Ausome Times | #1 - Ausome Foundation

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Volume #1 | January 25, 2022

A message from the Founder

I am very excited to introduce the release of our inaugural issue of the “Ausome Times”. This publication will be made available quarterly moving forward. I am excited to share all our first experiences here at Ausome Foundation. As we welcome 2022, we look at where we began to get where we are going.

In 2021 we presented our first tuition scholarships, hosted our first public event, launched a YouTube program dedicated entirely to Autism Spectrum Disorder (ASD), initially in Spanish, and received a Proclamation for all our efforts.

The Organization is initially helping the Miami Dade Community and is looking forward to quickly expanding to Monroe, Broward, and Palm Beach Counties and throughout the State of Florida. We believe that every individual diagnosed with Autism Spectrum Disorder (ASD) deserves the opportunity to achieve the best version of themselves.

The Ausome Foundation Corp. was established as a 501(c)(3) entity in 2021. The inspiration of creating a foundation began shortly after the diagnosis of Autism Spectrum Disorder (ASD) of a close family member. This diagnosis was received 15 years ago after the recognition of various questionable developmental delays and the presence of maladaptive behaviors. At the time, the observation of the day-to-day obstacles that were real to the family such as lack of information, resources, guidance, assistance, and acceptance was overwhelming. While other families with children the same age were scheduling playdates, their lives were consumed with therapy day after day, year after year.

I chose to become a leader and the one who sees obstacles we face in today’s world as motivation for new opportunities. I choose to believe that all individuals diagnosed with Autism Spectrum Disorder (ASD) are different not less. I look at the collective impact we can have by leaning on all our partners, investors, volunteers, and supporters. I invite each one of you reading this newsletter to contact our foundation and speak to one of the Ausome team members devoted to this initiative.

Gleyder Gonzalez

Founder & CEO

Integration of ABA Therapy in an Academic Setting

ABA therapy is a type of therapy that focuses on improving behaviors, such as social interaction, communication, everyday life skills like fine motor dexterity, hygiene, grooming to name a few. It is most commonly provided to individuals diagnosed with Autism Spectrum Disorder (ASD). Acknowledging proven theories and the benefits, with the belief that each individual child is unique, the school administrators at Golden Horizon Academy (GHA) chose to implement a curriculum that combines individualized teaching practices and incorporates ABA Therapy strategies.

Our learning pathway includes resources and assessments that are customized to fit our student’s needs and individual styles to obtain the best possible student outcomes.  Day to day education at GHA consists of individualized one-on-one lessons and the implementation of ABA programs while using supportive strategies described in behavioral plans.  This method ensures the successful understanding of the learning objectives by our students, as well as skill acquisition. The use of individual and group reinforcers, such as a token system and redirection plans are some of the strategies coupled into the GHA academic curriculum.  Teachers, Analysts, Registered Behavior Therapists, and support staff have aligned objectives and goals that allow them collectively to help each student to reach the best of their individual capabilities.  Once the behavior is adjusted, learning happens.

Ariagna Gonzalez

School Administrator

Golden Horizon Academy | www.goldenhorizonacademy.com

I have Medicaid Insurance. Now what?

If you are the parent or loved one of an individual diagnosed with Autism Spectrum Disorder (ASD) you have probably heard of Applied Behavior Analysis (ABA). It was most likely encountered while conducting research or during a visit or conversation with a medical professional.

Regardless of how you became aware, the one thing you know is the importance of this commonly used method for individuals diagnosed with autism spectrum disorder. (ASD) It is considered by many to be highly successful. Applied Behavior Therapy (ABA) is one of the oldest therapy methods first developed as early as the 1960s by Norwegian-American Clinical Psychologist and Professor at UCLA, Ivar Lovas.

For parents who are new to the method, Applied Behavior Therapy (ABA) can be a confusing topic. Applied Behavior Therapy (ABA) simplified is a type of therapy that focuses on improving specific behavioral challenges characterized by Autism Spectrum Disorder (ASD), such as social skills, communication, restrictive and repetitive behaviors.

Whether your insurance provider is Medicaid or Private, issued through your employer, an individual or family plan, it will most likely be covered under your plan as noted in the Florida Insurance Requirement for Autism Spectrum Disorder (ASD) Fla. Stat. Ann. §627.6686 Here are a few MUST haves to assist you through the Medicaid process. Please have the following ready on that initial call to the agency of your choice. Here is a step-by-step guide to assist you.

►Step One – Verify Eligibility

Agency will verify the client’s eligibility while conducting the intake call. If the Admissions Coordinator requested a copy of the insurance card, please send it as soon as possible.

►Step Two – Documentation

Once eligibility has been determined, the documentation listed below needs to be sent to the Admissions Coordinator to apply for an authorization:

A referral for ABA Therapy or an order form. Either one must contain the following:

Child’s name, diagnosis, and ICD-10-CM code (For example: Autism F84.0)
Must be up to date (dated within 1 year)
Signature of the physician including professional credentials. (Cannot be an RN or a PA)
A Letter of Medical Necessity. If you do not have one, contact the referring or diagnosing physician and request one. The letter should contain the following:
- Child’s name, date of birth, and diagnosis
- Statement ordering/recommending ABA therapy as medically necessary
- Signature of the physician including professional credentials.
An Individualized Education Program (IEP) School-aged children, attending public schools may send this as an evaluation along with the last progress note from the most recent consultation by a Neurologist/Psychologist/Psychiatrist/Pediatrician.

►Step Three – Consents

Once you have begun to send documentation, a request for a meeting should be scheduled. In this meeting, you will sign all agency consents, along with an explanation of all your rights as a client, and receive an in-depth explanation of the services and the rest of the process.

►Step Four – Evaluation

After the consents are signed, the agency will contact the Board-Certified Behavior Analyst (BCBA) that has been carefully screened for your case. The BCBA will then contact you to arrange meetings for him/her to evaluate your child. Once the BCBA feels they have conducted enough observations, they will start writing the Assessment and Treatment Plan.

►Step Five – Authorization

When the BCBA completes the Assessment and Treatment Plan, the request will be submitted to EQ Health Solutions (the Quality Improvement Organization for AHCA). EQ Health solutions can take anywhere from 5-15 business days to respond to our request.

►Step Six – Service

Finally, once the authorization from EQ is received, the Registered Behavior Technician (RBT) and the Board-Certified Behavior Analyst (BCBA) will be able to start services promptly. They will require the caregiver’s signature after every session, and it is also the responsibility of the BCBA to conduct parent trainings. The number one priority is always the well-being of the clients.

Yudeni Ramirez

Admissions Representative

MG Home Care Services

Understanding Your Insurance Plan & Navigating the Initial Authorization Process

Applied Behavior Analysis, often referred to as “ABA,” is a form of behavioral therapy commonly recommended for children who have been diagnosed with Autism Spectrum Disorder (ASD) and other developmental disabilities. If you have a child diagnosed with ASD, you have likely received a referral for ABA from your diagnosing physician, but what comes next? We routinely receive calls from parents and caregivers whose children have been referred for ABA Therapy, who know little about this evidence-based science.
Then to add to the stress, you need to learn how to access their child’s ABA therapy benefits through their private or group, insurance plans.
Below is a guide to getting started with your insurance, so that your child can access treatment as soon as possible. Early intervention is the key to achieving favorable results.
First, you will need a diagnosis. If you have private, group insurance (typically through your employer) chances are ABA Therapy will be covered under the Florida Autism Mandate; however, there are some important things to know to avoid running into roadblocks with your insurance. You must have your diagnosis paperwork handy and ready to go. While each insurance carrier defines “medical necessity” a bit differently, nearly all group plans will require your child to have an ASD diagnosis a.k.a. “F84.0” in order for your provider to request authorization for the initial assessment. What’s more, that diagnosis will ideally need to be based on a comprehensive diagnostic Evaluation or “CDE” by an M.D. or Psy.D. For most private, group plans, a prescription referral will NOT suffice to meet the medical necessity criteria set by your plan, so if you have not already completed a CDE you may wish to contact your child’s neurologist or psychologist and request to have one completed as soon as possible.
Once you have secured the diagnosis, your ABA provider will need you to complete various intake forms, gather your insurance card, and any other relevant information needed to verify your benefits. If ABA is covered by your insurance plan, you will be required to meet one or more than one of the following criteria; your deductible (the amount you must pay BEFORE your insurance will cover any costs associated with treatment), and then pay a coinsurance (a percentage of the total “allowed amount” your insurance pays), until you have reached your annual out-of-pocket maximum (the total you will have to pay for the year, after which your insurance will cover services at 100% until your plan benefit year renews) OR pay a copay (a daily flat fee for services)for each date of service rendered until you have reached your annual out-of-pocket maximum. In some (but not all) cases your provider may be able to obtain a record of any amounts you have already paid for the year and inform you. You can also always check for yourself by calling your plan or using the member online portal to verify accumulations.
Now that you know how much you can expect to pay for your child’s ABA therapy services, your provider-most commonly a Board-Certified Behavior Analyst “BCBA”- will need to request authorization to complete the initial assessment. Depending on your provider this assessment will likely take place over a series of interviews and direct observations of your child and should take anywhere from 8-10 hours to complete (including the time it takes for the provider to compose the written assessment and corresponding treatment plan). Once completed, your provider should review their findings with you and provide you with a written report known as a Functional Behavior Assessment (FBA). The FBA should summarize the results of any interviews, observations, and assessments completed during the entirety of the assessment process, and it should also include recommendations from the BCBA. These recommendations usually include the number of hours of 1:1 treatment, as well as program supervision and parent/caregiver training hours, that they feel are necessary for your child to achieve maximum progress. It is very important to review and discuss these recommendations before commencing a program to ensure you agree with the plan that will be developed. This “plan,” more formally known as the behavior Intervention Plan or “BIP,” is what your therapy team will use to guide your child treatment and it will typically include goals focused on reducing behaviors that impede your child’s ability to learn and/or their day-to-day life, and goals focused on increasing various skills that will help your child to achieve greater independence. Like the FBA, the BIP should be reviewed with you, and you should consent to treatment prior to any intervention beginning.
Finally, the authorization for ongoing services; once you and your provider have completed all these steps, they will be able to request authorization to provide ongoing services through your insurance. The insurance will review the diagnostic paperwork (again!), along with the FBA, the BIP, and any other supporting documents they may request to make their determination. If approved, usually the insurance will authorize treatment in 6-month increments, requiring your provider to complete semi-annual “reassessments” of your child’s progress to document the effectiveness of the ABA Therapy (so bear with your provider when they ask you to re-fill out ALLthat paperwork again…it’s to ensure your child can continue receiving services!). Each plan is a little bit different and may require varying degrees of paperwork and supporting documentation. It is important to keep good records of all your child’s medical and behavioral visits/services just in case you need to provide additional documents to secure the authorization.
Along the way, the reality is there will be some hiccups; but any quality provider should have the means to help you navigate the process and get you started as quickly as possible. Teamwork is a must to achieve success.

Taylor Tapia

Co-founder & CFO

FreshStarts Behavioral Therapy, LLC

Achievements

It is with great enthusiasm that I share this public announcement with our community. The foundation was presented with a Proclamation from The Mayor of the Village of Palmetto Bay, Karyn Cunningham. Said proclamation was presented on November 23, during our “Day of Gratitude Event” in Cutler Bay, by Missy Arocha, Village Clerk of Palmetto Bay accompanied by Mayor of Cutler Bay, Tim Meerbott. In addition to this honor, Mayor Cunningham named November 23rd “Ausome Foundation Day” in the Village of Palmetto Bay and encouraged members of the community for recognition and support of our mission.