Friday, February 7, 2014

Comments Requested for Proposed Changes to Texas' Children's Autism Program

The State of Texas is accepting public comment about proposed changes to its children's autism program until February 10, 2014. 

Sponsored by a grant from the Texas Department of Assistive and Rehabilitative Services, this program provides a variety of services on a sliding scale basis to children with diagnoses of an autism spectrum disorder and their families: therapy, parental training, service coordination, shadowing, in-home support, etc.

In an effort to serve more children (the program has an extensive waiting list), a number of modifications have been suggested. While many of these changes are positive, there are a few that are very disconcerting, particularly these:

"Program Eligibility Elements:
• Establish eligibility criteria to consider severity of impact of the autism diagnosis."


"Treatment Provider Qualification and Supervision Elements
• Change education, training or experience requirements
• Change credentialing requirements
• Change staff supervision requirements."

The proposed modifications pose a threat to the very clients they wish to serve. By using "severity criteria" to determine who "deserves" to be accepted into the program, the program is perpetuating the myth of functioning levels and will cause certain children will be unfairly denied services because it will be perceived that they do not "need" help.

By presumably diluting the qualifications of staff and the methods of supervision, the program endangers the physical and emotional safety of the children. Thorough, ongoing training and close supervision is imperative in such a program to ensure that services are rendered both ethically and effectively. Reducing these standards creates the potential of unnecessary risk and diminishes the program's impact as well.

Why do I care? Because Texas is a state where there is huge unmet need, and this statewide program fills a void for many. This program serves a racially and economically diverse population of children and families in a number of settings and provides them with resources, hope, education, and support. 

If "severity levels" are imposed, it implies that we need to "grade" our children. Who determines which child's autism diagnosis is "more severe" than another? What criteria does a child need to meet to "pass?"

If staff are not adequately trained, educated, and supervised, than how will they be able to distinguish between what is "aggressive behavior" and what is not? Whether a child is being "noncompliant" or whether it is something else? Without close supervision, who can gauge if the child's program is being implemented safely and properly?
implore you to consider sending a public comment letting the decision makers know that these modifications are NOT what these families need!

"DARS will be taking written comment from January 20, 2014, to February 10, 2014. Written comments may be submitted electronically to or sent by postal mail to:

Texas Department of Assistive and Rehabilitative Services
Center for Policy and External Relations, Mail Code 1423
4800 North Lamar Blvd.
Austin, TX 78751-2399."

Please see the embedded links for more detail on the DARS program if desired.

PLEASE take a moment and write a short, one or two sentence email! Public comments matter! Your remark might be the very one to change their minds! Please consider helping, because the advocate=you + me!

Quoted from the DARS website:

"The Current DARS Autism Program

• The DARS Autism Program serves Texas children ages 3 to 8 years old that have an autism spectrum diagnosis.
• Services are provided through contracts with local community agencies and organizations in six areas of the State. The providers are currently located in: Austin, Dallas, Fort Worth, Houston, Rosenberg and San Antonio.
• The Autism Program model provides comprehensive Applied Behavior Analysis (ABA) treatment services. These services are designed to address a child’s developmental needs in addition to behavioral challenges.
• Contractors vary in their delivery of comprehensive ABA services.
o Treatment intensity varies from 10-35 hours per week based on an individualized treatment plan developed by a Board Certified Behavior Analyst (BCBA) or Licensed Psychologist.
o Services are delivered by para-professionals under the supervision of a BCBA or Licensed Psychologist.
o Most services are provided in a clinic setting, although home-based services may be provided as needed.
• Children are eligible for up to 24 months of services.
• Services are currently capped at $5,000 cost per child per month, based on the number of service hours delivered and the contract rate; however, DARS may approve requests to exceed this amount on a per-case basis.
• All families are required to participate in the cost of services by paying a family cost share.
• DARS is the payer of last resort for services provided in the Autism Program. Texas Medicaid and CHIP currently do not provide reimbursement for ABA services (except through a small number of Medicaid long-term care waivers) and only 30% of the private insurance plans are required by Texas statute to cover the cost of autism treatment services.
• The program’s funds are State general revenue appropriated by the Texas legislature.

During the 83rd Legislative Regular Session, a Health and Human Services Special Provision provided additional funding to expand the program to new areas of the state. The Special Provision required DARS to develop a plan to increase the number of children receiving autism services while considering the following criteria:

• Evidence based treatment modalities;
• The average number of treatment service hours necessary to make a measurable impact on behavior and the most appropriate duration of time to ensure progress is maintained;
• Which age range of children benefits the most from treatment;
• Which provider qualifications are most appropriate for the delivery of treatment services;
• Best practices for including parental and caregiver training and involvement in treatment services;
• Best practices for inclusion of treatment services in an educational setting;
• State and federal laws related to insurance coverage of treatment services for autism; and
• Funding options for treatment services that include maximizing non-state payer sources such as public and private insurance and family participation.
Potential Modifications to the DARS Autism Program

DARS has contracted with the University of Texas, School Of Special Education to research different Autism treatment modalities based on the above listed criteria. The purpose of these public hearings is to receive input from interested stakeholders on modifications to the DARS Autism program. We are seeking comment on the potential changes to components of the DARS Autism program listed below:

Program Model Elements
• Change or expand the treatment services covered in the program
• Establish criteria for intensity of services allowed or required in the program
• Allow for service treatment in a group setting
• Increase the requirements for parent or school participation in the program model
• Establish requirements for location of service delivery
• Establish transition services criteria

Program Eligibility Elements
• Establish eligibility criteria to consider severity of impact of the autism diagnosis
• Change the age limits for eligibility in the program
• Change the length of time for eligibility in the program
• Change the maximum amount of treatment services allowed monthly or annually paid by the program
• Establish criteria for child attendance and parent participation for continued eligibility
• Establish family income limits for eligibility
• Establish program interest list criteria

Treatment Provider Qualification and Supervision Elements
• Change education, training or experience requirements
• Change credentialing requirements
• Change staff supervision requirements

Family Cost Share Elements
• Change how family cost share amounts are calculated
• Change how family income is determined for family cost share
• Change the definition of family for determining family cost share"