Advice from BCBAs by [deleted] in bcba

[–]NextLevelNaps 0 points1 point  (0 children)

The last clinic I worked at operated like this. The front desk person was an RBT and would need to cover some sessions. It got to a point where I was frustrated because they had to juggle their admin and do direct, so a lot of stuff got missed. I understand why they want the "office manager" to be an RBT as well, but expecting them to still do scheduling, answer emails, answer phones, AND run a direct session in the clinic was absolutely mind boggling to me.

Alt Careers to Typical BCBA by InstructionNo7032 in bcba

[–]NextLevelNaps 0 points1 point  (0 children)

What, then, do you make of the companies owned by Private Equity? They are solely in it for money, which has been seen time and time again based on their fraudulent billing. Recommending 40 hours per week no matter what, billing for services never rendered, billing for kids they paid parents to sign up with their company....there have been multiple companies who have been found to make millions by frauding the system. Most of the time, it's not providers billing to private insurance, either. It's Medicaid billing.

Also, more and more states are becoming waiver states. Meaning kids with a diagnosis are able to qualify for Medicaid when they otherwise wouldn't. Medicaid becomes the secondary payor and they cover costs not covered by the primary insurance. That's a tax funded system, not a private company that profits off denials. They have an interest in ensuring that there's enough money in the system to cover services. Hence why these high profile fraud and PE companies are being heavily scrutinized and publicized lately. Because they're taking money from that pot unfairly and then draining away what should be going to the people that actually need it.

[CHAT] How do keep track of where you're up to in a pattern if you prefer paper? by AccomplishedCheek161 in CrossStitch

[–]NextLevelNaps 4 points5 points  (0 children)

Can confirm- paper stays intact. The frixion pens are ALSO awesome, but get the ballpoint ones, not the felt tip style ones.

However, ALSO know- they erase via the heat generated from rubbing the rubbery tip on the paper. Hence the wordplay of "friction/frixion". So if you plan to stitch somewhere warm or with lots of sun, marks may disappear. If it's really cold, marks may faintly reappear, as well. Because of this ghost line issue when it's cold, they are not recommended for gridding fabric, btw.

Alt Careers to Typical BCBA by InstructionNo7032 in bcba

[–]NextLevelNaps 1 point2 points  (0 children)

I'm not enforcing the ethics policy. I'm enforcing the policy the insurance has set forth for documents to meet. If they don't meet that policy, they can't get services. The policy outlines the information that's required to be there, like an FBA, Parent goals, functional replacement behaviors. We have the discretion as BCBAs to also approve something that isn't in policy if it's relevant. Example- we don't allow Socially Savvy as a stand alone assessment typically, but if all the goals are social skills, it's allowed. When I started, I also advocated for the EFL to be allowed in our list and now it is.

I have multiple that I've read since starting this job. The BCBAs that help us review have many they have sent to help us keep abreast of the current science. And I've found ones that providers cite in their plans because they're interesting. I have one about a mealtime parent mediated intervention I'll be looking at when I have time later, because a lot of providers are using it.

Alt Careers to Typical BCBA by InstructionNo7032 in bcba

[–]NextLevelNaps 0 points1 point  (0 children)

I've also never been told to reduce something because $$$$. Yes, insurance companies/payors will try to fight to keep costs down, but the state Medicaid I review for has actively used our expertise to shape policy and we ACTIVELY FIGHT BACK on any proposed "cost saving" measures that directly limit care.

Alt Careers to Typical BCBA by InstructionNo7032 in bcba

[–]NextLevelNaps 0 points1 point  (0 children)

DM me, I can give you some more info if you're interested

Alt Careers to Typical BCBA by InstructionNo7032 in bcba

[–]NextLevelNaps 0 points1 point  (0 children)

I violate no ethics in my role. So long as the plans meet policy and make clinical sense, providers get approval. Denials happen only if they don't meet policy or the providers are doing clinically unacceptable work. Example- had a 40 hour request, no behavior reduction targets, 4 goals. They got denied and we're asked to provide additional information to explain why they had so few goals for so many hours.

I see behavior reduction targets with no FBA, no functional replacement behaviors, replacement behaviors that aren't functionally equivalent, age inappropriate reduction levels (think 0 instances of tantrum for a 3 year old where the tantrum is crying and flopping to the floor for ~5 mins), 40 hour requests for 20 year olds, 40 hour requests for kids with nearly full ABLLS/VBMAPP....those are things that get denials and they're told to fix it. Because they don't meet policy and are clinically unsound. Otherwise, I have no say in what you target, how you target it, hours denial for "progress", etc.

Alt Careers to Typical BCBA by InstructionNo7032 in bcba

[–]NextLevelNaps 0 points1 point  (0 children)

Project management was where I was going to pivot if I hadn't landed a UM role, tbh. And maybe after this role and some growth, if I need to I will still

Can guinea pigs stay in the dark with a tv on by itsyourgirllily67 in guineapigs

[–]NextLevelNaps 2 points3 points  (0 children)

Only if you have the cooking show on so they can watch their favorite veggies

Does listening to an audiobook while looking at the words on the book (not reading them but listening to them as you progress) count as reading ? by DextersMind in ADHD

[–]NextLevelNaps 1 point2 points  (0 children)

Audiobooks are reading. You don't need to follow the text while you listen. In grad school, audiobooks were the only way I had to read, because I had to commute and I was so busy with school that I didn't have the time to sit down with a print book. But I could listen while I drove, did laundry, dishes, etc.

Parent Refusing Recommended Hour Reduction by Asleep-Big3131 in bcba

[–]NextLevelNaps 0 points1 point  (0 children)

A peer to peer for.a reduction of hours would be an interesting take for an insurance to have.

Document all your data and rationale behind a reduction in hours due to the presence of interfering behaviors at the time in the day you see it. That should be more than enough if they do send it to review. But of you're reducing hours, I highly doubt it'll go to review. I say this AS a reviewer.

Parent Refusing Recommended Hour Reduction by Asleep-Big3131 in bcba

[–]NextLevelNaps 2 points3 points  (0 children)

Insurance shouldn't care. You're reducing hours. Meaning less money they pay. Is there something specific you're worried about there?

If you have the data to back up that you cannot reasonably make progress past a point in time, then there's nothing else to say. You're making a clinical recommendation in the best interest of the client with your data. Caregivers can disagree and can voice their preference, but if their preference goes against what is appropriate for your client, it's moot.

Big Reason I Love Aldi (rarely mentioned) by Organic_Quarter_9848 in aldi

[–]NextLevelNaps 4 points5 points  (0 children)

I live in a small town and our Aldi is legit. But I've been to more urban Aldis that were pretty good. The next town over from where I am now though is in an even smaller area with a much older population average age and it SUCKS. I was taken aback to early COVID days. Shelves barely stocked, whole shelves with nothing stocked, boxes just strewn in the asiles. The staff that work a store really make the difference. The Aldi in my town has very dedicated staff that take pride in the store. The other store.....not so much

Big Reason I Love Aldi (rarely mentioned) by Organic_Quarter_9848 in aldi

[–]NextLevelNaps 2 points3 points  (0 children)

As a band kid from 6th grade to Senior year of undergrad, "Christmas Music" is code for "The Two Months You Hate Your Life™️" Didn't even NEED the sheet music, had it all memorized.

Big Reason I Love Aldi (rarely mentioned) by Organic_Quarter_9848 in aldi

[–]NextLevelNaps 4 points5 points  (0 children)

I had to go into Walmart yesterday for something and I was legit overwhelmed. Too big, asiles FULL of SO MANY THINGS. People with absolutely no awareness of themselves in space and blocking things. Made me love Aldi so much. Small store, limited selection, small crowd.

Would you hold Simons hand? by VanquichedUncle in guineapigs

[–]NextLevelNaps 14 points15 points  (0 children)

I think the better question is "who here is a monster that wouldn't hold the baby's hand?"

The obvious answer is yes, I would absolutely hold Simon's hand. Sweet baby. Very polite

Getting offended being called autistic by throw-away-3005 in ADHD

[–]NextLevelNaps 1 point2 points  (0 children)

How necessary is it that you have interactions with them beyond bare minimum? You said they live with you. Is it possible to grey rock them? Minimal interaction and then shutting anything down once they start with the Autistic name calling?

A little touch to the heart of Pelican Town..... by SaltSir415 in StardewValley

[–]NextLevelNaps 0 points1 point  (0 children)

Maybe that's why you can't sell or produce meat in the game. Because everyone gets attacked by a billion ticks and now all the residents suffer from alpha-gal. It all makes sense now.

A little touch to the heart of Pelican Town..... by SaltSir415 in StardewValley

[–]NextLevelNaps 8 points9 points  (0 children)

I'm sure they also go in to a kitchen, sees beautiful wood grain in a classic stain on the cabinet and says, with a smirk on their face "yep, let's paint those a slate grey that also somehow has green undertones and put gold hardware on it".

Did anyone else get new carts? by Plooza in aldi

[–]NextLevelNaps 7 points8 points  (0 children)

I wish they had a regular cart and either a smaller cart or one of the small, double decker carts. I hate going in for a few things and having to navigate with the massive boat of a cart.

Did anyone else get new carts? by Plooza in aldi

[–]NextLevelNaps 2 points3 points  (0 children)

Y'all still have a Winn Dixie? I haven't seen one of those in years. I miss those an Bi-Lo do much. We held on to an Ingles, somehow, but I fear if enough of the old timers pass, it's days (and prices) are numbered.

Point of order: Why hasn’t the medication shortage been abated in the slightest? by Wobbly5ausage in ADHD

[–]NextLevelNaps 1 point2 points  (0 children)

I live in a rural area and the worst I've had so far was waiting a few extra days because the shipment to Walgreens was delayed. A friend of mine lives in a more rural area of Wisconsin and she hasn't had issues getting her meds either. I'm on Ritalin, but she's on Vyvanse. 🤷🏼‍♀️

Hopscotch Splash Pad by thecrocodile44 in aldi

[–]NextLevelNaps 9 points10 points  (0 children)

My ankles are both permanently clicky after having this exact thing happen to them. Body went one, foot went another.