Let’s tell the truth: PH95 is not a “loophole.”

Medical Assistance (Medicaid) Category PH95 was created by an act of the PA legislature in the late 1980s. Just like the legislatures in 32 other states, Pennsylvania’s elected representatives decided that the 14th Amendment (the one that established the right to “equal protection under the law”) applies to children with disabilities, regardless of their parents’ incomes. That some self-proclaimed advocates, especially those touting “decades” of experience, would call for the elimination of the PH95 category of Medical Assistance in Pennsylvania is not surprising. The same group came out to support Act 62 (requiring a license from the Board of Medicine for some supervisors of Autism treatment) which has crippled the ability of most providers of BHRS (“Behavioral Health Rehabilitation Services”) to deliver quality, essential treatment to children with Autism Spectrum Disorders.  The sponsors of Act 62 misguidedly confused “credentials” with “competence” (as if the acquisition of a paper certificate would somehow bestow competence on practitioners, or that the lack of that magical piece of paper could somehow revoke the competence that providers had been demonstrating for months – if not years – prior to the stillbirth of Act 62). The State Medicaid Agency backed Act 62 in Pennsylvania, just like the State Medicaid Agencies did in 30 other States, because it would drive kids with Autism Spectrum Disorders off the Medicaid roles.  Employees of the State Medicaid Agency in Pennsylvania and their fellow “advocates” have been calling for the “repeal” of PH95 for decades, referring to it (in official, written documents no less) as a “loophole” — as if that is an appropriate term for an act of the Pennsylvania legislature.

I have decades of experience too, and all of it supports the sensibility, humanitarian necessity, and fiscal responsibility of allowing people who have incomes “above the Federal Poverty Level” to receive Medical Assistance benefits if they are under the age of 21 and disabled. By giving those kids access to treatment, the State and Federal government are making a bet that treatment early in life will result in a lower need for treatment in the remainder of life. That’s a terrific bet, and explains why the legislature in 33 states, including Pennsylvania, decided to make that bet, despite the pleadings of others who didn’t do the math and think that this fiscally responsible and humanitarian gesture somehow entitles thousands of people to get what they don’t deserve.

The fact is, most affluent people don’t get Medical Assistance benefits because they don’t need it. Most “poor” people don’t need it, either. Children with disabilities desperately need it and it’s morally and fiscally misguided, at least, to think that taking away Medical Assistance eligibility from the few who qualify under PH95 will have more than a superficial impact on Medicaid in Pennsylvania. How about looking at the hundreds of millions of dollars that have been swallowed up by schools in Pennsylvania (over $150 million last year alone) without the slightest oversight by the Managed Care Organizations or other apparent controls. If saving Medicaid money is your big concern, take it from the schools — there’s SO much more available there. Over $50 Billion nationwide in the last decade alone.  But that’s unthinkable.

It should be just as unthinkable to take Medicaid money from your neighbors whose family income rises above the Federal Poverty Level (hint: it’s less than $2,500 monthly for a family of four). Sure, there are a few families with high incomes who are taking advantage of the system, but their children are no less impaired than their poorer neighbors’ kids. The altruism of PH95 is a virtue that we should be able to afford, no matter how much or how little we make individually and we surrender it for no good reason.

You can learn the truth about PH95, Medicaid, the EPSDT benefit as a Civil Right for children enrolled in Medicaid, Autism, ADHD treatment and much more at the website of The Institute for Behavior Change – an organization I founded in 1997 to recruit, train, deploy and monitor the performance of new professionals treating children with mental illness symptoms in their homes, schools and communities:  www.ibc-pa.org


I’ve been invited to The Institute for Pure and Applied Knowledge (IPAK) conference in June

The Institute for Pure and Applied Knowledge (IPAK) has invited me to participate in their conference in Pittsburgh, PA from June 15-17.  I participated in a conference call with the founder of the organization, Dr. James Lyons-Weiler on March 30th.  The Pittsburgh conference in June will bring medical doctors and other scientists together for what promises to be a groundbreaking event that will lead to new research and treatment modalities for children with Autism Spectrum Disorders and other disabilities.

Hope you can join us there!  Listen to the conference call here.



Supreme Court rules in landmark case with implications for in-school treatment providers

The February, 2017 Fry v. Napoleon Community Schools Supreme Court ruling appears to indicate that if a child is prescribed a Behavioral Health Rehabilitation Service (TSS, MT or BSC in Pennsylvania) by a licensed practitioner of the healing arts in any State which is funded by the EPSDT mandate of the Medicaid Act, then the parents of that child can bring a suit in Federal court, bypassing the “FAPE” court (pun intended) that schools offer and get a ruling as to whether or not the school can bar the entry of a trained mental health professional on their premises (whether or not they claim to already employ comparably skilled, trained or supervised people on-site to do the same tasks).  If the parents win, their lawyer can collect “attorney’s fees.”  This balancing of the scales in the education of children with disabilities is long overdue.  Parents no longer have to ask permission from education authorities to bring their complaints about the denial of their child’s access to mental health treatment services to Federal court authorities!

This ruling, described in the SCOTUS blog by Amy Howe (http://www.scotusblog.com/author/amy-howe) has terrific implications for all of the children who need honest mental health treatment professionals beside them in school in order to address their mental illness symptoms – NOT to get a “free, appropriate public education.”  It is now possible for parents to go to the Court Room without having to ask permission to leave the Class Room.

Amy’s analysis is here: http://www.scotusblog.com/2017/02/opinion-analysis-court-outlines-boundaries-disabilities-education-cases

Making information about EPDST funded mental health treatment for children more widely available to children is the focus of The Issachar Project   This short video explains the essentials of EPSDT funding for the treatment of mental illness symptoms in children:  https://www.youtube.com/watch?v=kwsdiQ0JKo8


Understand how EPSDT funds mental health treatment for children — in 5 minutes

Understand EPSDT funding to help children with behavior challenges – in less than 5 minutes.


Pass it on!


A Necessary Addition to the New BHRS – IBHS Regulations

The National Academy of Sciences (NAS), chartered by the US Congress more than 150 years ago to advise Congress on matters of science, published the results of an exhaustive study of the behavioral treatment needs of children with Autism Spectrum Disorder symptoms in 2001. In that study, they revealed that children who didn’t receive at least 25 hours of year-round “intensive, individualized treatment” did not have a reasonable probability of symptom reduction. The American Academy of Pediatrics (AAP) published the results of their own studies in 2007 and 2012 that came to the exact, same conclusions: Children with Autism Spectrum Disorders require a MINIMUM of 25 hours of “intensive, individualized treatment” in order to have a reasonable probability of symptom reduction.

Because insurance companies exist to spread the funds they control as widely as possible (giving as little as possible to as many of their members as possible), there is an unavoidable conflict between their mission and achieving the NAS and AAP standards for prescribing “intensive, individualized treatment” to children with Autism symptoms. Insurance companies routinely authorize just 10 or fewer hours of intensive, individualized treatment (TSS service), and they routinely cut off treatment authorizations after 3 years or less. The fact that the State has encouraged and supported these under-prescribing practices for decades is widely known; it is the biggest reason for the passage of Act 62 which was intended to make more funding for the treatment of Autism available.

For these reasons, it is essential that a reference to the NAS and AAP national standards for the prescription of “intensive, individualized treatment (TSS service)” has to be included in the IBHS regulations currently being drafted to replace Behavioral Health Rehabilitation Services (BHRS) that have been called “wraparound services” in Pennsylvania. With a reference to national standards in the new IBHS regulations, prescribers who recognize a child’s true need for “intensive, individualized treatment (TSS service)” can confidently write prescriptions that will deliver the minimum amount of treatment necessary to reasonably have an impact on the child’s Autism symptoms.

Without that explicit reference in the regulations to an unequivocal national standard, insurance companies and their supporters will continue to water-down and dilute the prescribing practices of honest, ethical and knowledgeable practitioners and force them to accept lower standards of care for the children they are trying to treat. This is the “state of the art” now. This sad status quo will continue unless the regulations include national standards of care for children with Autism Spectrum Disorder symptoms. It won’t matter if the treatment providers have become better trained and more skilled. If they can’t deliver the amount of treatment that the child actually requires because an insurance company can maintain pressure to lower levels of treatment, it won’t matter how good the treatment providers are.

The IBHS workgroup meets on January 20th.  Its work is nearly finished.  It has to insist that the NAS and AAP national standards are included in the IBHS regulations in order to give prescribing practitioners the support that they desperately need in order to deliver and defend the honest, helpful treatment prescriptions that children with ASD symptoms need. Without the addition of those national standards, it will be “business as usual” despite having better qualified providers.

Learn more at www.ibc-pa.org


A saying attributed to Buddha now circulating on the internet calls for a response

I recently saw something on the internet that begs a response.  Buddha is reported to have said:  “Believe nothing.  No matter where you read it, or who said it, no matter if I have said it, unless it agrees with your own reason and your own common sense.”  Whether or not Buddha said it many, many years ago, it’s bad advice now, especially for people living in America.  Here’s why:

If your ability to reason has been stunted by years of schooling that reveal only one route to truth (deductive reasoning), instead of its alternative (inductive reasoning, where truth is measured in probability, not the “certainty” offered by deductive reasoning based on the “acknowledged truthful facts” generously provided by the various authorities for your peace of mind), you can’t rely on your own “common sense” because it doesn’t EXIST anymore.  That’s the true legacy of schooling in America for the past 100 years, and especially so in the last 50.  We keep electing the leaders that our leaders want us to elect, by offering us their choices.  It’s a downward spiral.  See?  The only way out to recover from this situation is to “unflush the toilet” and that’s impossible, since there are too many people riding the spiraling stream downward.  The best we can hope for is to find a way to climb out of the bowl.  That’s what being an entrepreneur is all about – climbing out of the bowl. 

Best wishes for 2017 to all of the other entrepreneurs out there.


Has a New Era of openness & responsiveness dawned at Pennsylvania DHS?

I had a very productive meeting today with several members of the PA Department of Human Services regarding plans to transition from BHRS (wraparound) services to “Intensive Behavioral Health Services” (IBHS) over the next year or so. I was reassured that the new license that will be required for BHRS providers to become eligible providers of IBHS will be accessible to BHRS providers that currently deliver services in compliance with all existing standards, so my organizations should be able to become licensed as IBHS providers without any doubt. Continued affiliation with existing Behavioral Health Managed Care Organizations should also not be a problem, but that remains to be seen (although I’m optimistic).
It appears that DHS may be in the process of becoming more accessible and responsive, following several decades of maintaining a decidedly “different” attitude. Hopefully, the shape of things to come will continue to be positive. At least I’ve finally been allowed to receive and review the draft IBHS regulations, and have been invited to submit comments and recommendations directly to DHS authorities.