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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