unanimously opposed.
National Public Radio reports that the first task resulting from the new laws would be establishment of a federally funded "high-risk pool" program to cover those turned down for preexisting conditions by private insurance. Currently the law would call for 90 days to do so. NPR also describes some of the related details.
Among some of the questions still circulating is the cost of the laws.
The Congressional Budget Office (CBO) recently issued reports of their assessment and analysis of national costs/benefits of health care (and education) reform specific to this legislation (H.R. 4872 & H.R. 3950).
which is the Senate version of health care reform that was originally passed by the Senate on December 24, 2009. H.R. 3590 is scheduled to be signed into law by President Obama on March 23, 2010 at 11:15 AM EDT.
Within minutes of the passage of H.R. 3590, the House also passed by a vote of 220 to 211 a reconciliation bill,
which encompasses amendments to H.R. 3590 proposed by the House. The U.S. Senate still has to deliberate and approve H.R. 4872; it is required to commence those deliberations after H.R. 3590 is enacted into law by the President's signature, to allot at least 20 hours of debate to the matter, and due to technicalities the reconciliation bill requires only a simple majority for passage. The Senate calendar shows deliberation on H.R. 4872 commencing Tuesday, March 23, 2010 at 2:15PM EDT, although it is possible that could change.
H.R. 3590 does include a behavioral health provision for mental health and substance abuse treatment, however behavior analysts are not listed among those providers explicitly identified for reimbursement as part of a treatment team. It has also been noted by Autism Votes that the behavioral health clauses as enacted do not have sufficient reach to benefit more than a relative minority of families seeking ABA services, since this coverage is not required for all plans excepting,
(1) plans offered by state-based exchanges, through which individuals and small businesses can purchase coverage; and
(2) plans offered in the individual and small group markets outside the exchange.
The Arc struck a more optimistic note in changes that it sees as improvements in coverages, benefits and Long-Term Supports for those with developmental disabilities.
The reconciliation act, H.R. 4872 makes additional specification for covered professionals, under,
TITLE K--PROMOTING PRIMARY CARE, MENTAL HEALTH SERVICES, AND COORDINATED CARE
Sec. 1308. Coverage of marriage and family therapist services and mental health counselor services.
News reports and analysis will undoubtedly continue over the coming days clarifying the relative strengths and weaknesses of the enacted legislation, with some dependency on the outcome of the Senate actions yet to occur on H.R. 4872.
The Arc Applauds House Passage of Health Care Reform Legislation 3/22/2010
Washington, D.C. (March 22, 2010) - Press Release
Describes changes that The Arc sees as positive in coverages, benefits and Long-Term Services and Supports for those with developmental disabilities
S. 45 would classify and define detailed oversight of Level IV treatment interventions (those utilizing aversives as a last resort for dangerous or self-destructive behaviors which have failed to be resolved under less intrusive interventions) in facilities receiving public funding,
at the state level by a statewide committee of specific composition,
at a facility level by a facility peer-review committee of specific composition, and would require
direct supervision and physical presence as specified in the bill.
Standards of procedures, safeguards, required documentations, competencies of the committees and supervisors, and scope of use are defined in S.45.
S. 46 would establish a special commission to investigate and make legislative recommendation on the adequacy and effectiveness of laws and and regulations governing use of behavior modification techniques, including aversive procedures and the principles of applied behavior analysis across all public or private agencies in Massachusetts receiving public funding, including state agencies and contracted providers.
After its investigation, the commission would develop and recommend a unified set of standards for the use of behavior modification procedures in all agencies and programs licensed, funded and/or regulated in Massachusetts. The standards would include the minimum qualifications for staff involved in the development and direct implementation of aversive procedures and the review and monitoring requirements for such interventions. The commission is also required file a report the results of the investigation and recommendations with the clerks of the Massachusetts Senate and House of Representatives by a specified date.
The composition of the commission would be the following state officers or designees:
Governor, Senate President, Speaker of the House, Senate and House Chairs of the Joint Committee on Children and Families, the Chief Justice of the Probate and Family Court. the Commissioner of the Department of Developmental Services, the Commissioner of the Department Mental Health , the Commissioner of the Department of Early Education and Care, the Commissioner of the Department of Elementary and Secondary Education, the Commissioner of the Department of Children and Families, the Commissioner of the 26 Department of Youth Services, the Executive Director of the Disabled Persons Protection Commission, the Chairman of the Governor’s Commission on Mental Retardation, the Executive Director of the Massachusetts Psychological Association, and a Licensed Applied Behavior Analyst or Certified Behavior Analyst to be appointed by the Governor. The Governor would also appoint at least one disability advocate and one service provider whose agency conducts behavioral intervention programming.
This evening, March 3, 2010, the U.S. House of Representatives passed by a vote of 262 to 153, the House Committee on Education and Labor Substitute for H.R. 4247, formerly known as the "Preventing Harmful Restraint and Seclusion in Schools Act", and now renamed,
"...The Keeping All Students Safe Act would establish, for the first time, minimum federal standards to provide equal protections to all students, in every state across the country. It would make clear that physical restraint or locked seclusion should be used only when there is imminent danger of injury and only when imposed by trained staff. It would prohibit mechanical restraints, such as strapping children to chairs, misusing therapeutic equipment to punish students or duct-taping parts of their bodies and any restraint that restricts breathing.
It would also prohibit chemical restraint, which are medications used to control behavior that are not consistent with a doctor’s prescription.
The bill would prohibit school staff from including restraint or seclusion as planned interventions in student’s education plans, known as Individualized Education Programs (IEPs). It would also require schools to notify parents immediately after incidents when restraint or seclusion was used..."
If H.R. 4247 progresses to Federal law, it would apply to all public and private schools which accept Federal funding, and all states would be expected to comply with, if not exceed, the conditions specified in the bill.
The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury on January 29, 2010 issued the awaited interim final rules [http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf ] resulting from passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The notice/press release below outlines changes resulting from the passage of MHPAEA, and requests comment during a comment period of 90 days on certain areas of the interim final rules. While the notice/press release is retained in full, some areas have been highlighted and bulleted to emphasize important areas of the law's requirements, areas that comment are being requested for, how to submit comments on the MHPEA interim rules, and how to request materials in an alternative accessible format. ----------------------------------------
Paul Wellstone, Pete Domenici Parity Act prohibits discrimination
WASHINGTON, Jan. 29 /PRNewswire-USNewswire/ -- The U.S. Departments of Labor, Health and Human Services (HHS), and the Treasury today jointly issued new rules providing parity for consumers enrolled in group health plans who need treatment for mental health or substance use disorders.
"Today's rules will bring needed relief to families faced with meeting the cost of obtaining mental health and substance abuse services," said U.S. Secretary of Labor Hilda L. Solis. "The benefits will give these Americans access to greatly needed medical treatment, which will better allow them to participate fully in society. That is not just sound policy, it's the right thing to do."
"The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care," said Secretary of Health and Human Services Kathleen Sebelius. "I applaud the longstanding and bipartisan effort that made these important new protections possible."
"Workers covered by group health plans who need mental health and substance abuse care deserve fair treatment," said Deputy Treasury Secretary Neal Wolin. "These rules expand on existing protections to ensure that people don't face unnecessary barriers to the treatment they need."
The new rules prohibit group health insurance plans — typically offered by employers — from restricting access to care by limiting benefits and requiring higher patient costs than those that apply to general medical or surgical benefits. The rules implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
MHPAEA greatly expands on an earlier law, the Mental Health Parity Act of 1996, which required parity only in aggregate lifetime and annual dollar limits between the categories of benefits and did not extend to substance use disorder benefits.
The new law requires that
any group health plan that includes mental health and substance use disorder benefits along with standard medical and surgical coverage must treat them equally in terms of out-of-pocket costs, benefit limits and practices such as prior authorization and utilization review.
These practices must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits.
For example, a plan may not apply separate deductibles for treatment related to mental health or substance use disorders and medical or surgical benefits. They must be calculated as one limit.
MHPAEA applies to employers with 50 or more workers whose group health plans choose to offer mental health or substance use disorder benefits.
The new rules are effective for plan years beginning on or after July 1, 2010.
The Wellstone-Domenici Act is named for two dominant figures in the quest for equal treatment of benefits. The late Sen. Paul Wellstone, D-Minn., who was a vocal advocate for parity throughout his Senate career, sponsored the ultimately successful full parity act. He was joined by former Sen. Pete Domenici, R-N.M., who first introduced legislation to require parity in 1992. Champions of the legislation also included the bipartisan team of Rep. Patrick Kennedy, D-R.I., and former Rep. Jim Ramstad, R-Minn.
The issue of parity dates back more than 40 years to President John F. Kennedy, and also was supported by President Clinton and the late Sen. Edward Kennedy.
The released interim final rules released today were developed based on the departments' review of more than 400 public comments on how the parity rule should be written. Comments on the interim final rules are still being solicited.
Sections where further comments are being specifically sought include so-called "non quantitative" treatment limits such as those that pertain to the
scope and duration of covered benefits,
how covered drugs are determined (formularies) and
the coverage of step-therapies.
Comments are also being specifically requested on the regulation's section on "scope of benefits" or continuum of care.
Comments on the interim final regulation are due 90 days after the publication date. Comments may be emailed to the federal rulemaking portal at http://www.regulations.gov.
Comments directed to HHS should include the file code CMS-4140-IFC.
Comments to the Department of Labor should be identified by RIN 1210-AB30.
Comments to the Treasury's Internal Revenue Service should be identified by REG-120692-09.
Comments may be sent to any of the three departments and will be shared with the other departments.
Please do not submit duplicates.
U.S. Department of Labor releases are accessible on the Internet at http://www.dol.gov. The information in this news release will be made available in alternate format (large print, Braille, audio tape or disc) from the COAST office upon request. Please specify which news release when placing your request at 202-693-7828 or TTY 202-693-7755. The Labor Department is committed to providing America's employers and employees with easy access to understandable information on how to comply with its laws and regulations. For more information, please visit http://www.dol.gov/compliance.
SOURCE U.S. Department of Labor
RELATED LINKS http://www.dol.gov ------------------------------------ For more information:
Federal Register: Tuesday, February 2, 2010 Part IV: Department of the Treasury, Internal Revenue Service, 26 CFR Part 54 Department of Labor, Employee Benefits Security Administration, 29 CFR Part 2590 Department of Health and Human Services, Centers for Medicare & Medicaid Services, 45 CFR Part 146 Interim Final Rules Under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; Final Rule http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf
Good summary article of the rules release, application and comment submission Registration required to access. Interim rule issued on mental health parity ModernHealthcare.com By Jessica Zigmond Posted: January 29, 2010 - 5:59 am ET
Prefacing note: While this report is being shared as a "news item of interest" as a public event in progress, it seems relevant at this time to state that this report is not taking an editorial position on the legal aspects or allegations of this case nor the specific claimants, nor does this constitute legal interpretation. Please see the court documents for relevant specifics.
On Wednesday, January 27, 2010, a decision authored by Justice Laurie D. Zelon of the Court of Appeals of California, Second District, Division Seven was handed down in California reversing a lower court ruling, and remanding to trial court with directions; this decision allows a previously filed suit to proceed to trial. The suit filed by Arce alleges that an insurer improperly denied applied behavior analysis and speech services as categorical practice and that such denial on the specified basis constitutes violation of California's Mental Health Parity law (AB88: Insurance Code §§10144.5 & Health and Safety Code§1374.72 ). Another aspect of the case in question is the provision of service by providers that are not licensed or state certified. The case in question is ARCE v. KAISER FOUNDATION HEALTH PLAN, INC.
----------------------------- FOR FURTHER INFO/FURTHER READING
Decision transcript From Leagle, inc. ARCE v. KAISER FOUNDATION HEALTH PLAN, INC. ANDREW ARCE, a Minor, etc. et al., Plaintiffs and Appellants, v. KAISER FOUNDATION HEALTH PLAN, INC., et al., Defendants and Respondents. B215861. Court of Appeals of California, Second District, Division Seven. Filed January 27, 2010.
Other articles and reports related to ARCE v. KAISER FOUNDATION HEALTH PLAN, INC. and regulation of ABA coverage C.A. Revives UCL Action Against Kaiser Over Autism Services By KENNETH OFGANG, Staff Writer Metropolitan News-Enterprise Thursday, January 28, 2010
