The

INSTITUTE

for Behavior Change

www.ibc-pa.org

 

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    Learn how EPSDT (Medicaid) can fund mental health treatment in homes and schools responsibly

 

 

   11/11/11 Conference Introduction and presentation by Lorri & Daniel Unumb on Medical Necessity

 

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    BHRS - Successful MH Treatment for Children funded   by Medicaid since 1992

    Independent Treatment research - 887 cases; over 75% successful

CMS Director's June 2011 letter complimenting IBC's Executive Director on the IBC model for BHRS

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The Children's Behavioral Health Center

Imagine that any child from Pennsylvania with a disability who does not yet have Medical Assistance benefits can receive an expert diagnostic evaluation and consultation with a licensed psychologist and certified school psychologist with more than 30 years' experience in the field of children's mental health in about a month.  The Center closed its Coatesville location after three years of nonsupport by County or State officials, but these services are still available and can be delivered to Pennsylvania children who are disabled but who do not yet have Medical Assistance benefits -- without need for the approval of any government official or insurance company.  The evaluation is absolutely free to qualified Pennsylvania residents under the age of 21, regardless of family income. 

Please call 610-524-8706 for more information or Contact the CBHC staff by e-mail.

Fast answers to frequently asked questions about Evaluations

 

I can't believe you can do these evaluations so quickly.  And at no cost.  How is that possible?  

 

Different evaluations have different purposes.  We do not offer medical evaluations.  We are behavioral scientists, not physicians, and our evaluations are targeted to providing a comprehensive review of your child's strengths, weaknesses and needs from a biological-psychological-social perspective that will establish your child's eligibility for Medical Assistance benefits if he or she has a mental illness that is recognized by the Pennsylvania Department of Public Welfare.   Obviously, we don't make a profit on our evaluations to determine a child's eligibility for Medical Assistance benefits; we do them because they need to be done quickly so that necessary treatment services can get started.  You should obtain other evaluations to serve other needs, and we will help you determine what those other needs might be when we meet with you.

Like all organizations that provide evaluation services (hospitals, etc), more than one professional is involved in the evaluation process, including people with Masters degrees in psychology who work under the close supervision of licensed psychologists to conduct interviews, collect behavioral information and create draft evaluation reports that a licensed psychologist with decades of experience helping children relies upon in meeting with you and your child in order to rapidly form responsible professional conclusions about your child's strengths, weaknesses and needs.  This licensed psychologist completes the evaluation, generates the final diagnoses and recommendations, and is fully responsible for the content of the evaluation report, but a large part of the evaluation is performed by unlicensed supervisees.  By dividing up the responsibility for the evaluation in this way, it is possible to perform an excellent, comprehensive evaluation quickly and cost-efficiently that achieves its intended primary purpose: determining whether or not your child is eligible for Medical Assistance benefits due to a mental illness.

If my child must have Medical Assistance (MA) to get these services, is my child eligible for Medical Assistance? 

Yes, if he/she lives in Pennsylvania, is under 21 years of age, and has a disability, your child is almost certainly eligible for Medical Assistance benefits.  It costs you nothing to ask.  Please call anytime:  610-524-8706 for more information.  If you would like written information about the evaluation process or the Institute for Behavior Change, including our Organizational Chart, click here.

How long does it take to get an evaluation from you to determine my childís eligibility for MA benefits? 

Provided that your child is a Pennsylvania resident under 21 years of age with a disability and without Medical Assistance benefits, if you can visit our office with your child (outside Coatesville in Chester county) the evaluation can be completed in a few hours, and the written report of the evaluation can be delivered to you in less than 30 days. 

 What does your evaluation involve? 

About one hour of your responding to questions about your child, completing a brief behavior rating scale about your childís typical behavior, and having the child meet briefly face-to-face with a licensed psychologist.  The psychologistís finished report can usually be delivered to you in less than 30 days.  It will be about 12-15 pages long and will cover everything that any insurance company, funding agency or treatment service provider in Pennsylvania could possibly want.    

Who performs this evaluation? 

A trained mental health professional will ask the questions, write down your answers and help you complete the behavioral rating scale.  A licensed professional psychologist and Certified School Psychologist will meet with your child face-to-face and complete the evaluation.  

Besides establishing a child's eligibility for MA benefits due to a mental disability, does your evaluation have any other uses? 

Yes.  Our evaluation reports have served four additional purposes simultaneously: 

1.       Establish eligibility for Early Intervention services if your child is under the age of 5 and has a significant developmental delay.

2.       Determine your child's entitlement to special education services in school.

3.       Establish your childís entitlement to professional behavioral support services in your child's home or school if your child has a need for these services, including EPSDT "Behavioral Health Rehabilitation" (BHR) services -- sometimes (mistakenly) called "wraparound" services.

4.      Create an integrated, individualized behavioral Treatment Plan for your child that will be acceptable to any Managed Care Organization in Pennsylvania for delivering EPSDT BHR services if theyíre needed.

 

Is there a waiting list for these evaluations?

           

No.   If your child needs help, call us:  610-524-8706.  We can usually get started in less than two weeks. 

 

Why isn't there any cost for these evaluations to determine a child's need for Medical Assistance benefits? 

 

The cost is paid 100% by the Medical Assistance (Medicaid) program in the State of Pennsylvania, regardless of family income, if your child is found to be eligible for Medical Assistance benefits.   If we donít believe that your child will qualify for Medical Assistance benefits, we will tell you so before the evaluation, so there will be no cost to you in any case, and no unnecessary travel to our office.  If you want a different type of evaluation (academic achievement, intelligence, personality), our staff can also help you, but there will be a cost to you (that cost may or may not be reimbursable in whole or in part by your private insurance company).

 

What if I already have Medical Assistance benefits for my child and I live in Chester County, PA? 

 

Unfortunately, if your child already has MA benefits and you live in Chester County, PA our staff canít help you until you get permission from the county government to get services from the psychology group that we work with (The Network for Behavior Change -- the largest private practice of psychology in Pennsylvania dedicated exclusively to helping children).  Itís unfortunate, we have tried to change their policy, but we have to follow it if you live in Chester County, PA.  To get the County's permission, you have to visit one of the evaluation providers theyíve chosen for you and that evaluator has to prescribe the services your child needs.  After you have their prescription, if they prescribed EPSDT BHR services (sometimes mistakenly called "wraparound" services), you can probably get those services from the Network for Behavior Change....

 

The good news:  Because our staff have been delivering these services for more than a decade to children as young as 18 months of age, we can probably help you work-through just about any situation in this field that confronts your child.  Please call us anytime:  610-524-8706.

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Last updated: 01/02/12.