DDA Waiver Notice & Potential Changes

By Trish Thrush, Health Law Advocate/Insurance Navigator

* This is intended for informational purposes only and is not medical or legal advice.*


You might have received this notice from the Developmental Disabilities Administration.

What does this mean?

Developmental Disabilities Administration Waiver Funds/Services must only be used after you have exhausted all other funding sources.  This means that you must provide proof that you cannot get a service/therapy from your insurance company before using DDA waiver funds.

What Services might be first accessed through Private insurance or Medicaid before using DDA funds?

Behavioral Support & Consultation (might include ABA), Staff and Family Consultation & Training, Nursing Services, Physical Therapy, Occupational  Therapy,  Speech Therapy, Durable Medical Equipment & Services (might include incontinence supplies), Peer Mentoring and Specialized Psychiatric Services.


Providing Proof that you cannot access services through Private Insurance:

  • Find out if you have coverage in your Plan. To do so you can request a copy of the Plan Document (also sometimes called the Summary Plan Description-SPD or Benefits Booklet). This is the contract between the employer (or yourself if you purchased the plan) and the insurance company detailing the benefits of the Plan. Click here for instructions on how to obtain a copy.
  • Check the Plan Document for coverage or exclusions. The Plan Document is the contract between the employer (or yourself if you purchased the plan) and the insurance company detailing the benefits of the plan. Click here for instructions on how to obtain a copy. If you are unsure or cannot locate the information please give the WAAA office a call. We can help! One of our advocates loves big Plan Documents and cannot lie (it’s awful and I’m sorry but I’m not taking it back).

If you have coverage but there are no providers in your area that can provide services within a reasonable amount of time (30 days):

  • Call your insurance company and ask for a list of all the in-network providers within a reasonable distance of your home – we suggest 30 miles.  If you get stuck in the time vortex that is “let me transfer you to another department so they can transfer you back” give us a call! We can’t restore your sanity after being on hold for 30 minutes listening to a monotone voice tell you that you can go to the insurance company’s website – that you’ve already used to unsuccessfully find providers – but we can help!  
  • Use this Blank Call Log to document the responses of the providers.
  • Provide a copy of the completed Call Log to your DDA Case Manager.
  • Please consider sharing a copy of the call log with WAAA. It helps us to know when networks are not meeting our community’s needs.
  • Then it’s dance party time because you just did insurance stuff.

If you don’t have coverage:

  • Request that your child’s pediatrician or general physician submit a request for prior-authorization of the service. This should result in an official approval or denial of coverage.
  • Give a copy of the Plan Document and the letter of denial to your DDA Case Manager.
  • Please consider sharing these with WAAA as well. We can use them to help you appeal for coverage through your private insurance. Also, reading Plan Documents keeps our insurance advocate from making up more “songs” (see below).



If there are no providers that can provide services within a reasonable amount of time:

  • Call your Medicaid/Apple Health Managed Care Plan and request a list of providers of the service within a reasonable distance of your home. For ABA use this blank Call Log to call each Medicaid/Apple Health ABA provider and ask them the questions in Column I “Call Summary”. For other services use this Blank Call Log.
  • Once you have completed this provide a copy to your DDA Case Manager.
  • Please also provide a copy to WAAA. We love collecting documentation. Seriously we’re like documentation hoarders. Thank goodness for electronic storage or we would be swimming in paper right now. And I swear we will use them for good – to improve access to treatment. You have my word as an advocate and a banana intolerant coffee lover (hey it’s a good oath-have you had a better one today? I think not).

If you have any trouble please…

Call WAAA (call WAAA) on the line
Call us, call us any, anytime
Call WAAA (call WAAA) my friend
You can call us any day during business hours (business hours)
Call WAAA!

See, she has too much time on her hands. For the love of all that is good in the world give her your documents people!

Premium Payment Program

If you have private insurance and Medicaid, you can apply to the HCA’s Premium Payment Program, which helps with out of pocket expenses. Also, if you have dual insurance (private and Medicaid), you can apply to Hogwarts. Obviously, an owl has to bring you an invitation first, but until then you can apply for the Premium Payment Program, which is nearly as cool as magic because it helps pay for your insurance premiums. Find out more about it by clicking here.


Recruiting a Program Manager

Job Title: Program Manager
Reports to: CEO

The Program Manager is responsible for identifying, securing and enhancing sources of organization funding. He/she is responsible for community engagement statewide, connecting with coalitions, partnerships and advocacy organizations. He/she is responsible for collating and submitting grant applications to public and private sources. The Program Manager works collaboratively with staff and consultants to develop proposals, and prepare timely and accurate grant reports. The Program Manager serves as the lead point of contact on each proposal, managing the submission process, and providing content, editing, and overall project planning.

Key Responsibilities and Accountabilities:

  • Research and identify viable corporate, foundation, and government funding prospects on a regular basis by staying current with issues related to healthcare advocacy
  • Engage and maintain contact with statewide networks of community leaders (agencies, foundations, corporations) addressing all areas of healthcare disparity
  • Support prospective funder vetting and cultivation and current funders stewardship by exhibiting knowledge and understanding of funder priorities
  • Build and maintain a portfolio of constituents, including grant-making organizations, overseeing review of a submitted grant applications in order to supply additional supportive material
  • Participate in funder briefings as required.
  • Work closely with CEO and program directors to refine grant making policies and procedures.
  • Manage the completion and submission of timely and accurate progress reports when required by funders
  • Collaborate with program staff to craft compelling proposals, aligning program goals and objectives with funder priorities and giving areas;
  • Write and submit letters of inquiry and full grant proposals, including narrative, attachments, and budgets;
  • Coordinate grant compliance, ensuring timely submission of contracts, grant acknowledgement, and reporting calendar;
  • Co-write interim and final grant reports with program staff to capture progress and outcomes;
  • Participate in all other department administration responsibilities
  • Collaborate with program staff in all aspects of Continuous Program Quality Assessment Model: logic model design, goal and objective setting, data collection tool design and administration, and yearly reporting.
  • Recruit evaluation interns to enter, analyze and report on program outcome
  • Track grant proposals in database and prepare monthly reports on status of portfolios and submissions.
  • Generate financial information, including budgets and financial reports, for grant proposals and grant reports, in collaboration with staff.
  • Assist with other fundraising projects as requested.

Education and Experiences:
Minimum Requirements

  • Extensive and in-depth familiarity with systemic aspects of healthcare and health issuance disparity for individuals with disabilities
  • Demonstrated writing, communication, and organizational skills.
  • Understanding of issues related to individuals with ASD, mental health, family services, or willingness to learn.
  • Knowledge of national, state and local funders supporting health insurance navigation
  • Skilled in networking, building and maintaining relationships with decision makers, leveraging effective oral, visual, and written communication.
  • Ability to work collaboratively with staff and other partners in developing grant proposals and for reporting purposes.
  • Ability to work independently and demonstrated skills in time management and project management.
  • Proficient in Microsoft Word, EXCEL, database spreadsheets, and Internet research.
  • Experience with CRM and other online database desired.
  • Willingness to occasionally work evenings and weekends.
  • Background clearance from the Department of Justice.
  • Ability to travel statewide, to site visits and funder meetings, as needed.
  • Bachelor’s degree in Business Administration, Marketing, Communications or related field.
  • Strong and consistent attention to detail, prompt follow-through, and commitment to high quality output.

Preferred Qualifications

  • Background in public health and government relations
  • Meet timelines and manage multiple and diverse projects simultaneously.
  • Demonstrate self-starter with ability to work well independently, as well as being a contributor in a highly dynamic team environment.
  • Plan strategically, think creatively and building long-term relationships with grantors.
  • Work with confidential information and show discretion.
  • Be flexible, creative, solution oriented, and have energy and stamina for periodic demanding schedule.
  • Manage in a climate of change and ambiguity.
  • Analyze and develop budgets.


  • 40 hours per week


  • Competitive; dependent on qualifications

To Apply: Interested applicants should submit a resume, cover letter, character and professional references and availability schedule

To Apply: Interested applicants should submit a resume, cover letter, character and professional references and availability schedule to: Arzu@washingtonautismadvocacy.org


ABA treatment ‘boot camp’ created as result of WAAA vs. WHCA settlement

June 17th, 2014 – WAAA commends Northwest Autism Center for creating a 12 weeks of intensive, one-on-one treatment at a new clinic  – one of just two of its kind in the state to open in response to the 2012 settlement allowing autistic children covered by Medicaid to receive “applied behavioral analysis,” or ABA, treatment.  We encourage other non-profit organizations offering ABA clinical programs to consider serving low income children and their families statewide.


Jessica Ley leaned close toward the 5-year-old sitting opposite her in a child-size chair, and she had his full attention.

“Spell ‘at,’ ” she said.

“A-T,” Darrin McCanna said, and it was cause for a mini-celebration.

“Bubbles or jumps?” Ley asked.

He chose jumps. “3-2-1, blastoff!” Ley said, and she hoisted him over her head as he laughed and covered his eyes with his hands.


(SR Photo: Dan Pelle)
Darrin, diagnosed with autism when he was almost 4, was in his third week of 12 weeks of intensive, one-on-one treatment at a new clinic at the Northwest Autism Center – one of just two of its kind in the state to open in response to a 2012 settlement allowing autistic children covered by Medicaid to receive “applied behavioral analysis,” or ABA, treatment.

Widely recognized as effective, ABA can help children with autism learn skills as varied as communication and toothbrushing. Making consistent use of positive reinforcement, it considers children’s environments as they relate to their behaviors. By changing the environment, therapists can change children’s behaviors.

Many insurers have balked at paying for ABA treatment, but more are doing so as a result of lawsuits. The Spokane clinic is based on a model created by the state Health Care Authority in response to the settlement.

The clinic, within the autism center on the lower level of St. Anne’s Children and Family Center at 25 W. Fifth Ave., hosted a pair of open houses last week along with presentations about ABA and insurance reform.

“Families need to know that things are changing,” said Dawn Sidell, the autism center’s executive director.

Legislators are more informed about autism and the need for coverage for treatment, she said. And “as the insurance coverage provides opportunities for organizations like mine to treat, it also provides opportunities for education and training, and it’s going to spill over.”

Treatment ‘boot camp’
Early intervention can be critical for children with autism.

The new clinic is for children ages 2 to 5 diagnosed in the past 12 months by an approved provider.

It’s designed to be the first place children go for treatment, Sidell said, providing an in-depth evaluation, an individualized treatment plan and help transitioning to day care or school.


(SR Photo: Dan Pelle)
“The core deficits around autism – the communication, the socialization, behavioral issues – those are the things that are going to be primarily addressed,” Sidell said.

Dana Stevens, the autism center’s clinical director, called the clinic an “ABA boot camp.”

“The families get trained on it. The kids get intensive services,” Stevens said. “We have a really good idea of who these kids are in assessments and what they need for intervention and different environments. This would be the jumpstart for them to go on to different treatments.”

Children receive 12 hours a week of mostly one-on-one treatment at the clinic; they sometimes meet in small groups to work on social skills. The clinic provides speech therapy when needed. Clinic staffers meet with the children’s next caregivers or teachers and help them develop a what’s-next plan.

Each treatment room has a window, allowing parents to watch, and parents get three hours a week of training and education about autism and ABA, including how to access services through school districts. Home visits help parents identify areas to work on with their children.

“This clinic is not only intensive for the child,” Sidell said. “It is for the whole family.”

Providers in training
While the clinic only serves children who qualify for Medicaid, Sidell said the clinic hopes to expand to accept children covered by private insurers.

One hurdle: finding enough qualified treatment providers.

“There’s a huge need in the community for those children to be served as well,” she said. “But we can only provide that service as quickly as we can identify qualified providers.”

Treatment is overseen by nationally certified ABA providers, who are in short supply.

But Sidell said she’s hopeful training at area universities will help boost their numbers in clinics as well as at schools, day cares, and psychology and social work offices.

Ley, the therapy assistant who worked with Darrin McKenna last week, is a graduate student at Gonzaga University, where a master’s program prepares students to take the exam to be a board-certified behavior analyst.

Whitworth University has a proposed graduate-level program under review by the National Behavior Analyst Certification Board. The program could be running by next fall and would initially probably admit 10 to 15 students seeking to become certified ABA providers, special-education professor Flint Simonsen wrote in an email.

And WSU Spokane’s health sciences campus “is eager to explore partnerships” with the autism center, spokeswoman Terren Roloff said, and hopes to create clinical opportunities for students to learn about autism treatment.

‘My son had a voice’
Tara McCanna, Darrin’s mother, said the clinic already has helped him. By the end of his first day, she said, he could count by fives to 20 – on his way to 100, a previously set goal he hadn’t been able to progress toward before. Now he can button a shirt.

She attributed his successes to the clinic’s one-on-one approach.

Before he worked on spelling words during his session last week, Darrin worked a shoelace. Later, he built with blocks.


(SR Photo: Dan Pelle)
Throughout the session, Ley offered small rewards tailored to Darrin’s preferences as she led him through exercises tailored to his needs. The spelling work was designed to improve Darrin’s skills, but also to help him practice responding on demand to verbal prompts for school.

While the clinic is designed mostly to be a first stop for families of autistic children, Darrin already had received ABA treatment through the Domino Project, the autism center’s early education program.

The results were striking, McCanna said.

“He didn’t talk, and then he talked,” she said. “I mean, my son had a voice. From not speaking to speaking, that really was amazing.”

• To learn more about the 12-week clinic, contact the Northwest Autism Center at (509) 328-1582 or email info@nwautism.org.

Originally featured in The Spokesman-Review 

Medicaid ABA Plan Update

WAAA Baby BoyThe state Medicaid ABA plan is being submitted to CMS (Centers for Medicare and Medicaid Services) and we should have federal approval soon.  We recognize Medicaid is struggling with Applied Behavior Analysis (ABA) provider capacity, reportedly due to providers being unable to accept Medicaid’s reimbursement rates.

We are deeply saddened that hundreds of children have been wait listed, and authorizations for ABA have expired without any actual treatment commencing. It is troubling that only a small fraction of what the Legislature authorized for this program last year has been accessed, even with over a thousand children waiting to receive services.

If a child in your care has had an authorization for ABA in 2013 and they have not received any ABA therapy, we would like to hear from you.  Please contact your WAAA advocates.  Let us know when your child was pre-authorized for ABA and how long they’ve been on a waiting list.

WA The 1st state to Set Standards For Paraeducators In Public Schools

The_Washington_State_CapitolWashington Autism Alliance & Advocacy commends Sen. Andy Hill for his leadership and vision of setting standards for para-educators in public schools.  The result would be better training and a career path for para-educators who deliver 52% of all instruction to special education students.  Please click here learn more about this bill.  Please consider sending a thank you note to Senator Hill for his support and leadership.



Cigna ABA National Class Action Settlement



A Notice of Class Action Settlement in the Class Action Lawsuit involving Cigna’s denial of coverage for Applied Behavioral Analysis (ABA) on the grounds that ABA is investigative or experimental was mailed on November 26, 2013.  If you received the Notice in the mail, you have been identified as a potential member of the class and may be entitled to monetary compensation.  If you did not receive the Notice in the mail, but fall within one of the following categories, you may be a potential member of the class that was not identified in the initial search.


The Court has certified the class to include individuals who meet the following criteria:


(1)  Persons that are or were enrolled in a plan administered by one of the Cigna companies and made a claim, including a request for pre-service authorization, for ABA therapy for Autism Spectrum Disorder that was denied between November 24, 2004 and October 31, 2013, and the grounds for denial were that ABA therapy is deemed to be investigative or experimental; OR


(2)  Persons that participated in the NetApp Medical Plan and their coverage or rider provided by one of the Cigna companies for ABA for Autism Spectrum Disorder was terminated or discontinued as of July 1, 2011, or had a claim for ABA denied between July 1, 2011 and October 31, 2013, regardless of the stated reason for denial.


If you received the Notice in the mail, what should you do?


This means that you are on the list of identified class members submitted to the Court.  As this was a preliminary notice, you are not required to take any action at this time.  Once the Court gives final approval of the settlement, you will receive another notice with directions for submitting a claim for monetary compensation.


If you did not receive the Notice in the mail, but fit one of the categories listed above, what should you do?


This means that you were not identified in the initial search for class members and therefore are not on the list submitted to the Court.  You should promptly contact the attorneys representing the Plaintiff Class at the number listed below if you would like to have an opportunity to participate in the settlement.


Attorneys Representing the Plaintiff Class:

Brian Saxe

Mantese Honigman Rossman and Williamson P.C.

1361 E. Big Beaver Road, Troy, MI 48083

Phone: (248) 457-9200

Notice of ABA Settlement – Cigna

Proposed Settlement – Aetna – Out of Network services (2001-2013)



A Notice of Proposed Settlement has been released in the Class Action Lawsuit involving Aetna’s method of reimbursing claims for covered services and supplies provided by Out-of-Network Providers.  If the Settlement is approved by the Court, the Settlement Agreement provides for monetary benefits to be provided by Aetna to members of the Settlement Classes who have not opted-out of the settlement

The Settlement Classes include both Subscribers and Providers.


Subscribers: If you were an Aetna Plan Member at any time from March 1, 2001 through August 30, 2013 and received a Covered Service or Supply from an Out-of-Network Health Care Provider or Out-of-Network Health Care Provider Group, and your resulting claims for reimbursement included Partially Allowed Claims, you are a member of the settlement class and may be eligible for payment if you qualify and submit a valid Claim Form.


Providers: If you were an Out-of-Network Health Care Provider or Out-of-Network Health Care Provider Group at any time from June 3, 2003 through August 30, 2013, provided Covered Services or Supplies to Aetna Plan Members, and the resulting claims for reimbursement included Partially Allowed Claims, you are a member of the settlement and may be eligible for payment if you qualify and submit a valid Claim Form.


If you think you’re included in the class, what should you do?

The following table summarizes your legal rights and options, but please review the full Notice of Settlement carefully to fully understand your legal rights and options.



SUBMIT A PROOF OF CLAIM FORM The way to get a payment if you qualify. You must fill out and return the attached Claim Form (with any necessary supporting documentation) by first class mail, postmarked no later than March 28, 2014.
ASK TO BE EXCLUDED Get no payment. The only option that allows you to individually sue Aetna over the claimsresolved by this Settlement.
OBJECT Write to the Court about why you do not agree with the Settlement.
GO TO A HEARING The Final settlement Hearing will be held on March 18, 2014 at 10:00 a.m., at which timethe Federal Court Judge will make a final decision as to whether the Settlement is fair to all members of the Settling Classes. If you wish, you may attend the hearing and ask to speak to the Court about the Settlement.
DO NOTHING Get no payment and give up your right to sue Aetna over the claims resolved by this Settlement


Please visit the site below for more information on the Proposed Class Action Settlement, including Frequently Asked Questions (FAQ’s), the Notice of Proposed Settlement, and the Proof of Claim Form that you will need to submit:



You may also obtain additional copies of the Notice of Proposed Settlement and Proof of Claim form, as well as responses to Frequently Asked Questions (FAQ’s) on the Settlement Administrator’s website: www.berdonclaims.com;

by mail at:

Aetna UCR Litigation

c/o Berdon Claims Administration LLC

P.O. Box 15000

Jericho, NY 11853-0001

by phone at: 800-600-3079;

by fax at: 516-393-0031; or

by email to aetna@berdonclaimsllc.com


Cigna to Provide Compensation for Autism ABA Therapy Under Class Action Settlement

Cigna to Provide Compensation for Autism ABA Therapy Under Class Action Settlement

Current and former Cigna insurance policyholders will receive compensation for applied behavior analysis (ABA) treatment for autism previously denied by the company.   (Judge Approves $2.4M Cigna Autism Denial Class Action Settlement)

A Pennsylvania federal judge gave preliminary approval to a $2.4 million class action settlement that would resolve a dispute between Cigna Corp. and a nationwide class that accused the company of improperly denying benefits for some types of autism spectrum disorder treatment.

On Oct. 31, U.S. District Judge Juan R. Sanchez approved the proposed class action settlement, which would provide compensation to current and former Cigna insurance policyholders who claim that, starting in Nov. 2004, they were denied benefits for their children’s autism treatments that had been deemed by Cigna to be “experimental, investigational or unproven.” Class Members will be able to submit claims for reimbursement for the treatment that was denied by Cigna.

Plaintiff Kristopher Churchill initially filed the class action lawsuit in 2010, alleging that Cigna has a policy of classifying Applied Behavior Analysis (ABA) as an experimental autism treatment and does not provide insurance coverage for the treatment. Churchill argues that ABA is a well-recognized and scientifically valid form of treatment for children with autism. It is backed by the U.S. Surgeon General and the National Institute of Mental Health. When the class action lawsuit was filed, 26 states, including Pennsylvania, mandated insurance coverage for ABA treatment.

Under the terms of the proposed class action settlement, Cigna has agreed to produce a list of all individuals who were enrolled in a Cigna health plan and made a claim for ABA for autism spectrum disorder that was denied because the treatment was deemed to be “investigative or experimental” since Nov. 24, 2004. Cigna will also provide a list of all individuals who participated in the NetApp Medical plan whose coverage or rider provided by Cigna for ABA for autism spectrum disorder was denied since July 1, 2011.

The $2.4 million class action settlement fund will compensate an estimated 350 to 400 Class Members. A final approval hearing has been set for Feb. 9 in the U.S. District Court for the Eastern District of Pennsylvania.

Judge Sanchez appointed Class Action Administration Inc. as the Settlement Administrator. Under the terms of the class action settlement, the Settlement Administrator has 30 days to notify potential Class Members about the settlement, who will have five months to submit a claim.

Further information about the Cigna ABA Claim Denial Class Action Settlement was not immediately available. Please keep checking Top Class Actions for details on how to file a claim or sign up for our free newsletter below.

The plaintiffs are represented by Gerard V. Mantese, Brian M. Saxen and David F. Hansma of Mantese Honigman Rossman & Williamson PC; Gregory B. Heller of Young Ricchiuti Caldwell & Heller LLC; and John J. Conway of John J. Conway PC.

The Cigna ABA Denial Class Action Lawsuit is Churchill, et al. v. Cigna Corp., et al., Case No. 2:10-cv-06911, in the U.S. District Court for the Eastern District of Pennsylvania.

SOURCE: topclassactions.com




JPMorgan Chase Adds Autism Benefits to Employee Health Plan

NEW YORK, Nov 26, 2013 (BUSINESS WIRE) –JPMorgan Chase & Co. is adding autism benefits for employees participating in the company’s health plan. Effective January 1, 2014, intensive behavior therapy for treatment of autism spectrum disorders, such as Applied Behavior Analysis (ABA) Therapy, will be a covered benefit for employees and their families.

“JPMorgan Chase is excited to offer ABA Therapy and provide this important treatment alternative for the children of our employees,” said Stephen Cutler, JPMorgan Chase General Counsel and Advisor to Access Ability, the firm’s Business Resource Group (BRG) for employees affected by disabilities. “One in 88 children is diagnosed with Autism. With almost 160,000 employees enrolled in our U.S. medical plan, we are confident that this important new offering will change the lives of many of our employees.”

“For many years, my son was unable to receive the necessary treatments he needs, due to a lack of insurance treatment coverage. This change will allow us to provide a therapy that will help him prosper,” said Michael Giangregorio, Vice President in U.S. Fixed Income at JPMorgan Chase. “Thank you to the leadership of JPMorgan Chase for recognizing this need and for taking the necessary steps to help ensure that my son reaches his fullest potential.”

ABA Therapy focuses on increasing positive behaviors while reducing those that cause harm.

“We constantly review our benefits programs and offerings to make sure they address the needs of our employees and their families,” said John Donnelly, head of Human Resources, JPMorgan Chase & Co. “I am particularly pleased about this new benefit as I have been actively involved in helping children with autism as a supporter of Heeling Autism, a program sponsored by Guiding Eyes for the Blind that enhances safety, companionship and opportunities for independence for autistic children.”

About JPMorgan Chase & Co.

JPMorgan Chase & Co. is a leading global financial services firm with assets of $2.5 trillion and operations worldwide. The Firm is a leader in investment banking, financial services for consumers and small businesses, commercial banking, financial transaction processing, asset management and private equity. A component of the Dow Jones Industrial Average, JPMorgan Chase & Co. serves millions of consumers in the United States and many of the world’s most prominent corporate, institutional and government clients under its J.P. Morgan and Chase brands. Information about JPMorgan Chase & Co. is available at www.jpmorganchase.com.

SOURCE: JPMorgan Chase & Co.

 JPMorgan Chase & Co.

Media: Jennifer Kim   212-622-7068   jennifer.h.kim@jpmchase.com

Copyright Business Wire 2013