MEDICAID, EPSDT and BHRS The Greatest Treatment
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MEDICAID
EPSDT and BHRS
The Greatest Treatment Funding Secret Ever Concealed
Steven Kossor, Licensed Psychologist Executive Director, The Institute for Behavior Change
The short version….
A word of thanks….
US Congressman Jim Gerlach has been a strong supporter of the Institute for Behavior Change and of my efforts to bring quality mental health treatment services to people, especially those who have developmental disabilities, for many years. I deeply appreciate his consistent and enthusiastic endorsement of my work and look forward to future opportunities to share new ideas with others. Steve Kossor
July 9, 1868
(the first Johnson Administration)
14th Amendment to the Constitution
All US citizens [of any age] shall have equal protection under the law.
rich or poor
rich or poor
rich or poor
rich or poor
rich or poor
1965
(the second Johnson Administration)
“A great society protects its weakest members.” Medicaid is created as a joint federal and state program to finance health care treatment for diagnosed, episodic illness in low-income individuals. It has no specific standards related to children.
1965
Medicaid: To provide Medically Necessary treatment to those who need it. Requires no Federal Reauthorization.
It’s▲forever.
functionally
1965 Medicaid “Medical Necessity”
Is it Reasonable? Is it Necessary? Is it Appropriate, according to evidence-based practices? Then it’s Medically Necessary.
1967
Height of the Vietnam war 50% of draftees
ARE UNFIT FOR MILITARY SERVICE!
(because of untreated childhood illnesses)
Who will fight our wars?
1967 E
arly and
P
eriodic
S
creening,
D
iagnosis and
T
reatment
For children under 21 years of age: Question: Is it intended to correct or ameliorate defects & physical & mental illnesses and conditions discovered by the screening process?
Yes? Then it’s “Medically Necessary.”
Each state is permitted to create its own version of the “medically necessary” treatment definition, but all states are required to comply with the federal EPSDT standard in order to continue accessing federal Medicaid funds, so the definitions can’t stray too far…..
1988 and 1989
The Medicare Catastrophic Coverage Act of 1988, P.L.100-360
Less-restrictive Medicaid eligibility standards
The Omnibus Budget Reconciliation Act of 1989
Mandatory EPSDT services in all 50 states
No “Asset Test” for Medicaid Eligibility
Medicaid Spending in 2004
(in millions)
Medicaid Cost Containment Efforts
Note: Most changes do not apply to “EPSDT”
Positive Changes in Medicaid
Note: Most changes do apply to “EPSDT”
Key concepts in treatment funding
EPSDT services must be provided to children enrolled in Medicaid whether or not the services are provided for in any State Plan.
Medicaid, not the school, must
pay for covered services to a child if funding is in dispute.
Pending Plans for changes in Medicaid
What is the official PA DPW stance on Behavioral Health Rehabilitation Services (BHRS)? This is an excerpt from the document submitted to the CMS by Pennsylvania’s DPW regarding the changes that the CMS was proposing to the “Rehabilitation Option.”
Rehabilitation vs. “habilitation”
Treatment Effect
“Neurotypical”
With Treatment
Without Treatment
EPSDT Benefits
Treatment AND Prevention services Physical, Speech & Related Therapies Hearing Services Eye Examinations & Eyeglasses Durable Medical Equipment Home, Residential & Inpatient Care Dental Care Other Services (including mental health care)
The remainder of this presentation will focus on the Behavioral Health Rehabilitation Services that can be delivered to disabled children through the EPSDT mandate of Medicaid. See 42 USC §1396d (r) (5).
2005 The Deficit Reduction Act (DRA)
Children will… “still be entitled to receive EPSDT benefits in addition to the benefits provided by the benchmark coverage...” The Centers for Medicare and Medicaid Services (CMS) “will not approve any state Medicaid plan that does not include the provision of EPSDT benefits.”
CMS Administrator Mark B. McClellan, “Statement on EPSDT Coverage for Children Under 19,” April 2006.
Available at www.tilrc.org/Real%20Choice%20Website/epsdt0406htm.
42 CFR Chapter VII Subchapter XIX §1396d [Sec. 1905(a)] “The Social Security Act”
Definitions For purposes of this subchapter— (a) Medical assistance The term “medical assistance” means payment of part or all of the cost of the following care and services … (if provided in or after the third month before the month in which the recipient makes application for assistance) … for individuals who are— (i) under the age of 21, or, at the option of the State, under the age of 20, 19, or 18 as the State may choose, …
42 CFR Chapter VII Subchapter XIX §1396d [Sec. 1905(r)(5)] “The Social Security Act”
(r) Early and periodic screening, diagnostic, and treatment services
(5) Such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan. Nothing in this subchapter shall be construed as limiting providers of early and periodic screening, diagnostic, and treatment services to providers who are qualified to provide all of the items and services described in the previous sentence or as preventing a provider that is qualified under the plan to furnish one or more (but not all) of such items or services from being qualified to provide such items and services as part of early and periodic screening, diagnostic, and treatment services.
42 CFR Chapter IV Part 440.130
[Sec. 1905(a)(13)] “The Social Security Act”
(a) ‘‘Diagnostic services,’’ except as otherwise provided under this subpart, includes any medical procedures or supplies recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under State law, to enable him to identify the existence, nature, or extent of illness, injury, or other health deviation in a recipient. (c) ‘‘Preventive services’’ means services provided by a physician or other licensed practitioner of the healing arts within the scope of his practice under State law to (1) Prevent disease, disability, and other health conditions or their progression; (2) Prolong life; and (3) Promote physical and mental health and efficiency. (d) ‘‘Rehabilitative services,’’ except as otherwise provided under this subpart, includes any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under State law, for maximum reduction of physical or mental disability and restoration of a recipient to his best possible functional level.
Medicaid Eligibility: CATEGORICALLY needy
Qualified Pregnant
Medicare beneficiaries women families with children Security Income (SSI)
Low-income
Supplemental
recipients
Anyone
under age 21 with income less than a specified percent of the Federal Poverty Level
Medicaid Eligibility: Medically Needy
Those who, except for income and resources (assets), would be eligible as “categorically needy.”
There How Does
are no “asset tests” anymore.
much “income” does a child have? parental income always “count?”
hint: no
Pennsylvania’s “Medically Necessary” definition under Medicaid Regulations
STATEMENT OF POLICY DEPARTMENT OF PUBLIC WELFARE OFFICE OF MEDICAL ASSISTANCE PROGRAMS [55 Pa. Code Chapter 1101] General Provisions §1101.21a. Clarification Regarding the Definition of “Medically Necessary” – statement of policy. A service, item, procedure or level of care that is necessary for the proper treatment or management of an illness, injury or disability is one that: (1) Will, or is reasonably expected to, prevent the onset of an illness, condition, injury or disability. (2) Will, or is reasonably expected to, reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury or disability. (3) Will assist the recipient to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the recipient and those functional capacities that are appropriate of recipients of the same age.
Who decides if treatment is “medically necessary”
If a licensed practitioner of the healing arts prescribes a treatment “to correct or ameliorate a physical or mental defect or condition” and it works, it is medically necessary and Medicaid can fund it, regardless of whether it is an “accepted medical practice” in someone else’s opinion.
The Social Security “Blue Book” lists disabilities that qualify a child as a person with a disability under Medicaid
42 CFR Chapter IV Part 440.230
(b) Each service must be sufficient in amount, duration, and scope to reasonably achieve its purpose. (c) The Medicaid agency may not arbitrarily deny or reduce the amount, duration, or scope of a required service […] to an otherwise eligible recipient solely because of the diagnosis, type of illness, or condition. (d) The agency may place appropriate limits on a service based on such criteria as medical necessity or on utilization control procedures. Here enters the MCO
The children by numbers
15,575 children receiving Medical Assistance in the County.
(SAMHSA estimates 10% of children require MH treatment)
1,557 children on MA in the County who should be getting MH treatment (not D&A), based on SAMHSA’s estimate. 658 children on MA in the County who are getting some Mental Health services from any source whatsoever. 899 children on MA not getting any MH help whatsoever. But less than 20 cases are on the MCO Waiting List… Guess which number the MCO & County government focuses on….
Relationship between “levels of need” and PA DPW “medical necessity” criteria
Wraparound Philosophy
Services must be “time limited” (a year or less). Services must be “titrated” (reduced over time). Services must be replaced by “naturally occurring” [i.e., low-cost or no-cost] supports as quickly as possible. Treatment skills must be “transferred” to parents and other caretakers. Caretakers must be present at all times while treatment services are being rendered. Services can not be delivered in a doctor’s office.
NONE of this is part of the EPSDT system!
…they make bullets – we make armor
Now, as a professional who has prescribed BHRS treatment, we expect you to predict exactly what troublesome behavior the child will be displaying between 10 and 11 am on Mondays, Tuesdays, Wednesdays…. and use this form to do it.
T
Titration that makes sense
T T T
Ô
20
20
20
20
Here are some other things that most people don’t know anything about….
This is the “last word” about what children with Autism spectrum disorders require in order to have a reasonable probability of reducing their symptoms of autism.
© 2001 National Academy Press
Here are some other things that most people don’t know anything about….
The National Academy of Sciences completed this research with funding from the US Dept. of Education and that’s the only reason it’s called “Educating” and not “Treating” children with Autism.
Here are some other things that most people don’t know anything about….
AT LEAST 25 hours of “intensive, individualized treatment” every week.
2008:
“There are no other studies planned. This was intended to be a definitive report about what children on the Autism spectrum need.”
- James P. McGee, Study Director
For every expert, there is an equal and opposite expert….
BHRS was never meant to treat children with
PART II: How to treat mental illness in children
We’ve explored the Medicaid statute. We’ve explored the EPSDT mandate. We’ve identified what is possible. Now, we’ll look at what is working.
They Work!
300 Treatment records
2002-2006
Children ages 2-17
Overall Treatment Effectiveness
WORSE 1% 1
STABILIZED 18%
BETTER 71 %
They Work!
Lack of Safety Awareness
WORSE 11%
300 Treatment records
2002-2006
Children ages 2-17
Physical Aggression
STABILIZED 6%
WORSE 14%
STABILIZED 14%
BETTER 85%
BETTER 72%
Noncompliance with Adult Prompts
WORSE 7% STABILIZED 11%
BETTER 82%
They Work!
300 Treatment records
2002-2006
Children ages 2-17
Communication Deficits
WOR SE 11%
Socialization Deficits
WORSE 14%
ST A B I LI ZE D
BETTER 63%
26%
BETTER 64%
STABILIZED 22%
One of the 301 treatment records of a child with an Autism Spectrum Disorder
TSS effect on behavior
1 2
1 0
8 physical aggression 6 socialization noncompliance 4
2 BEFORE TSS 0 1 2 3 4 5 6 7 Weeks 8 9 1 0 1 1 1 2 1 3 AFTER TSS
Another successful treatment record of a child with an Autism Spectrum Disorder
TSS effect on behavior
1 2
1 0
8 Safety Awareness 6 P hysical Aggression Noncompliance 4
2 BEFORE TSS 0 1 2 3 4 5 6 7 Weeks 8 9 1 0 1 1 1 2 1 3 AFTER TSS
They Worked!
treatmentplansthatworked.com
has more than 150 “treatment plans that worked” available on-line for download – with the data that documents it.
A subscription with unlimited access (including loads of information on EPSDT and especially “BHR” mental health treatment services) is $65
The #1 source for information worldwide Google “Treatment plans for children”
PA Prescriptions for EPSDT services
Behavior Specialist Consultant (BSC)
licensed or unlicensed psychologist Masters or Doctoral degree “in a clinical field” One year of experience working with children
Philadelphia requires 2 years post-graduate experience
Mobile Therapist (MT)
licensed or unlicensed psychologist Masters or Doctoral degree “in a clinical field” One year of experience working with children
BSC and MT providers are supervised closely each week by licensed psychologists at the Institute for Behavior Change in Pennsylvania.
See http://www.ibc-pa.org/job_descriptions.htm for more information.
TSS?
What’s that?
Therapeutic Staff Support (TSS) is provided in Pennsylvania by a person with a Bachelors degree (usually in psychology) who works 1:1 with the child for several hours each day, at home, in school, and in the community.
Prescriptions for 20 or more TSS hours weekly are often appropriate, necessary and authorized by the MCO if the child’s behavioral data supports the need for TSS service.
w w w . ib c - p a .or g
Recommendations
Ribbit…
Parents and others interested in quality mental health care for children should look into EPSDT Behavioral Health Rehabilitation (BHR) services. EPSDT is in your state, EPDST BHR Services work, and they may be totally free regardless of family income. There isn’t a private health insurance plan anywhere in America that offers treatment options like EPSDT BHR services. The Institute for Behavior Change is available to help any State government, psychologist or other “licensed practitioner of the healing arts” implement a more successful, cost-efficient, professional and outcome-based implementation of EPSDT BHR services.
More information is available at www.ibc-pa.org
MEDICAID
EPSDT and BHRS
The Greatest Treatment Funding Secret Ever Concealed
Steven Kossor, Licensed Psychologist Executive Director, The Institute for Behavior Change
The short version….
A word of thanks….
US Congressman Jim Gerlach has been a strong supporter of the Institute for Behavior Change and of my efforts to bring quality mental health treatment services to people, especially those who have developmental disabilities, for many years. I deeply appreciate his consistent and enthusiastic endorsement of my work and look forward to future opportunities to share new ideas with others. Steve Kossor
July 9, 1868
(the first Johnson Administration)
14th Amendment to the Constitution
All US citizens [of any age] shall have equal protection under the law.
rich or poor
rich or poor
rich or poor
rich or poor
rich or poor
1965
(the second Johnson Administration)
“A great society protects its weakest members.” Medicaid is created as a joint federal and state program to finance health care treatment for diagnosed, episodic illness in low-income individuals. It has no specific standards related to children.
1965
Medicaid: To provide Medically Necessary treatment to those who need it. Requires no Federal Reauthorization.
It’s▲forever.
functionally
1965 Medicaid “Medical Necessity”
Is it Reasonable? Is it Necessary? Is it Appropriate, according to evidence-based practices? Then it’s Medically Necessary.
1967
Height of the Vietnam war 50% of draftees
ARE UNFIT FOR MILITARY SERVICE!
(because of untreated childhood illnesses)
Who will fight our wars?
1967 E
arly and
P
eriodic
S
creening,
D
iagnosis and
T
reatment
For children under 21 years of age: Question: Is it intended to correct or ameliorate defects & physical & mental illnesses and conditions discovered by the screening process?
Yes? Then it’s “Medically Necessary.”
Each state is permitted to create its own version of the “medically necessary” treatment definition, but all states are required to comply with the federal EPSDT standard in order to continue accessing federal Medicaid funds, so the definitions can’t stray too far…..
1988 and 1989
The Medicare Catastrophic Coverage Act of 1988, P.L.100-360
Less-restrictive Medicaid eligibility standards
The Omnibus Budget Reconciliation Act of 1989
Mandatory EPSDT services in all 50 states
No “Asset Test” for Medicaid Eligibility
Medicaid Spending in 2004
(in millions)
Medicaid Cost Containment Efforts
Note: Most changes do not apply to “EPSDT”
Positive Changes in Medicaid
Note: Most changes do apply to “EPSDT”
Key concepts in treatment funding
EPSDT services must be provided to children enrolled in Medicaid whether or not the services are provided for in any State Plan.
Medicaid, not the school, must
pay for covered services to a child if funding is in dispute.
Pending Plans for changes in Medicaid
What is the official PA DPW stance on Behavioral Health Rehabilitation Services (BHRS)? This is an excerpt from the document submitted to the CMS by Pennsylvania’s DPW regarding the changes that the CMS was proposing to the “Rehabilitation Option.”
Rehabilitation vs. “habilitation”
Treatment Effect
“Neurotypical”
With Treatment
Without Treatment
EPSDT Benefits
Treatment AND Prevention services Physical, Speech & Related Therapies Hearing Services Eye Examinations & Eyeglasses Durable Medical Equipment Home, Residential & Inpatient Care Dental Care Other Services (including mental health care)
The remainder of this presentation will focus on the Behavioral Health Rehabilitation Services that can be delivered to disabled children through the EPSDT mandate of Medicaid. See 42 USC §1396d (r) (5).
2005 The Deficit Reduction Act (DRA)
Children will… “still be entitled to receive EPSDT benefits in addition to the benefits provided by the benchmark coverage...” The Centers for Medicare and Medicaid Services (CMS) “will not approve any state Medicaid plan that does not include the provision of EPSDT benefits.”
CMS Administrator Mark B. McClellan, “Statement on EPSDT Coverage for Children Under 19,” April 2006.
Available at www.tilrc.org/Real%20Choice%20Website/epsdt0406htm.
42 CFR Chapter VII Subchapter XIX §1396d [Sec. 1905(a)] “The Social Security Act”
Definitions For purposes of this subchapter— (a) Medical assistance The term “medical assistance” means payment of part or all of the cost of the following care and services … (if provided in or after the third month before the month in which the recipient makes application for assistance) … for individuals who are— (i) under the age of 21, or, at the option of the State, under the age of 20, 19, or 18 as the State may choose, …
42 CFR Chapter VII Subchapter XIX §1396d [Sec. 1905(r)(5)] “The Social Security Act”
(r) Early and periodic screening, diagnostic, and treatment services
(5) Such other necessary health care, diagnostic services, treatment, and other measures described in subsection (a) of this section to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan. Nothing in this subchapter shall be construed as limiting providers of early and periodic screening, diagnostic, and treatment services to providers who are qualified to provide all of the items and services described in the previous sentence or as preventing a provider that is qualified under the plan to furnish one or more (but not all) of such items or services from being qualified to provide such items and services as part of early and periodic screening, diagnostic, and treatment services.
42 CFR Chapter IV Part 440.130
[Sec. 1905(a)(13)] “The Social Security Act”
(a) ‘‘Diagnostic services,’’ except as otherwise provided under this subpart, includes any medical procedures or supplies recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under State law, to enable him to identify the existence, nature, or extent of illness, injury, or other health deviation in a recipient. (c) ‘‘Preventive services’’ means services provided by a physician or other licensed practitioner of the healing arts within the scope of his practice under State law to (1) Prevent disease, disability, and other health conditions or their progression; (2) Prolong life; and (3) Promote physical and mental health and efficiency. (d) ‘‘Rehabilitative services,’’ except as otherwise provided under this subpart, includes any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts, within the scope of his practice under State law, for maximum reduction of physical or mental disability and restoration of a recipient to his best possible functional level.
Medicaid Eligibility: CATEGORICALLY needy
Qualified Pregnant
Medicare beneficiaries women families with children Security Income (SSI)
Low-income
Supplemental
recipients
Anyone
under age 21 with income less than a specified percent of the Federal Poverty Level
Medicaid Eligibility: Medically Needy
Those who, except for income and resources (assets), would be eligible as “categorically needy.”
There How Does
are no “asset tests” anymore.
much “income” does a child have? parental income always “count?”
hint: no
Pennsylvania’s “Medically Necessary” definition under Medicaid Regulations
STATEMENT OF POLICY DEPARTMENT OF PUBLIC WELFARE OFFICE OF MEDICAL ASSISTANCE PROGRAMS [55 Pa. Code Chapter 1101] General Provisions §1101.21a. Clarification Regarding the Definition of “Medically Necessary” – statement of policy. A service, item, procedure or level of care that is necessary for the proper treatment or management of an illness, injury or disability is one that: (1) Will, or is reasonably expected to, prevent the onset of an illness, condition, injury or disability. (2) Will, or is reasonably expected to, reduce or ameliorate the physical, mental or developmental effects of an illness, condition, injury or disability. (3) Will assist the recipient to achieve or maintain maximum functional capacity in performing daily activities, taking into account both the functional capacity of the recipient and those functional capacities that are appropriate of recipients of the same age.
Who decides if treatment is “medically necessary”
If a licensed practitioner of the healing arts prescribes a treatment “to correct or ameliorate a physical or mental defect or condition” and it works, it is medically necessary and Medicaid can fund it, regardless of whether it is an “accepted medical practice” in someone else’s opinion.
The Social Security “Blue Book” lists disabilities that qualify a child as a person with a disability under Medicaid
42 CFR Chapter IV Part 440.230
(b) Each service must be sufficient in amount, duration, and scope to reasonably achieve its purpose. (c) The Medicaid agency may not arbitrarily deny or reduce the amount, duration, or scope of a required service […] to an otherwise eligible recipient solely because of the diagnosis, type of illness, or condition. (d) The agency may place appropriate limits on a service based on such criteria as medical necessity or on utilization control procedures. Here enters the MCO
The children by numbers
15,575 children receiving Medical Assistance in the County.
(SAMHSA estimates 10% of children require MH treatment)
1,557 children on MA in the County who should be getting MH treatment (not D&A), based on SAMHSA’s estimate. 658 children on MA in the County who are getting some Mental Health services from any source whatsoever. 899 children on MA not getting any MH help whatsoever. But less than 20 cases are on the MCO Waiting List… Guess which number the MCO & County government focuses on….
Relationship between “levels of need” and PA DPW “medical necessity” criteria
Wraparound Philosophy
Services must be “time limited” (a year or less). Services must be “titrated” (reduced over time). Services must be replaced by “naturally occurring” [i.e., low-cost or no-cost] supports as quickly as possible. Treatment skills must be “transferred” to parents and other caretakers. Caretakers must be present at all times while treatment services are being rendered. Services can not be delivered in a doctor’s office.
NONE of this is part of the EPSDT system!
…they make bullets – we make armor
Now, as a professional who has prescribed BHRS treatment, we expect you to predict exactly what troublesome behavior the child will be displaying between 10 and 11 am on Mondays, Tuesdays, Wednesdays…. and use this form to do it.
T
Titration that makes sense
T T T
Ô
20
20
20
20
Here are some other things that most people don’t know anything about….
This is the “last word” about what children with Autism spectrum disorders require in order to have a reasonable probability of reducing their symptoms of autism.
© 2001 National Academy Press
Here are some other things that most people don’t know anything about….
The National Academy of Sciences completed this research with funding from the US Dept. of Education and that’s the only reason it’s called “Educating” and not “Treating” children with Autism.
Here are some other things that most people don’t know anything about….
AT LEAST 25 hours of “intensive, individualized treatment” every week.
2008:
“There are no other studies planned. This was intended to be a definitive report about what children on the Autism spectrum need.”
- James P. McGee, Study Director
For every expert, there is an equal and opposite expert….
BHRS was never meant to treat children with
PART II: How to treat mental illness in children
We’ve explored the Medicaid statute. We’ve explored the EPSDT mandate. We’ve identified what is possible. Now, we’ll look at what is working.
They Work!
300 Treatment records
2002-2006
Children ages 2-17
Overall Treatment Effectiveness
WORSE 1% 1
STABILIZED 18%
BETTER 71 %
They Work!
Lack of Safety Awareness
WORSE 11%
300 Treatment records
2002-2006
Children ages 2-17
Physical Aggression
STABILIZED 6%
WORSE 14%
STABILIZED 14%
BETTER 85%
BETTER 72%
Noncompliance with Adult Prompts
WORSE 7% STABILIZED 11%
BETTER 82%
They Work!
300 Treatment records
2002-2006
Children ages 2-17
Communication Deficits
WOR SE 11%
Socialization Deficits
WORSE 14%
ST A B I LI ZE D
BETTER 63%
26%
BETTER 64%
STABILIZED 22%
One of the 301 treatment records of a child with an Autism Spectrum Disorder
TSS effect on behavior
1 2
1 0
8 physical aggression 6 socialization noncompliance 4
2 BEFORE TSS 0 1 2 3 4 5 6 7 Weeks 8 9 1 0 1 1 1 2 1 3 AFTER TSS
Another successful treatment record of a child with an Autism Spectrum Disorder
TSS effect on behavior
1 2
1 0
8 Safety Awareness 6 P hysical Aggression Noncompliance 4
2 BEFORE TSS 0 1 2 3 4 5 6 7 Weeks 8 9 1 0 1 1 1 2 1 3 AFTER TSS
They Worked!
treatmentplansthatworked.com
has more than 150 “treatment plans that worked” available on-line for download – with the data that documents it.
A subscription with unlimited access (including loads of information on EPSDT and especially “BHR” mental health treatment services) is $65
The #1 source for information worldwide Google “Treatment plans for children”
PA Prescriptions for EPSDT services
Behavior Specialist Consultant (BSC)
licensed or unlicensed psychologist Masters or Doctoral degree “in a clinical field” One year of experience working with children
Philadelphia requires 2 years post-graduate experience
Mobile Therapist (MT)
licensed or unlicensed psychologist Masters or Doctoral degree “in a clinical field” One year of experience working with children
BSC and MT providers are supervised closely each week by licensed psychologists at the Institute for Behavior Change in Pennsylvania.
See http://www.ibc-pa.org/job_descriptions.htm for more information.
TSS?
What’s that?
Therapeutic Staff Support (TSS) is provided in Pennsylvania by a person with a Bachelors degree (usually in psychology) who works 1:1 with the child for several hours each day, at home, in school, and in the community.
Prescriptions for 20 or more TSS hours weekly are often appropriate, necessary and authorized by the MCO if the child’s behavioral data supports the need for TSS service.
w w w . ib c - p a .or g
Recommendations
Ribbit…
Parents and others interested in quality mental health care for children should look into EPSDT Behavioral Health Rehabilitation (BHR) services. EPSDT is in your state, EPDST BHR Services work, and they may be totally free regardless of family income. There isn’t a private health insurance plan anywhere in America that offers treatment options like EPSDT BHR services. The Institute for Behavior Change is available to help any State government, psychologist or other “licensed practitioner of the healing arts” implement a more successful, cost-efficient, professional and outcome-based implementation of EPSDT BHR services.
More information is available at www.ibc-pa.org
