2. Summary of Legislation
• Final draft signed on
April 2nd, 2012
– Applies to state
mandated plans
• PEIA
• CHIP
• BCBS
– Does not include…
• Self-funded plans
• Medicaid/Medicare
• Small businesses
3. 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 by
BCBA
– WWW.TRAINWV.ORG
– WWW.BACB.COM
4. How to Qualify
• Treatments that are medically necessary
– Prescribed by licensed physician or a licensed
psychologist
• Age limitations
– 18 mos – 18 yrs
– By age 8
5. Continuation of Services
• Progress reports
– Condition is improving in response to treatment
– Maximum improvement has not be attained
– Anticipated improvement is attainable in a
generally reasonable amount of time.
6. TRAIN WV
Training and Resources for Autism Insurance Navigation
Our goal is to increase access to
effective, empirically validated
services to individuals with
autism across the mountain state.
7. TRAINWV: A Brief Background
• Training and Resources for Autism Insurance
Navigation
– Grant funded project
– identify implementation issues
– Work with stakeholders to find solutions
– Disseminate information
– Run a demonstration and training facility
8. Highlights Over the Past Year
• Resources
– WWW.TRAINWV.ORG
• Connect with providers
• Discussion board
• Additional Resources
– Slideshows
– Copy of legislation
– FAQ about autism
insurance reform law
10. Highlights Continued
• Events
– Stakeholders meeting
• Collaborative event to
identify implementation
issues
– Conferences
• AUCD
• ABAI
• Annual Families
Conference
• University colloquia
11. 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
12. 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
13. Suggested Next Steps
• MOTIVATE and EMPOWER
– Change in self-funded policies
• Continue to train and educate next generation
of BCBAs
– (# students)
– Undergraduate course sequence
• TRAIN as a platform for communication