8/22/17

Many concerns have been sharedwith me by parents and providers after the meeting on 7/27/17. The following is a summary of some of the key concernsexpressed and a few of the suggestions that were made:

ATAP

Lack of consistency and clarity in the communication, such as:

-Parents receiving e-mail about a change, then being told to disregard

-Parent and providers said they were unclear about RBT deadline, which resulted in breaks in care and regression, etc.

-Logistical difficulties, such as timesheets changed two times and parent had not been told about either change, with references to attachment in e-mail an U.S. mail that were not included in either

-Sometimes parents learn about changes “though the grapevine” rather than directly

-More communication about how /why plans are changed would be helpful

RBT

Difficulty finding and keeping RBTs

-Will RBTs be willing to work for less pay? (especially since they do not receive any benefits)

-Rural communitieshave extra hurdles, such as: Competition with higher paying mining jobs and jobs with fewer “headaches”, RBT candidates can include people who have difficulty with testing, or young college-age kids who cannot make a long-term commitment, RBT incur extra costs to take tests, etc.

-Some RBTs have quit or ready to quit due to difficulties getting paid

-RBT candidates not paid for prep for RBT certification and all it entails

Implications:

-Families unable to find RBTs, disruption in care leads to regression (impacts the whole family)

-High turnover of RBTs negatively impacts kids’ progress

Timeline for obtaining RBT certification

-BCBA has limited time to gauge if person will be a good RBT, which is not sufficient, due to the following:

  • 40-hour course, plus review and prep
  • BCBAs wants to be confident RBT candidates will pass since they pay for with their own money
  • RBT tied to the BCBA’s license
  • High level of responsibility - RBTs are going into homes and working with nonverbal kids

-Takes 4-6 weeks to schedule test once candidate is ready (which I confirmed with Pearson Vue)

PALCO

-It has been difficult for families to ensure RBTs are paid in a timely manner (more recent problem), such as:

  • Small change in timesheet lead to RBT not being paid
  • Delay payment once candidate did get RBT certification
  • 1 parent reported spending 13 hours on hold (between June and July) to find out why someone was not paid

-Some families have been told by PALCO it is an ATAP problem and by ATAP that it’s a PALCO problem

SERVICE DELIVERY / RATES / GENERAL

-Families are VERY concerned they will not be able to hire staff and decide who comes into their home!

-Can families hire new tutors / interventionists or only people already in the system?

-Telemedicine - What does research say about telemedicine used for ABA treatment?

-Is ATAP reducing hours? Some would like to see more hours per week provided by ATAP (and sited related research) and worried things are moving in the wrong direction

-Will future families only receive funds for less effective, non-research based treatment? (not ABA)

-Will reimbursement rates be lowered in September? If so, it will be even harder to attract BCBAs to Nevada, more companies/agencies will go out of business, and fewer kids will get services

-Re: a verylarge company in southern Nevada,

  • Serves high percentage of kids in Nevada, if they cannot stay in business with current Medicaid rates – What will happen to all the kids they serve?
  • There are many Medicaid eligible kids served by this company,but for whom ATAP has not been able to find Medicaid providers – Concern was expressed that this is an indicator that current Medicaid rates are not workable

-Will we end up with a two-tiered system?

SUGGESSTIONS / REQUESTS

-Town Hall meetings with sufficient notice for stakeholders to make arrangements so they can attend

-Allow time for proposed changes to be reviewed by stakeholders and information disseminated in a timely manner to providers and families

-Can we have an official ruling from the Attorney General’s office regarding the law about Medicaid reimbursement rates?

-Policy manual developed / updated, with a grievance process for families

-Parent advocacy team on ATAP

-If PALCO goes away, can companies/agencies receive fiscal management fees (if any) currently paid to PACLO to help defray their costs for taking on the extra responsibility?

-Companies/agencies would like more time for persons to become RBT certified, such as 3-4 months

Gwynne Partos

Vice-Chairperson,

Nevada Commission on Autism Spectrum Disorders

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