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Flow Chart for Behavioral Services
1
Behavioral Services determined as a need through the Individual Program Planning team (IPP/IFSP)
2
Service Coordinator (CSC) sends parent to Behavior Orientation
3
Parent attends Behavior Orientation and signs Consent Forms
Private/Self-Funded Insurance
If Parent Goes Through a Private or Self-Funded Insurance
Condition: Under age 26/Any diagnosis
4
Parent contacts Private Insurance (P.I.) to confirm coverage
If Approved
5
Set up services funded through Private Insurance
6
Parent calls CSC at NLACRC for possible co pay, deductible and co-insurance assistance
7
Parent calls and chooses an agency for the 16 hour Parent Education Group (PEG)***
8
Parent calls and chooses an agency for Behavior Assessment and In-Home services
9
Services Begin funded through Private Insurance
If Denied
5
Parent requests denial letter or no coverage letter
If Medi-Cal
6
Parent provides letter to Medical plan (see Medical Column)
If No Medi-Cal
6
Parent provides letter to CSC at NLACRC. Parent files appeal with P.I
7
CSC monitor status of appeal
8
CSC authorizes services funded by NLACRC and continues until appeal process is complete
Medi-Cal
If Parent Goes through Medi-Cal
Condition: Under age 21/Any Diagnosis
- Has Medi-Cal with assigned Managed Care Plan (MCP)
- Only has Medi-Cal or Private insurance denies ABA Service
4
Parent calls and chooses any agency for the 16 hour Parent Education Group***
5
Parent informs CSC of agency choice and waits for approval to attend 16 hour PEG***
6
Parent attends and completes 16 hour PEG***
7
Parent calls and chooses an agency contracted with their Medical Plan for Behavior Assessment and In-Home services
If Approved
8
Services Begin funded through Medical
If Denied
8
Parent provides denial letter to CSC at NLACRC
9
Parent files appeal w/ DHCS
10
CSC monitors status of appeal
11
CSC authorizes services with NLACRC and continues until appeal process is complete
Regional Center (NLACRC)
If Parent Goes Through NLACRC
Condition: Any age/Any diagnosis
- Has Medi-Cal Fee-For-Service (FFS) (Straight Medi-Cal)
- Medi-Cal and/or Private insurance Denies Service
- No insurance or generic resource
Condition: Over 21 years old
- Has Medi-Cal with Assigned Plan or FFS
- Any diagnosis
4
Parent calls and chooses any agency for the 16 hour Parent Education Group
5
Parent informs CSC of agency choice and waits for approval to attend 16 hour PEG
6
Parent attends and completes 16 hour PEG
7
Parent calls and chooses any agency on NLACRC Vendor List for Behavior Assessment and In-Home services
8
CSC authorizes Behavior Assessment
9
Parent completes Behavior Assessment
10
Agency submits Behavior Assessment report to NLACRC for review
11
Services Begin funded through NLACRC
***16 hour Parent Education Group (PEG) is a Regional Center funded service available to all consumers and their families regardless of funding source for Behavior Services. The class is not mandatory for families obtaining ABA coverage through their health insurance. However, we highly encourage this class to learn the basics of ABA and become familiar with the principles of learning which will be applied when in-home services begin. In addition, parents seeking co-pay, co-insurance, or deductible assistance from NLACRC must attend the 16 hour PEG.