Autism Insurance Reform in Rhode Island

1. Autism Insurance Reform in Rhode Island Dr. Andrea Chait Director, Pathways Strategic Teaching Center A program of the J. Arthur Trudeau Memorial Center

2. Steps toward insurance reform in RI • Special House Commission to Study the Education of Children with Autism in the State of RI • To make a comprehensive study of the education of children with autism particularly those with the diagnosis and assessment • The prevalence of numbers in this state; the effect on and the role of families • The appropriate goals for education • Effective interventions and education programs • Public policy approaches to ensuring access to appropriate education and personnel preparation

3. Special House Commission • Commission began in 2008 with members from: • Clinical Psychology • Education • Colleges & Universities • Department of Health • Medicine • Service Providers • Local Organizations

4. Steps toward insurance reform • Commissions focus turned to insurance • Autism Speaks representatives Lorri Unumb (VP, State Government Affairs) and Judith Ursitti (Director, State Government Affairs) attended several meetings to offer expertise • Commission drafted the legislation

5. Steps toward licensure • Debate among language regarding the credentials of providers • Major points: • BCBAs should be supervised by licensed psychologists • Both BCBAs and licensed psychologists should be independent providers • Unanimous commission agreement that BCBAs and licensed psychologist should be independent providers of ABA.

6. Public Hearings/House Bill • At the initial public hearing, a psychologist representative of the commission withdrew support for the bill requesting that only licensed professionals provide ABA • With the support of Judith Ursitti, family members affected by autism, and professionals, the bill continued to move forward as written

7. Public Hearings/Senate Bill • Initially the bills were identical • At this point, private meeting were held to negotiate with the insurance companies • Outcome: • Age cap at 15 • Monetary cap of $32,000 • Credentials of providers required licensure and BCBA • Bill passed

8. Effective January 1, 2012 Any individual proving ABA shall be: • Individually licensed by DOH as a healthcare provider/clinician and nationally certified as a BCBA and credentialed by the insurer OR • Individually nationally certified as a BCaBA supervised by a BCBA who is licensed by the DOH as a psychologist, social worker or therapist and credentialed by the insurer

9. As of Oct. 2011 • There are a total of 61 professionals certified by the Behavior Analyst Certification Board

10. Qualified Providers • The exact number of professionals licensed & BCBA or BCBA-D is undetermined but our best guess is approximately 5 professionals meet this criteria in the state of Rhode Island

12. Movement for Licensure • With the support of Judith Ursitti, we met with the Senate Policy Director and Deputy Director to begin drafting licensure • Advocates: Dr. Sheila Quinn, Brian McGovern, Judith Ursitti, & Dr. Andrea Chait • We pushed for the BACBs model licensure act and they used components from that act • Policy director stated she would be contacting RIPA to discuss further

13. Movement for Licensure • The next meeting was held to review the draft with: • The head of the psychology licensing board and RIPA legislative representative • The manager of public affairs and government relations for RIPA

14. Concerns of Psychologists • BCBA’s have a limited scope of practice  • Experts in the field would be excluded from providing services because they are not BCBA’s • They did not want to include reference to the BACB in the licensure • Medicaid will possibly deny claims when passed on by private health insurance due to the lack of providers

15. Senate Policy • Revised draft • Second meeting • Additional concerns by psychologists expressed

16. Psychologist Concerns • They do not want a bachelors level license (i.e., they want BCaBAs excluded from licensure) • They want the licensing standards similar to other masters level licenses (i.e., post grad experience/supervision) prior to licensure • They would like the board to offer temporary permits as a way to enable people to practice with appropriate supervision until licensed • They want to make sure that LBA records will be considered medical records and patients privacy will be respected • They want to add a coordination piece with other healthcare providers • They want to specify the role of supervision (for the BCBA) • Their primary concern was the competent psychologists who have been practicing ABA for years will no longer be able to practice without obtaining a second license and their BCBA

17. Questioning the BACB Credential A. Degree Requirement: • Possession of a minimum of a bachelor's and a master's degree that was conferred in behavior analysis or other natural science, education, human services, engineering, medicine or a field related to behavior analysis and approved by the BACB

18. Next Steps • Senate Policy will revise draft based on feedback and submit to the DOH and Insurance Representatives for further discussion • Anticipate submission of bill in January

19. Thank You Judith Ursitti, Director State Government Affairs, Autism Speaks Lorri Unumb VP State Government Affairs, Autism Speaks Dr. Sheila Quinn Salve Regina University Brian McGovern Behavior Analyst, Pathways Caitlin Thomas-Henkel & Marie Ganim RI Senate Policy Office