SC AUTISM SERVICES DIRECTORY

Transcription

1 The LUCAS Network Loving Unconditionally Children with Autism Support Network Derrick and Sandrine Howle 203 Biscayne Drive Greenville, SC LOVI G U CO DITIO ALLY CHILDRE WITH AUTISM SUPPORT ETWORK L.U.C.A.S. etwork SC AUTISM SERVICES DIRECTORY The LUCAS etwork maintains the Autism Services Guide for SC as a service to families as a reference tool. Every effort is made to ensure listings are up-to-date. Lucas etwork does not endorse or claim to have personal knowledge of the abilities of those listed. The resources listed in this document are not intended as an endorsement by the LUCAS etwork of any resource or as a tool for verifying the credentials, qualifications, or abilities of any organization, product or professional. Users are urged to use independent judgment and request references when considering any resource associated with diagnosis or treatment of autism, or the provision of services related to autism.

2 2 LUCAS etwork Autism Service Directory Outline 1. Ryan s Law Page 6 2. SC PDD Waiver Program Page State Autism Agencies Page 22 SCDDSN SCDHHS Tefra Babynet 4. County Autism Agencies Page State on-profit Autism Organizations Page Diagnostic Services Page Therapy Service Providers (OT, Speech, and/or PT) Page ABA Therapy Providers in SC Page ABA Providers certified by DDS for the PDD Waiver Page Doctors Page 70 Pediatricians Developmental Pediatricians DAN Doctors in SC GFCF Diet Doctors 11. Dentists Page Optometrists Page AIT Providers Page Schools for Children with Autism Page Daycare/Childcare/Babysitters Page Autism Friendly Churches and Places of Worship Page Center for Disability Resources Library Page Sport activities for Special eeds Children Page Parent/Child Advocates Page Special eeds Attorneys Page Financial Services Page 97

3 22. Horseback Riding Therapies Page Therapy Dogs Page Music Therapies Page Autism Friendly Restaurants Page Food Supplements and Autism Therapy Supplies Page Hair Cutters Page Support Groups Page Social Groups for Individuals with Autism Page Counseling services and/or social skills training Page Summer, Day and Weekend Camps for Children with Autism Page Teenage and Adults with Autism Services Page Special eeds Adult Employment Resources Page Books to read Page ational Autism Associations Page 122

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5 5 L.U.C.A.S. Network (Loving Unconditionally Children with Autism Support Network) was created in 2007 by Derrick and Sandrine Howle in honor of our son, Lucas, who has autism. We developed a network of parents to help Lorri Unumb, Marcella Ridley, and Lisa Rollins (The SC Angels of Autism) two year effort to get Ryan s Law passed in SC. Through correspondence with many of these families during and after the successful passage of Ryan s Law in June of 2007, we felt compelled to share our story and experiences of Lucas battle with autism with other families in hope of making a difference in the lives of families suffering from this disorder and of making these families battle a little easier. The creation of this Autism Services Directory is meant to be a guide to families across SC in search of the different services available to the autism community. We have included as many service providers as we can. Most have been recommended by families across SC. These providers that have a recommendation by a family will be marked with next to their names. For those not marked, as we receive information from families recommending them as a provider, we will add the symbol to their names. Even with these recommendations, users are urged to use independent judgment and request references when considering any resource associated with diagnosis or treatment of autism, or the provision of services related to autism. The symbol autism. next to a provider indicated that this person or group has a child or children with We hope that you find this directory helpful and we will update it as more recommendations become available or changes need to be made. Your feedback and requests concerning this directory is greatly appreciated. We also request more information from the other areas of SC. We are located in the Upstate and a majority of the members of LUCAS Network are located in this area so we are relying on those of you from the Pee Dee area, Rock Hill Area, Lowcountry area, Midlands, Grandstrand, and Savannah River Area to send us your service provider recommendations as well. Sandrine & Derrick Howle Loving Unconditionally Children with Autism Support Network (L.U.C.A.S. Network) 203 Biscayne Dr Greenville, SC Home # (864) Cell # (864) June 16, 2010

6 Ryan s Law 6 The text of Ryan's Law AN ACT TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING SECTION SO AS TO REQUIRE HEALTH INSURANCE COVERAGE, INCLUDING COVERAGE UNDER THE STATE HEALTH PLAN, FOR AUTISM SPECTRUM DISORDER AND TO DEFINE "AUTISM SPECTRUM DISORDER" AS AUTISTIC DISORDER, ASPERGER'S SYNDROME, AND NOT OTHERWISE SPECIFIED PERVASIVE DEVELOPMENTAL DISORDER. Be it enacted by the General Assembly of the State of South Carolina: Coverage required for autism spectrum disorder SECTION 1. Article 1, Chapter 71, Title 38 of the 1976 Code is amended by adding: "Section (A) As used in this section: (1) 'Autism spectrum disorder' means one of the three following disorders as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association: (a) Autistic Disorder; (b) Asperger's Syndrome; (c) Pervasive Developmental Disorder - Not Otherwise Specified. (2) 'Insurer' means an insurance company, a health maintenance organization, and any other entity providing health insurance coverage, as defined in Section (6), which is licensed to engage in the business of insurance in this State and which is subject to state insurance regulation. (3) 'Health maintenance organization' means an organization as defined in Section (8). (4) 'Health insurance plan' means a group health insurance policy or group health benefit plan offered by an insurer. It includes the State Health Plan, but does not otherwise include any health insurance plan offered in the individual market as defined in Section (11), any health insurance plan that is individually underwritten, or any health insurance plan provided to a small employer, as defined by Section (17) of the 1976 Code. (5) 'State Health Plan' means the employee and retiree insurance program provided for in Article 5, Chapter 11, Title 1. (B) A health insurance plan as defined in this section must provide coverage for the treatment of autism spectrum disorder. Coverage provided under this section is limited to treatment that is prescribed by the insured's treating medical doctor in accordance with a treatment plan. With regards to a health insurance plan as defined in this section an insurer may not deny or refuse to issue coverage on, refuse to contract with, or refuse to renew or refuse to reissue or otherwise terminate or restrict coverage on an individual solely because the individual is diagnosed with autism spectrum disorder.

7 (C) The coverage required pursuant to subsection (B) must not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than the dollar limits, deductibles, or coinsurance provisions that apply to physical illness generally under the health insurance plan, except as otherwise provided for in subsection (E). However, the coverage required pursuant to subsection (B) may be subject to other general exclusions and limitations of the health insurance plan, including, but not limited to, coordination of benefits, participating provider requirements, restrictions on services provided by family or household members, utilization review of health care services including review of medical necessity, case management, and other managed care provisions. (D) The treatment plan required pursuant to subsection (B) must include all elements necessary for the health insurance plan to appropriately pay claims. These elements include, but are not limited to, a diagnosis, proposed treatment by type, frequency, and duration of treatment, the anticipated outcomes stated as goals, the frequency by which the treatment plan will be updated, and the treating medical doctor's signature. The health insurance plan may only request an updated treatment plan once every six months from the treating medical doctor to review medical necessity, unless the health insurance plan and the treating medical doctor agree that a more frequent review is necessary due to emerging clinical circumstances. (E) To be eligible for benefits and coverage under this section, an individual must be diagnosed with autistic spectrum disorder at age eight or younger. The benefits and coverage provided pursuant to this section must be provided to any eligible person under sixteen years of age. Coverage for behavioral therapy is subject to a fifty thousand dollar maximum benefit per year. Beginning one year after the effective date of this act, this maximum benefit shall be adjusted annually on January 1 of each calendar year to reflect any change from the previous year in the current Consumer Price Index, All Urban Consumers, as published by the United States Department of Labor's Bureau of Labor Statistics." Time effective SECTION 2. This act takes effect July 1, 2008, and applies to health insurance plans issued, renewed, delivered, or entered into on or after this act's effective date. 7

8 8 Ryan s Law for Dummies- A simplified way to understand what it covers: Ryan's Law passed on June 7, 2007, and it went into effect on July 1, It requires insurance companies doing business in South Carolina (with 4 exceptions, below) to cover autism treatments. It also prohibits insurance companies from refusing to cover someone because that person has autism. Behavioral therapy benefits under Ryan's Law are limited to $50,000 per year. To be eligible, a child has to be diagnosed by age 8. Benefits are available to that child until age 16. To find out whether your insurance company will have to cover your child's autism treatments, you need to talk to your employer. Ryan's Law applies to all people who are covered by private insurance in South Carolina EXCEPT for these 4 categories: 1 - People employed by the federal government and thus covered by Tricare (the military insurance) or one of the FEHBP plans (the federal civilian insurance). 2 - People who get their insurance through a self-insured company. For example, my children are insured through my husband's policy, and my husband is employed by a law firm called Moore & Van Allen. Moore & Van Allen is a self-insured company, meaning that they pool their money together to insure themselves. (This gets confusing, because many self-insured companies contract with an insurance company, such as CIGNA or BCBS, to administer their plan. Thus, you cannot just look at your insurance card to determine if your company is selfinsured; you have to ask your employer.) Typically, only large companies self-insure. 3 - People who get insurance through a small group (defined as fewer than 50 people). Typically, this is small businesses. 4 - People who buy individual insurance policies. If you are in any other category, such as a state employee with state insurance, or a employee of a medium-sized company or a large company that does not self-insure, then you should get coverage for autism treatments starting the next time your policy renews (after July 1). FYI, this bill was primarily intended to cover expenses for ABA therapy. But if you've had problems getting speech or OT covered because, for instance, the insurance company said the therapy was "habilitative" or "educational in nature," Ryan's Law should help with that, too.

9 SOUTH CAROLI A: Frequently Asked Questions About Ryan s Law (Source: Autism Speaks) 9 What does S.C. Code Ann do? Broadly speaking, S.C. Code Ann : Applies to children diagnosed with autistic spectrum disorder at age 8 or younger and continues to apply up to the age of 16. Requires most state-regulated group insurance policies to provide coverage for the treatment of autism spectrum disorder as prescribed by the insured s treating medical doctor in accordance with a treatment plan. Coverage for any care besides behavioral therapy cannot be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable than those that apply to physical illness generally under the health insurance plan. Plans must provide at least $50,000 of coverage per year for behavioral therapy (including applied behavioral analysis). The specific terms and provisions of this law are described in more detail in this FAQ document. When did the law requiring insurance companies to cover services for children with autism spectrum disorder go into effect? July 1, It applies to applicable health insurance plans issued, renewed, delivered, or entered on or after that date. Will my employer-provided health insurance be required to cover my child s autism services? Employers with at least 51 employees for at least 50 percent of its working days during the preceding calendar year and that offer group health insurance coverage are required to offer autism services for children under the age of 16. If your employer has 50 or fewer employees, your child may still receive services through the Pervasive Developmental Disorder Program if they qualify. Are there limits on what our private insurance is going to be required to cover? Insurance companies are required to cover the costs of all treatment prescribed by the insured s treating medical doctor at the same rate that their plans cover physical illness with the exception of behavioral therapy. Insurance companies can limit their coverage of behavioral therapy to $50,000 of coverage per year. How will the law be enforced? The South Carolina Department of Insurance has regulatory authority over state-regulated health insurance programs doing business in South Carolina. The Department uses this authority to enforce the law. Covered Services What coverage is mandated by law? The law does not specify exact treatments that are mandated. However, the law does state that the plan must provide coverage for the treatment of autism spectrum disorder and specifies that the coverage is to be prescribed by a treating medical doctor in accordance with a treatment plan. While any treatment prescribed by a treating physician may be subject to coordination of benefits, participating provider requirements, utilization review, and medical necessity limitations, insurance companies covered by the law risk penalty if they refuse coverage for proven treatments of autism. Is applied behavioral analysis (ABA) covered? Yes, the law specifically mentions behavioral care and creates a minimum benefit of $50,000 a year.

10 10 Will all of the Autism Spectrum diagnoses be covered, or those diagnoses with the keyword of autism? The law specifically defines autism spectrum disorder as including Autistic Disorder, Asperger s Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified. Coverage is mandated for all three of these diagnoses. Does Autism Spectrum Disorder have to be the primary diagnosis for the child in order to qualify for coverage? No, there is no requirement that ASD must be the primary diagnosis for the child to qualify for coverage. Is Case Management covered? Case Management is not a mandated under S.C. Code Ann Who determines what services are medically necessary? The patient s physician or psychologist indicates on the treatment plan what services are medically necessary, however there is a utilization review process within the insurance company that may review the services ordered on the treatment plan.1 Will the new law require insurance companies to cover the cost of social groups? Must it be prescribed by a physician? S.C. Code Ann does not include a "list" of covered services. Rather, the law requires coverage for specific types of services. Therefore, coverage under the bill will be determined by the insurance company based on the requirements of the law, whether the treatment is medically necessary, and whether the treatment is ordered as part of the child s treatment plan by a licensed physician.2 Private Insurance Will an insurance company be able to question my child s existing autism diagnosis? Diagnoses are subject to utilization review of health care services including review of medical necessity. However, once a diagnosis and treatment plan are agreed upon, the health insurance plan may only request an updated treatment plan once every 6 months from the treating medical doctor to review medical necessity, unless the treating doctor and the health insurance plan agree that a more frequent review is necessary. Will insurance companies be able to deny services if my child is not making sufficient progress or has reached a plateau in his/her progress? A treatment plan prescribed by a physician is subject to utilization review and medical necessity review. While an insurance company could decide that services are no longer medically necessary, such a decision would be subject to external review under the Health Carrier External Review Act. Will private insurers be developing their own medical necessity criteria? Private insurers will use their own medical necessity criteria. The patient s physician or psychologist indicates on the treatment plan what services are medically necessary, however there is a utilization review process within the insurance company that may review the services ordered on the treatment plan.3 1 Language is from Pennsylvania FAQ. 2 Id. 3 Id.

11 11 Will my child be covered under the mandate if I buy my health insurance through the individual market? No. The mandate does not apply to health insurance companies selling plans over the individual market. I am a state employee or retiree and my family is insured by the State Health Plan. Is my child s coverage included in the mandate? Yes, the State Health Plan is included within the mandate. Are all group plans offered by (non-small business) employers required to cover autism care as provided by the mandate? No. Some employers fund their own health benefit program, which means they do not pay premiums to an insurance company to spread the risk of their employees. These health benefit programs are not regulated by the state of South Carolina, but are regulated by the federal government under the Employer Retirement Income Security Act (ERISA). Self-funded employer plans are not covered under the state mandate. How do I know that my health benefit plan is a self-funded plan? Consult with your employer.

12 SC PDD Waiver Fiscal Year 2009/2010 Funding Amount in State Dollars ($7.5 million) 12 South Carolina Department of Disabilities and Special eeds Pervasive Developmental Disorder Program Legislative History During the 2006 session of the South Carolina General Assembly, parent advocates organized a grassroots initiative seeking new legislation that would require insurance companies to provide coverage for the treatment of a Pervasive Developmental Disorder (PDD). At the time the insurance companies opposed this mandate. As a compromise to both help families and hold insurance companies harmless, $3 million in non-recurring funds was appropriated to the Department of Disabilities and Special Needs (DDSN) by the General Assembly. These one-time funds came with specific instructions to the agency, via a budget proviso, regarding the new program to be coordinated with the Department of Health and Human Services (DHHS) to provide therapies to young children diagnosed with a PDD. During the legislative process it was acknowledged that some children were receiving some services through the BabyNet program or through their school. It was clear that this new program and new funds were not to replace or enhance these pre-existing entitlement programs. Those are to continue. The new DDSN/DHHS initiative is not an entitlement program and is to be separate from BabyNet and education services, thus not duplicating state services. Program Description The Pervasive Developmental Disorder Program (PDD) has two primary operational components: the Pervasive Developmental Disorder Waiver and the Pervasive Developmental Disorder State Funded Program. Both components focus on utilizing the principles of Applied Behavior Analysis to treat children who have been diagnosed with a Pervasive Developmental Disorder to include Autistic Disorder (here in after referred to as autism) and Asperger s Syndrome. Under the PDD Program, the SC Department of Disabilities and Special Needs (DDSN) will coordinate the provision of Service Coordination and Early Intensive Behavioral Intervention (EIBI) Services. EIBI services consist of assessment and behaviorally oriented treatment of children with a diagnosis of a neurological disorder under the DSM-IV category of Pervasive Developmental Disorder. EIBI services are based on an individuals child s strengths and challenges and their need for a structured, individualized curriculum. Trained professionals will coordinate, implement and render the EIBI service. Providers selected by the child s parents/guardians will utilize Applied Behavior Analysis to develop the child s skills in the area of cognition, behavior, communication and social interaction that are central to autism and Asperger s Syndrome. Applied Behavior Analysis (ABA) is the process of systematically applying interventions to improve socially significant behaviors, and to demonstrate that the interventions employed are responsible for the improvements in behavior. Socially significant behaviors include reading, social skills, communication, and adaptive living skills. Adaptive skills include gross and fine motor skills, eating and food preparation, toileting, personal self-care, and home and community orientation.

13 Providers of EIBI services will have the latitude to recommend and employ various instructional methodologies used in ABA based programs such as, but not limited to, Discrete Trial Training, Errorless Teaching, Visual Communication Systems, chaining, shaping, task analysis, and Incidental Teaching. Eligibility Criteria In order to be eligible for services through the PDD Waiver/PDD State Funded Program, children must: 1. Meet the target population criteria as follows: Be ages 3 through 10 years. Diagnosed with a PDD by age eight years. The diagnosis must be made by a qualified, licensed or certified diagnostician. Children who are currently eligible for DDSN under the Autism Division must meet these criteria. Diagnostic documentation must include information supporting a DSM-IV rating. a. For an autism diagnosis, there must be evidence of at least two of the following: Autism Diagnostic Observation Schedule (ADOS), Autism Diagnostic Interview (ADI), Social Communication Questionnaire (SCQ), or Childhood Autism Rating Scale (CARS). b. For an Asperger s Syndrome diagnosis there must be evidence ruling out autism using previously mentioned tools and concluding with an additional adaptive behavior scale (i.e. Vineland) and one of the following: DSM-IV Criteria Checklist/Asperger s Disorder , Asperger s Syndrome Diagnostic Scale (ASDS), Asperger s Syndrome Diagnostic Interview (ASDI) or Online Asperger s Syndrome Information and Support (OASIS). c. For Other PDD diagnosis there must be evidence ruling out autism using previously mentioned tools and the DSM-IV Criteria Checklist/Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) and the Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS) Meets Medicaid financial criteria or provide documentation of financial ineligibility for Medicaid. 3. Assure that the child meets ICF/MR Level of Care medical criteria (as determined by the DDSN Consumer Assessment Team for this program.) Children who do not meet ICF/MR Level of Case, but meet all other eligibility requirements may receive services outside the waiver through the State Funded PDD program if funding is available. However, the child and parents/guardians must comply with all other program requirements and stipulations.

14 To maintain eligibility for services via the PDD Waiver or the PDD State Funded Program: 14 Applying For Services i. Services must be received within 30 days of enrollment into the PDD Waiver/State Funded program. ii. The child must receive at least one waiver service each month documented in the participant s record. iii. The Service Coordinator and, when specified, the Autism Division must receive required documentation from the EIBI provider within the timeframes identified beginning with the first month period following the initiation of service. iv. Proof of progress from the initial baseline derived from the preliminary assessment tool must be provided by the EIBI provider to the child s Service Coordinator and the Autism Division every six months. Currently Eligible DDS Consumers If a parent /legal guardian is interested in receiving EIBI services through the PDD Waiver and his/her child is currently eligible for DDSN services, the parent/legal guardian should contact the child s Service Coordinator and request that the child go through the intake process for the PDD Waiver. The Service Coordinator will: 1. Assure the child meets the target population criteria as follows: The child is age 3 through 10. The child was diagnosed with a PDD by age of eight. The diagnoses must have come from a licensed diagnostician. Diagnostic documentation must include information clarifying a DSM-IV rating. For an autism diagnosis, there must be evidence of at least two of the following: ADOS, ADI, SCQ, or CARS. For the other PDD diagnosis there must be evidence ruling out autism using previously mentioned tools and the DSM-IV Criteria Checklist/ PDD-NOS and the Scale of PDD-MRS. Meet Medicaid financial criteria or provides documentation of financial ineligibility for Medicaid. Assure that the child meets ICF/MR Level of Care medical criteria (as determined by the DDSN Consumer Assessment Team for this program.) 2. If it is determined that the child meets the target population criteria, the Service Coordinator will: Assist the parent/legal guardian with completing the application: Request for PDD Waiver Slot allocation: Cover Sheet. This form must be signed by the parent/legal guardian. Complete the form Request for ICF/MR Level of Care for the PDD Waiver and gather all documents necessary for CAT to complete a LOC. Determine the parent s/legal guardian s interest in the Responsible Party Directed Care option. If the parent s/legal guardian s express an interest in serving as the Responsible Party or desire more information about this option, the SC will give them the document PDD Program Responsible Party Directed Care Enrollment Information. When the child is awarded a slot for services, the SC will assist the parents/legal guardians with completing all necessary forms.

15 Once the aforementioned tasks have been completed, a packet containing all information will be sent to the Enrollment Coordinator. If no slot is available, the child s name will be placed on a waiting list. When slots become available, the packet of the first child s name from the waiting list will be forwarded to CAT for a LOC determination. on DDS Consumers To be considered for the PDD Waiver, children who are not consumers of DDSN must go through Screening, Intake, and Service Coordination Selection. Screening Screening is the process initiated by the child s parent/legal guardian via the PDD Intake and Referral Call Center. The PDD Intake and Referral Call Center serves as the single entry point for participation in the PDD Waiver for all children not currently served by DDSN. The Call Center provides the caller with a brief overview of EIBI services. A trained screener asks the caller a series of questions to help determine if the child is appropriate for a referral. i. Families interested in receiving EIBI services must call the PDD Waiver Intake and Referral toll free number and leave their name and phone numbers. The screener will have 48 hours to return all calls. Calls will be returned in the order in which they were received. The date and time all calls are received and returned will be maintained in a log book by the Intake and Referral staff. ii. Upon making contact with a family, the screener will ask several questions to determine if the referral is appropriate. If responses indicate that the child may be eligible for EIBI services through the PDD Waiver, the screener will assist the parent through the intake process. If responses rule out the eligibility, the screener will confer with the Autism Division for conformation. If the Autism Division concurs with the screener the process will end. If this occurs, the family/legal guardian will receive from the screener, a Notice of Denial of Services stating the reason for the denial. The family/legal guardian will also be informed of their right to appeal per the SCDDSN Reconsideration Process and SCDHHS Medicaid Appeals Process. If the Autism Division does not concur, the child will continue through the process. 15 Intake Intake is the process in which specific documents are signed by the parent; records to support the applicant s diagnosis are requested, and additional information is provided to the parent about the PDD Waiver. If the child is screened in as appropriate for PDD services, the parent/legal guardian will be guided through the intake process by the PDD Intake and Referral Screener.

16 1. The screener will: Explain the process for applying for the PDD Waiver and EIBI services. Offer a choice of Service Coordination Provider. This will be documented on the Acknowledgement of Service Coordination Choice. The screener will inform the parent/legal guardian of all available Service Coordination providers in their county. Obtain the name, address and phone number of the child s physicians, teachers, and any other service providers. This information will be used to complete the Authorization for Release of Information forms so the child s records can be obtained. Assist the family with applying for Medicaid eligibility if the child is not a current recipient The screener will mail the family a packet that includes, a self-addressed stamped envelop, and the following documents: A letter explaining the enclosed packet. The Acknowledgement of Service Coordination Choice along with a list of SC providers for that county. A separate Authorization for Release of Information for each entity. The PDD Waiver Information Sheet. The PDD Disorder Program Fact Sheet. 3. After reviewing the information. The parent/legal guardian must sign the Acknowledgement of Service Coordination Choice and all Authorization for Release of Information forms. These documents must be returned to the screener for the process to continue. 4. When the completed documents are received from the parent/legal guardian, the screener will: Date stamp all documents. Review all documents to assure they have been completed, signed and dated. Contact the parent/legal guardian if information is missing or additional information is needed. Mail the Records Request Letter and release forms to the appropriate professional/provider.

17 5. Once all requested information has been received from the various professionals/providers who have served the child, the screener will date stamp all documents and conduct a thorough review of all documentation to determine if the records support the PDD. If records support that the child has autism or a PDD other than autism, the screener will forward to the Service Coordination provider of choice all documents pertaining to the child including a form indicating the presence of autism or the presence of a PDD. If no records are available or if records are available but insufficient to support that the child has autism or a PDD other than autism, the screener will forward to the Service Coordination provider of choice all documents pertaining to the child including the Recommendation for Evaluation form recommending an evaluation from the Autism Division or another diagnostic entity. If records do not support that the child has autism or a PDD other than autism, the screener will confer with the Autism Division for confirmation. If the Autism Division concurs with the screener the process will end. If this occurs, the family/legal guardian will receive from the screener, a Notice of Denial of Services stating the reason for the denial. The family/legal guardian will also be informed of their right to appeal per the SCDDSN Reconsideration Process and SCDHHS Medicaid Appeals Process. If the Autism Division does not concur, the child will continue through the process. 17 Service Coordination All families will have an opportunity to select a Service Coordination Provider of their choice. The Service Coordinator will assist the family in obtaining EIBI services. Each DSN Board and private Service Coordination provider will designate a specific person to receive information from the PDD Intake and Referral Call Center screener. When the designee receives information, they will complete a record of contact with the date and time the information was received. It will be at the discretion of the provider to assign a specific Service Coordinator. This assignment must be made within three days of receipt of the information from the Intake and Referral Center. Information received from the PDD Intake and Referral Center will dictate the specific actions of the Service Coordinator. 1. Autism or other PDD supported by records If it was determined by the PDD Intake and Referral Call Center that the child has autism it a PDD other than autism, the Service Coordinator will: Explain the Service Agreement to the parent/legal guardian and have them sign the form. Explain the Request for the PDD Waiver Slot Allocation: Cover Sheet to the parent/legal guardian and have them sign the form. Complete the Request for ICF/MR Level of Care for the PDD Waiver.

18 Send a packet containing all information to the Waiver Enrollment Coordinator. When a waiver slot becomes available, the Waiver Enrollment Coordinator will forward all documents to CAT for a LOC determination. If no slot is available, the child s name will be placed on a waiting list. If the child is placed on the waiting list, the Waiver Enrollment Coordinator will notify the family and Service Coordinator by letter. When slots become available, the packet of the first child s name from the waiting list will be forwarded to CAT for a LOC determination. Determine the parent s/legal guardian s interest in the Responsible Party Directed Care option. If the parent s/legal guardian s express an interest in serving as the Responsible Party or desire more information about this option, the SC will give them the document PDD Program Responsible Party Directed Care Enrollment Information. When the child is awarded a slot for services, the SC will assist the parents/legal guardians with completing all necessary forms No records available or records insufficient. If there were no records available or if records are available but insufficient for the Intake and Referral Call Center to make a determination, the Service Coordinator will: Explain the Service Agreement to the parent/legal guardian and have them sign the form. Make a referral to have the child evaluated at an Autism Division CARE Center or other diagnostic entity of the parent/legal guardian s choice. The results of the evaluation will be shared with the Service Coordinator if the parents have consented by signature. If it is determined that the child does not have autism or another PDD, the process will end. If this occurs, the family/legal guardian will receive from the screener, a Notice of Denial of Services stating the reason for the denial. The family/legal guardian will also be informed of their right to appeal per the SCDDSN Reconsideration Process and SCDHHS Medicaid Appeals Process. If it is determined that the child has autism or another PDD, the Service Coordinator will: a. Explain the Request for PDD Waiver Slot Allocation: Cover sheet to the parent/legal guardian and have them sign the form. b. Gather all documents necessary for CAT to complete a LOC.

19 19 I DEX OF FORMS FOR RESPO SIBLE PARTY DIRECTED CARE Forms General Information Info-Sheet 10 PPD Tuberculin Skin Test Requirements Line Therapist PDD Form RP 8 PDD Form RP 9 PDD Form RP 10 PDD Form RP 11 PDD Form RP 12 PDD Form RP 16 Form I-9 Form I-9 Sample Form W-4 PDD Program Line Therapist Information Sheet Electronic Funds Transfer and Payroll Tax Deduction Authorization PDD Responsible Party Directed Services Employee Payment Agreement PDD Program Line Therapist Responsibilities Agreement PDD Program Responsible Party-Directed Line Therapy Services Liability Statement PDD Program Responsible Party Line Therapy Daily Log Employment Eligibility Verification Employment Eligibility Verification Sample Employee s Withholding Allowance Certificate Responsible Party PDD Form RP 5 PDD Form RP 19 Form SS-4 Form SS-4 Sample Form 8821 Form 8821 Sample Form 2678 Form 2678 Sample PDD Program Responsible Party Information Sheet Responsible Party Line Therapist Invoice Application for Employer Identification Number Application for Employer Identification Number Sample Tax Information Authorization Tax Information Authorization Sample Employer/Payer Appointment of Agent Employer/Payer Appointment of Agent Sample

20 20 Service Coordination PDD Form RP 1 PDD Form RP 2 PDD Form RP 15 PDD Form RP 17 PDD Form RP 18 Info-Sheet 8 PDD Program Pre-Screening Assessment of Responsible Party Checklist of Items Needed for PDD Program Responsible Party-Direction of Services PDD Program Line Therapist Qualifications Checklist Authorization for PDD Waiver Responsible Party Line Therapy Authorization for PDD State Funded Program Responsible Party Line Therapy Responsible Party Directed Care Enrollment Information The Consultant forwards his/her evaluations to DDSN. A treatment plan is approved authorizing the number of hours of EIBI the child will receive based on individual needs. The Consultant then coordinates the implementation of the treatment plan. Trained individuals work with the child one-on-one in the child's home. During this year, DDSN developed a service manual for all providers to use. Results As of June 30, 2007, a total of 140 children have been accepted in the Pervasive Developmental Disorder Program. Of these 140 children, 89 meet Medicaid eligibility criteria, 33 are pending Medicaid eligibility, and 18 (13 percent) are participating with 100 percent state funds. There are 382 children on the waiting list. The new $4.5 million appropriated for FY 2008 will serve approximately 350 children on this waiting list. The original estimate was to serve only 220 children from the waiting list. However, it was originally estimated that only 60 percent of the children would be Medicaid eligible versus the current rate of 87 percent. In addition, the original cost estimate was $35,200 per child versus the current average of $38,783. These changes in current numbers will result in more children being served. Of the current PDD Program participants and applicants, 84% are male and 16% are female. Ninety-five percent (95%) of the children have a diagnosis of autism and 5% have other PDD diagnoses. Children ages 3 through 6 comprise 67% of participants and children age 7 through 10 comprise 33%. The average budget per child is $38,783. This equates to an average of 29 hours per week of applied behavior analysis therapy for these children. The number of hours provided each child is determined by the individual's initial assessment. This in-depth assessment consists of a battery of four standardized tests. The provider monitors the actual delivery of therapy performed by trained staff. After 12 months of prescribed therapy, the battery of standardized tests will be repeated to assess the progress made and the individual's new level of service need.

21 In the summer of 2006, DDSN set up meetings to recruit EIBI providers. This first effort generated 5 qualified providers. To date DDSN has recruited 13 qualified early intensive behavior intervention providers. The effort to recruit additional providers is ongoing, both instate and outside of South Carolina, to offer families a choice of providers and to ensure a sufficient supply of providers to meet the service demand. To further these goals, DDSN is also developing a fiscal intermediary service for families who choose to hire and coordinate their own therapists who would work with a qualified EIBI provider. Due to the enormous task of getting approval of a new Medicaid waiver, creating eligibility criteria, creating program and service criteria, determining and processing each child's eligibility, and recruiting and educating providers, among other activities, actual therapy services began the last quarter of the fiscal year. Therefore DDSN is unable to report on the developmental progress of program participants at this time. It is expected that results will be measurable after actual service delivery is in process for at least one year. 21

22 22 State Autism Agencies Autism Administrative Offices for SC (Copied directly from SCDDSN Website) SC Department of Disabilities and Special eed Autism Division 3440 Harden St Extension PO Box 4706 Columbia SC Phone: (803) V/TTY: (803) Toll Free: DSN-INFO ( ) Fax: (803) Midlands Office 8301 Farrow Rd Columbia SC Phone: (803) Fax: (803) serving residents of Aiken, Calhoun, Chester, Fairfield, Kershaw, Lancaster, Lexington, Newberry, Richland and York counties. Piedmont Office 269 South Church St, Suite 309 Spartanburg SC Phone: (864) Fax: (864) serving residents of Abbeville, Anderson, Cherokee, Edgefield, Greenville, Greenwood, Laurens, McCormick, Oconee, Pickens, Saluda, Spartanburg and Union counties. Coastal Office Fairfield Office Park 1064 Gardner Rd, Suite 302 Charleston SC Phone: (843) Fax: (843) serving residents of Allendale, Bamberg, Barnwell, Beaufort, Berkeley, Charleston, Colleton, Dorchester, Hampton, Jasper and Orangeburg counties. Pee Dee Office PO Box 3209 Florence SC Phone: (843) Fax: (843) serving residents of Chesterfield, Clarendon, Darlington, Dillon, Florence, Georgetown, Horry, Lee, Marion, Marlboro, Sumter and Williamsburg counties.

23 State Department of Health and Human Services (DHHS) 23 TEFRA (Medicaid) General info and Application: %20Katy%20Beckett.asp Checklist to make sure the parent has completed all the steps: BABY ET* Children With Special Health Care Needs : BabyNet What Is BabyNet Early Intervention Services F.A.Q. State ICC Policy Manual and Forms Links Return to CSHCN Programs BabyNet is South Carolina's interagency system of early intervention services for families who have infants and toddlers, birth to three years of age, with developmental delays or conditions associated with developmental delays. Children may be eligible for BabyNet if they are learning or developing slowly. Eligible children are served regardless of family income or nationality. BabyNet matches the special needs of infants and toddlers who have developmental delays with the professional resources available within the community. Services are provided in everyday routines, activities and places relevant to the life of the family. Anyone (a parent, doctor, caregiver, teacher or friend) can make a referral by calling the referral phone number listed below. The earlier you get help, the better. Early intervention makes a difference! BabyNet services are provided in accordance with Part C of the Individuals with Disabilities Education Act (IDEA). The South Carolina Department of Health and Environmental Control (DHEC) serves as the Lead Agency for BabyNet. To receive additional information or make a referral, please contact BabyNet at: Referrals: CareLine: Mailing Address: SC DHEC BabyNet 1751 Calhoun Street Columbia, SC Phone: (803) Fax: (803) babynet@dhec.sc.gov Information copied directly from DHHS website For regional information and contact go to: Addtional Information (pdf) 2006 Part C Application Part C State Performance Plan (SPP) for Memorandum of Agreement FY 2007 OSEP Grant Application Public comments on the FY 2007 application will be accepted until May 10, Comments should be addressed to: babynet@dhec.sc.gov OTICE: Baby et is not affiliated with callers from Contact your Service Coordinator or the nearest Baby et office if you have a question about requests for personal information about children receiving Baby et services.

24 County Autism Agencies 24 The following services for autism are coordinated through these county agencies: Day Habilitation Early Intervention Facility-Based Rehabilitation Supports Home Supports - Adult Companion Home Supports - Personal Care I Home Supports - Respite Care - Daily Home Supports - Respite Care - Hourly Prevocational Residential Habilitation - Community Training Home I Residential Habilitation - Community Training Home II Residential Habilitation - Supervised Living Program I Residential Habilitation - Supervised Living Program II Service Coordination Supported Employment ABBEVILLE COU TY Burton Center* 2605 Highway 72/221 East Greenwood, SC Phone: Fax: jfeltonburton@burtoncenter.org AIKE COU TY Aiken County Board of Disabilities* PO Box Vaucluse Rd (29801) Aiken, SC Phone: Fax: Homepage: rcourtney@aikentdc.org Tri-Development Center of Aiken County, Inc Vaucluse Road P.O. Box 698 Aiken, South Carolina Phone: (803) Fax: (803) rcourtney@aikentdc.org Homepage: Autism (also mental retardation and related disabilities and head/spinal cord injuries) ALLE DALE COU TY Allendale/Barnwell Disabilities & Special eeds Board* 914 Barnwell Highway (29810) P.O. Box 556 Barnwell, SC Phone: Fax: Homepage: ABCDSNB@barnwellsc.com

25 25 A DERSO COU TY Anderson Disabilities & Special eeds Board * 214 McGee Road Anderson, SC Phone: Fax: Homepage: dthompson@acdsnb.org BAMBERG COU TY Bamberg County Disabilities & Special eeds Board* Heritage Highway Denmark, SC Phone: Fax: gloriaj_29059@yahoo.com BAR WELL COU TY Allendale/Barnwell Disabilities & Special eeds Board* 914 Barnwell Highway (29810) P.O. Box 556 Barnwell, SC Phone: Fax: Homepage: ABCDSNB@barnwellsc.com BEAUFORT COU TY Beaufort County Disabilities & Special eeds Department * 1804 Old Shell Road P.O. Box 129 Port Royal, SC Phone: Fax: mwagner@bcgov.net BERKELEY COU TY Berkeley Citizens, Inc. * 1301 Old Highway 52 South P.O. Drawer 429 Moncks Corner, SC Phone: Fax: Homepage: AShook@bciservices.org CALHOU COU TY Calhoun Disabilities & Special eeds Board * 78 Doodle Hill Rd St. Matthews, SC Phone: Fax: rrobinson@calhoundsnb.org CHARLESTO COU TY Disabilities Board of Charleston County* 995 Morrison Drive P.O. Box Charleston, SC Phone: Fax: Homepage: kelliott@dsncc.com

26 26 CHEROKEE COU TY Cherokee Disabilities & Special eeds Board * 959 East O'Neal Street (29340) P.O. Box 340 Gaffney, SC Phone: Fax: pcooper@cherokeedsnb.org CHESTER COU TY Chester/Lancaster Disabilities & Special eeds Board* 1126 Camp Creek Road P.O. Box 577 Lancaster, SC Phone: Fax: jaltman@cldsn.org CHESTERFIELD COU TY Chesterfield Disabilities & Special eeds Board * 1224 East Boulevard P.O. Drawer 151 Chesterfield, SC Phone: Fax: ccbdsn@shtc.net CLARE DO COU TY Clarendon Disabilities & Special eeds Board * 312 Pine Street P O Drawer 40 Manning, SC Phone: Fax: jchristian@ccdsn.org COLLETO COU TY Colleton Co Board of Disabilities* 119 Charles Street P.O. Box 1547 Walterboro, SC Phone: Fax: dredd@colletondsn.org DARLI GTO COU TY Darlington Disabilities & Special eeds Board * 201 N Damascus Church Rd Hartsville, SC Phone: Fax: rthomas@dcdsnb.org DILLO COU TY Marion-Dillon Disabilities & Special eeds Board* 400 Martin Luther King Blvd. P.O. Box 1082 Marion, SC Phone: Fax: Homepage: gkeith@mddsn.org