a handbook for parents of children with autism spectrum disorders

Who determines if my child will receive the services recommended?Community Care reviews the information presented when a request is madefor behavioral health services. If the person reviewing the case (known asa “care manager”) feels that the information presented in the packet meets“medical necessity” criteria for the services requested, the packet will then beauthorized. The service provider will be contacted and given an authorizationnumber.If Community Care’s care manager is uncertain about whether the packetmeets medical necessity criteria or required information necessary to makea decision is missing, the evaluation will be further reviewed. In this case,Community Care may request more information from the provider or from theperson who did the evaluation. The parents are not required to do anythingfurther at this point. This request for information is not an indication that theservices will not be approved. It is simply a way to gather more information tobetter understand your child’s specific symptoms and behaviors. The providerwill have five business days to submit the requested information. Afterreceiving the additional information, Community Care will make a decisionwithin two days.What happens next if recommended services are approved?If Community Care approves services and a provider has been identified,the provider will then begin to provide services. Providers agree to initiatea member’s treatment if they have the staff and appropriate expertise. Theprovider then contacts the family and notifies them of a start date. Thefamily can choose a provider but may have to wait longer depending on theprovider’s availability. The provider will go to the identified setting and beginworking with the child. The BSC will begin the FBA. The goal is to understandthe function of each behavior and develop strategies for reducing theidentified behaviors in all settings. These services should be provided overthe length of the authorization period.“I believe thatevery one of us,regardless of ourtalents, skills,temperament, pastexperiences, orlevel of function, isintrinsically worthyof support to reachour fullest potential.I take as my guidefor action thisvision: that we are,each of us, preciousand beautiful.”—A person with AutismHow do I keep getting these services?Toward the end of the authorized period, the agency that is providingservices will request that your child be re-evaluated to determine the impactof services, any changes in behavior, and the continued needs of your child.Another evaluation will be completed along with another ISPT meeting withall relevant team members. This process continues throughout the entire timethat your child receives services.- Page 19 -