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.


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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


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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.


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