While self-funding an ABA program is an option for some families, many find privately paying for services to be cost-prohibitive. Fortunately, there are several avenues through which families may access partial or full funding for their children's programs. Below, please find a general overview of your funding options. We realize that this process may be complicated and confusing. We would be happy to speak with you at any time to guide you through these systems as effortlessly as possible and ensure your success.
» Health Insurance
Health Insurance funding is now a reality for our families accessing or wanting to access ABA services. In October of 2011, Governor Brown signed into law Senate Bill 946, requiring health care coverage for the behavioral treatment of children diagnosed with ASD. Derived from the Mental Health Parity Act (2000), this law mandates that Autism treatment be funded in the same manner as any other covered medical diagnosis. On July 1st 2012, the California Autism Insurance Mandate went into effect, requiring insurance companies to provide autism treatment coverage.
As we have licensed clinicians on our clinical team, our families have been receiving ABA as a covered medical benefit since October of 2011.
FirstSteps has successfully contracted and is in network with the following health insurance companies to provide intensive ABA treatment services (as of January 2016):
|Blue Shield of California||Anthem Blue Cross|
|United Behavioral Health||Optum|
|Aetna||Easter Seals Bay Area|
|Dean Health Plan||Magellan|
|Contra Costa Health Plan||Meritain|
If you are interested in using your Health Insurance Benefits to fund your child’s FirstSteps ABA services, we can help to expedite the process. Please contact our Director of Client Services, Whitney Vance, at 424-212-7932 for details. Depending on the service authorization requested, you will need to provide the following documents to your Insurance Company:
TO REQUEST AUTHORIZATION FOR AN ABA ASSESSMENT BY FIRSTSTEPS:
After your child receives a diagnosis, you will need to schedule a formal ABA Assessment to include an analysis of your child’s pre-treatment problem behavior and skill repertories, goals for treatment, and service recommendations to achieve those goals. In order for us to request authorization for the Assessment, we will need to submit your child’s original diagnostic report which includes the DSM V multiaxial diagnostic codes and the standard forms for your particular policy. A response from your insurance (authorization or denial) is generally provided within 5-10 days of the authorization request.
TO REQUEST AUTHORIZATION FOR ON-GOING FIRSTSTEPS ABA SERVICES:
If your child has already been receiving ABA Services or if an ABA Assessment has been completed, FirstSteps will request authorization from your health insurance provider for on-going ABA treatment services. We will need to submit your child’s original diagnostic report which includes the DSM V multiaxial diagnostic codes, your child’s ABA Treatment Plan with goals and service levels outlined, and the standard authorization forms for your particular policy. A response from your insurance (authorization or denial) is generally provided within 5-10 days of the authorization request.
Please be aware that the Autism Insurance Mandate only applies to those policies with “behavioral health benefits” for their enrollees. Other exclusions to the law are employer provided plans, referred to as “self-funded plans,” health care plans with the Board of Administration of Public Employees’ Retirement System (CalPERS), and Medi-Cal plans.
If your health care plan is not subject to the new Autism insurance law, it is likely that you will be able to secure funding for your child’s treatment services from your local Regional Center and/or School District.
» Regional Center
In California, services for those with developmental disabilities, including Autism, are coordinated through the Regional Center system of the Department of Developmental Disabilities (DDS). The 21 independently operated, non-profit Regional Centers are set up to help those with developmental disabilities and their families access services and supports including assessment and diagnosis, counseling, coordination of care, and the purchase of direct services, including behavior intervention services such as those provided at FirstSteps. If your child is under 3 years old, he or she may be able to access services via the Early Start Program. If your child is over the age of 3, he or she will access services via the Lanterman Act.
FirstSteps is a vendor of the following Regional Centers serving our families in Southern and Northern California:
- Harbor Regional Center
- Westside Regional Center
- South Central Los Angeles Regional Center
- Frank D. Lanterman Regional Center
- East Los Angeles Regional Center
- Tri-Counties Regional Center
- Regional Center of the East Bay
Based upon your needs and request, FirstSteps is willing and able to vendor with any Regional Center not listed above.
When considering your funding options, it is important for you to be knowledgeable of recent legislation impacting both Regional Center eligibility criteria and service allocation. With the new Autism insurance mandate and Regional Center's role as "payor of last resort," your Regional Center will now require you to first pursue ABA treatment funding via your Health Insurance policy and / or school district. To this end, families are now required to show evidence of denial of Autism / ABA services from their health insurance carrier before accessing Regional Center funds for ABA treatment intervention. However, even if you do not access your child's ABA services via the Regional Center system, your Regional Center will continue to provide your family support, access to generic services, IHSS assistance, respite care and now, in many cases, funding for your insurance copays.
The California Department of Developmental Services is the agency through which the State of California provides services and support to individuals with developmental disabilities. The Department of Developmental services believes the California developmental services community is best served by the open exchange of information and opinions. DDS may be contacted via email or phone: www.dds.ca.gov/complaints or 916.854.1987
» School District
If your child is age 3 or older and has special education needs, your school district will work with you and a team of specialists to develop his or her Individualized Education Program (IEP) - a legal process governed by the Individuals with Disabilities Education Act (IDEA). Under IDEA, all children are entitled to a "free and appropriate public education" (FAPE). Through the IEP process then, your child's individual educational goals are developed, and related services and supports necessary for goal achievement are assigned. If the IEP team (of which you are a member) determines that behavior intervention services are necessary for your child to receive FAPE and meet his or her goals, they may elect to contract the services of a non-public agency such as FirstSteps. Generally, services obtained through the IEP process are in place for one school year, and progress toward goals and continued need is reviewed annually. As a certified non-public agency (NPA) with the California Department of Education, FirstSteps contracts with the following school districts to provide behavior intervention services to the students of California:
- Bellflower Unified School District
- Buena Park Unified School District
- Brentwood Union School District
- Conejo Valley Unified School District
- Corona Norco Unified School District
- Downey Unified School District
- Dublin Unified School District
- El Segundo Unified School District
- Hawthorne School District
- Hermosa Beach City School District
- Livermore Joint Valley Unified School DIstrict
- Los Angeles Unified School District
- Manhattan Beach Unified School District
- Pleasanton Unified School District
- Palos Verds Peninsula Unified School District
- Redondo Beach Unified School District
- Torrance Unified School District
- Wiseburn School District
- LA Care
- Beacon Health Options
- Molina Healthcare
- Gold Coast Health Plan
- Alameda Alliance for Health
The first step in securing funding is to contact the appropriate funding source directly. Both your Regional Center and School District will need to evaluate your child in order to determine eligibility. Please refer to our Local Resources for the agency contact information. Also, please feel free to reach out to us for more information and assistance. We are happy to help you along in the process.
What's the next step? Find out what you can do to prepare while you wait for services begin.