I have been so busy finishing up the homeschooling year and jumping into my summer job, I haven't been on lately.

I just need to vent my frustration! javascript:emoticon('') P.J. was diagnosed with ASD in April, so when his re-evaluation for behavioral support came up in June, we asked for additional hours. Medical assistance mental health division responded by denying all of his TSS hours.

Do any of you get a TSS through medical (not educational)?

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PJ's Mom

Hi Pj's Mom. What does TSS mean? I think in every state we call it something different. Is it like the supplemental medicaid insurance? We get what is called Katie Beckett in RI. This is a state funded, not school funded program. A lot of kids with only ds have been denied over the years, as the children got older and as the budget cuts got bigger. Melly has DS/ ASD and Ad/hd, so she still gets those benefits. It pays for home help for me. I have someone who comes in for 20 hours a week to help with Daily Living skills and with whatever Melly needs help with. Is this what you mean? If so, I think it's terrible that your son has been denied. That dual diagnosis is a big one. I'd fight it if you can.

Yes, Melissa's is considered medical, not educational.


Michelle

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Can you appeal the decision?

We didn't get any more financial or services support when Robert got the extra diagnosis.
Its sucks and it is very hard at times.
I'd love to be able to have money to pay someone to be with Robert while I am with my other daughter. That falls to my husband, its a big strain on family life, sometimes!!

I also had have had to pay privately for Behavioural Therapy and its expensive.

If you can appeal, do so!

And Good Luck!

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Linda & John
mom to Hannah Kate (Age 16 ), Robert (Aged 10 - DS)


First Communion Day

Talitha has been diagnosed with ADHD, severe Apraxia and some sensory issues but that doesn't give us any extra funding either.

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Karyn
Mum to Nikki (Jul 89), Stefanie (Sep 96), Joel [June 98] and Talitha (DS) (Nov 05) AVSD/PDA repaired 23 March

"I will praise You, for I am fearfully and wonderfully made; Marvelous are Your works, and that my soul knows very well." Psalm 139:14

We are in Pennsylvania, and Matthew gets TSS and BSC hours. I didnt know there was any other way to get tss except through medical assistance. You should be able to file a grievance and fight the denial. I have done this before one time when our summer increase in hrs was denied. We collected data and pled our case. I won. Every other time our hrs have been approved and he has had services for 3 and a half years. I don't know what your biggest behavioral issues are, but Matthew's biggest issue is safety. They have a hard time denying hrs with safety concerns. Self injury behavior is another issue that justifies hrs. I am hearing of lots of denials or reduction of hrs around here, too.

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Heather
Matthew 5-21-03 DS, PDD-NOS and Ryan 2-14-01

TSS is Therapeutic Support Staff. It is a person who is trained to implement behavioral plans. P.J. escaped from his classroom three times last year. He hits himself forcefully on the head when angry. He was beginning to show aggression toward peers at preschool. When I took him to Bible School in June, he sat under a table and cried most of the time. (This is not separation anxiety, he normally has no problem being apart from me in other settings.) We have lots more goals related to attention, compliance, transitions and communication.

Both PJ's Behavioral Specialist consultant and the BSC who works with my older son, who also has Autism Spectrum Disorder, were flabbergasted by the denial. I keep wondering if we are being discriminated against because of homeschooling or because of his Down syndrome diagnosis. I have appealed once and am in the process of appealing again. I have contacted some non-profit agencies to try to get some help with advocacy.

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PJ's Mom

Quote:

We have lots more goals related to attention, compliance, transitions and communication.

Us too! Sounds like you are on top of things....keeping my fingers and toes crossed that your appeal is upheld!

Keep us posted if you can.

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Linda & John
mom to Hannah Kate (Age 16 ), Robert (Aged 10 - DS)


First Communion Day

Make sure your treatment plan has goals for stopping the self injury and aggression. Also a safety goal about the running away. My son has DS and pdd-nos and has never been denied services all together. Just once he was denied a summer increase, but we resolved that through an appeal. How many hrs are you asking for. Too many might throw up a red flag. Is the insurance company recommending something else? You may need to list the asd diagnosis before the DS because DS doesn't qualify for wraparound.

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Heather
Matthew 5-21-03 DS, PDD-NOS and Ryan 2-14-01

It seems like forever since I have had the time to get on the forum. I am thankful for those of you who check in regularly to provide support for others. I just want to share that after going through the appeal process the second time, and gathering information from several more source, we were finally approved for 15 of the 22 hours requested. It has really been benefitting Peter and our family. We have just asked to go up to 18 hours at his re-evaluation.

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PJ's Mom