By: Beth Vaughan (with the help of Missy Rolison)

Paul Napier (Founder and Executive Director) and Melissa Rolison (Billing Manager) of Reaching Milestones came back from DC with good news after they attended the ACD Roundtable Meeting (Autism Care Demonstration Project under the TRICARE Health Benefit) at the Pentagon on May 5, 2015. Paul was one of only three ABA providers to attend the meeting in person. He was able to ask a question in reference to supervision, which sparked more discussions amongst the other providers. Paul advocated strongly for improvement in the behavior supervision policies and they have agreed to review this and should have a response sometime in July.

In addition to Paul and the ABA providers, other notable attendees included: 2-Star General, Deputy Undersecretary of Defense (this is the first time ever that the Department of Defense has intervened in a Tricare issue), The American Academy of Pediatrics, APBA, BACB, and Karen Driscoll (Associate Director, Federal Government Affairs & Military Relations – Autism Speaks). The overall consensus was that the Generals and every person in attendance seemed authentic and genuine in their efforts towards improvement.

Below are the notes that summarize the key points from the Roundtable Meeting. The notes were taken by Megan Miller, BCBA and do not represent the Military Health System. The biggest win/takeaway was the cost shares for retiree (or non-active duty) families that will apply to their catastrophic cap. Huge for retiree families!

Reimbursement Rates

Reimbursement rates were discussed and the status regarding the rate change was provided. It was indicated that RAND was hired to help determine market rate for reimbursements. RAND is still working on this determination by looking at going rate for Medicaid and private insurance for every state. It was indicated that they will choose the reimbursement rate by finding the going rate in every state and that will set reimbursement rate. Reasons identified for doing it in this way were that it is: cost effective, ensure don’t adversely impact market place. Because this work has not been finished, rates will stay as is $125/hr BCBAs, $75/BCaBA until next fiscal year. Lastly, it was indicated that this has been well communicated and ample warning will be provided when it is time to implement state by state reimbursement rates.

Cost Shares

The issue of cost shares was also discussed. For non-active duty family members, the cost were not applying to the cap but it is a long process to change the requirements. It was indicated that they are allowing DHA to pursue the option of having these costs apply to cap. Cannot officially announce as policy yet. The policy change will first need to be announced in Federal Register. Once permission is given to make the change, the goal is to have it go into effect 60 days from that point.

Waitlists

The issue of long waitlist was discussed. There seems to be a disconnect between the information that Tricare has about waitlists and the actual waiting time that parents are experiencing to get access to services. The plan right now is to have all providers encourage people on their waitlist to contact their regional contractor to let them know they are on a waitlist. A more formal process for identifying families on waitlists is also being developed and will be communicated.

Behavior Techs and Supervision

An overview was given regarding the current requirements for technicians and supervision. This topic produced a lot of discussion and concerns were voiced over the wait time in credentialing technicians and the supervision requirements of per beneficiary and 2 contacts per month. It was indicated that the “monthly” requirements refers to a 30 day period not the calendar. It was indicated that work will be done to determine the best solution for supervision requirements that balance quality of care with not being overly burdensome and logisitically impossible for providers. The BACB indicated that their requirement is 2 contacts per month not per client and that it is logistically difficult to expect a tech who sees 3 or 4 clients to then have 6 to 8 contacts per month.

Communications

It was indicated that there is a flow chart being developed to give beneficiaries and providers contact information for each different person they would need to contact within Tricare. This should help people have an avenue for resolving issues because it will be more clear who to contact.

A new brochure about ABA coverage was also passed out and will be disseminated for families. There will also be communication efforts on the Tricare.mil website and social media to keep people updated of changes.

Do-Outs

The following activities were listed as things that will be done based on the meeting today:

• Need points of contacts
• Need to work with Tricare providers to get good reimbursement
• Beta test for autism code under ICD 10 to make sure there aren’t issues. Get input from providers
• Waitlists at MTFs need to get this information. Working on a process to know the population that is out there
• Education and Training process how to manage the waitlist
• Supervisory requirements: balance between patient safety and not too onerous for ability to serve

Please go to www.tricare.mil for up to date information from Tricare.

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Medical experts will also be available to discuss the expansion of this program and ensure questions continue to be answered on how the implementation of the Autism Care Demonstration improves Autism healthcare. The Department of Defense has decided that the current reimbursement rates for ABA therapy will remain in effect through the end of the current Fiscal Year (9/30/2015).

The TRICARE Comprehensive Autism Care Demonstration (ACD) incorporates existing Applied Behavior Analysis (ABA) policies into a single program for all TRICARE beneficiaries with Autism Spectrum Disorder (ASD). A number of beneficiaries and providers – including Reaching Milestones – have expressed concerns about the proposed changes. Some of these include: Reimbursement rate changes will adversely affect access to providers; out-of-pocket-costs for non-active duty are higher than the costs for active duty; providers aren’t being educated on these policy changes, etc.

Reaching Milestones is lucky to have people like Paul representing the Autism community and fighting to maintain higher standards of services for the kids of military families at the highest level.

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Easter is upon us and that means bunnies, eggs, and the ultimate treat of PEEPS!  Peeps, those yummy, gooey, delicious sweet marshmallow treat is finally here.  Peeps come in all sorts of colors: purple, pink, yellow, and our favorite color at Reaching Milestones, blue.  Peeps come in adorable shapes of bunnies, eggs, and the classic baby chick.  But, what happens to these poor Peeps when Easter is over?  More than likely our little Peeps will go on a clearance shelf, and no one will bring them home.  They will no longer have their luster of fluffy goodness because the holiday is over.  Well, Reaching Milestones will not let this happen to our Peeps, especially our blue Peeps!

We all know how popular the “ALS Ice Bucket Challenge” became last year on social media. For those who are not aware, the Ice Bucket Challenge took place from July 29 – August 12, 2014.  People were challenged to either dump or submerge themselves in ice water, while filming themselves.  Once the task was completed the individuals would post the film onto social media and challenge others to complete the same task in 24 hours. If individuals did not wish to participate in the challenge, they could donate money for research for ALS on the ALS association website.  The ALS association and its 38 chapters received over 4.1 million dollars in donations during that July/August time frame compared to the 1.12 million; they rose from the prior year around the same time frame, (http://www.alsa.org/about-als/).  Think about how much awareness was made just from a small and fun challenge on social media; over 4.1 million dollars’ worth.  ALS affects 30,000 Americans age range from 40 to 70 (http://www.alsa.org/about-als/).

Autism affects one in ever sixty eight children.   April 2^nd is World Autism Awareness Day; it is the day to “Light up Blue”, and raise awareness of those who are affected by Autism.  April 2^nd is the first day of Autism Awareness Month.  What can we do as a community to raise more awareness and funding for research on Autism?  Reaching Milestones wants to help our community by spreading more awareness to others and funding for research to Autism Speaks ( https://www.autismspeaks.org/about-us).

What will Reaching Milestones do for our community? We are going to ….. EAT BLUE PEEPS!    That’s right we are going to save the blue Peeps and raise awareness for Autism.  Our office at St. Mary’s developed a new and fun “challenge”.  They have named it “Peeps for our Peeps”, and our first challenge was launched April 2^nd 2015.  This challenge is very similar to the ALS ice bucket challenge.  It’s a very simple gooey challenge:

1. Once you have been “Called out” on social media you have 24 hours to fit as many blue Peeps in your mouth as possible (without choking of course), film this challenge, and “call out” at least three people.
2. While having the Peeps in your mouth you must say the phrase, “Please Play Peeps for Our Peeps.”
3. Post the video onto the Peeps for Our Peeps Facebook page.
4. If a person who was “called out” does not wish to participate in the video challenge they can donate to the “Light it up Blue” campaign through Autism Speaks (https://www.autismspeaks.org/) or on our “Donate Now” action button on our homepage (http://www.reachingmilestones.com/).

Let’s make this go “viral”.  This small challenge could help spread awareness and possibly more funding for research on Autism.  Get your Peep on!

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On April 2nd all around the world buildings, homes, landmarks, and historical places will Light It Up Blue in support of National Autism Day. What is Light It Up Blue? The movement encourages you to change white bulbs outside or inside of your house or business to blue bulbs in order to shed light on Autism. This national campaign was started by Autism Speaks; the world’s leading Autism science and advocacy organization. On December 18, 2007, the United Nations General Assembly, by unanimous consent, designated April 2nd as World Autism Awareness Day. The Light It Up Blue campaign started in 2010 to celebrate this day and raise awareness for those affected by Autism.

This campaign has grown to worldly proportions! There are currently 1,000 buildings in over 180 U.S. cities and 30 countries around the world participating in the campaign. Some of these buildings include the Empire state building, Leaning Tower of Pisa, Los Angeles International Airport, Universal Studios Orlando, and the International Space Station. The upcoming 2015 campaign is set to include The Crazy Horse Memorial in South Dakota, Palm Beach Royal Park Bridge in West Palm Beach, Florida, and The Great Pyramid of Giza in Egypt.

In order to make this campaign an even bigger success in 2015 we need to show our support! There are many ways that you can make a difference. You can start as small as taking a blue selfie and using the hashtag #LIUB to spread awareness on social media or as large as contacting local city officials and businesses to join in the blue movement. Some other ways to Light It Up Blue involve tinting windows with blue gel sheets, projecting the Autism Speaks logo onto your building, or asking friends, family, and coworkers to wear blue April 2nd. There are also many businesses that will participate in raising awareness this April through special discounts and donations. Some of those businesses include Toy’s R Us, Dollar General, Walgreens, and Build A Bear. Once you’ve changed the bulbs, taken your selfies, and gotten your blue gear on you can also text AUTISM to 25383 to make a $10 donation to Autism Speaks. Let’s make 2015 the bluest year yet! Join Reaching Milestones as we Light It Up Blue for National Autism Awareness Day on April 2nd! Make sure to post your blue photos on our FaceBook with the hashtag #LIUB.

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On September 29^th, Autism Speaks held its annual Autism Walk at the Jacksonville Landing.  The Walk itself was definitely a success, as was the Reaching Milestones with BCS tent.  The weather was perfect, the Landing was packed, and the BCS sensory booth was full of awesome (and sometimes messy) activities.

Who knew that water beads (those little colored balls that florists will put in the bottom of a vase of flowers) would be such a huge success?  Since the Walk took place on a Saturday, the BCS staff prepared two different bins of the water beads for the table– one filled with orange and blue for the Gators, and the other with garnet and gold for the Seminoles.  It was fairly evident that the kids were more enthralled by the actual texture of the water beads than by the rivalry that the colors represented, but there were a few parents who appreciated the effort.

Also on the Reaching Milestones with BCS table, one could find a large container of a very interesting concoction known as “moon-dough.”  Moon-dough looks similar to Play-Doh, and it is easily molded.  What makes it so unique is the fact that it is virtually weightless.  Watching a child’s face as he or she reached into the tub and picked up a softball-sized mound of the dough, just to realize it weighed as much as a feather, was priceless.

Unquestionably, Squishy-Baff was the biggest hit of the 2012 BCS booth. (Yes. It is really called Squishy-Baff.) According to the product’s website, you use Squishy-Baff to, “…turn ordinary water into glorious colorful goo and then back again. Create fun goo adventures, while feeling it squishing between your fingers and toes!”  This stuff is awesome.  Seriously.  BCS filled up an elevated kiddie pool and a huge storage bin with this mixture of gooey goodness, threw in some toys, and history way made!  Okay.  Maybe that is a little bit of an exaggeration, but the kids really, really loved it.  A few loved it so much they tried to eat it, and one little guy couldn’t get enough of it simply by reaching his hands into it, so he climbed right on in the pool!

So many people took time out of their busy schedules to come out and walk for a cause that is so close to the hearts of so many.  The weather was awesome, the kids were happy, and as a whole, the day was perfect.

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