My name's Jonathan Mueller. I'm the host of Building Better Businesses in ABA Podcast, and my guest today is Mariel Fernandez. Marielle is the president-elect of the TEXABA Public Policy Group and works full-time for Blue Spring Pediatrics and Public Policy Advocacy and Regulatory Affairs. She has her master's and undergrad from Auburn, War eagle has been a BCBA since 2004. Mariel, welcome to the pod.
Thank you so much for having me. I am so excited to be here today.
Well, this is an important conversation to me, Mariel, because it involves access and it's one of the things that I am most passionate about. I believe healthcare is a human right, and it doesn't matter. It shouldn't matter if, you know, if someone has, private and commercial insurance or Medicaid or anything else.
one stat I saw that I'm help hoping you can help me with is that something like 80 to a hundred thousand children with an autism diagnosis have Texas Medicaid, and yet, you know, haven't had access to life-changing ABA services, at least until the, the Texas Medicaid program kicked in in in February, which we'll talk more about. what did it take, you think, for the state to finally recognize that there was freaking unacceptable?
hard work, A decade of hard work, a decade of advocacy from parents, from professionals, providers, attorneys, legislators, everybody. It's been a solid decade of work. We really started this venture back in 2012 before, before the CMS, letter even came out in July, 2014. My career in Texas started back in 2004, and I was at the time working in Houston at TEXANA Center, which is one of the local intellectual developmental disability authorities.
It was one of a handful of ABA programs back in 2004 in the state, and my job was to provide, um, family guidence. That was it through general revenue dollars, because there was no insurance autism mandate, there was no coverage. I got to spend a couple hours a week with kids for maybe six months if I was really lucky. And that was all, all the access that they were gonna get to improve their quality of life, unless the family was wealthy and they could afford to pay privately.
And so a lot of families that I worked with the very beginning of my career were families with Medicaid, whom, were able to really amazingly change their child's outcomes with just those few hours a week and just learning some basic skills. And so, about 10 years ago, some states started really covering ABA through their state Medicaid plans and grassroots efforts and parents are how so much change happens in this country legislatively, particularly with this population.
And, you know, providers started getting phone calls from families saying, well, I heard from so-and-so over there that they now have this benefit. that's kind of where everything started. So it's been 10 years of incredibly hard work and I never thought I would spend a decade on a single issue ever in my career, but it's been well worth it.
just your, your service, to helping to get here is extraordinary. And I wish Mariel that, gosh, I had known you back in 2012. I'll never forget at Ascend at one of my organizations. So we had psychologists, right? and so, we could diagnose kiddos and then it was the recommendation would come and they're yes, now we want ABA, we're desperate, and it was, Shoot, what do we do? This is back in 2018. I, and here's what I'll never forget.
I was driving all over Houston, all over Brazos County, Bryan College Station, after having gotten these gut-wrenching phone calls, to your point around like families are calling providers saying, what can I do? I wanna get my kiddos services. We were going to public defender's offices, how do we go and push back? It's not right. We were gonna like courthouses. I mean, it was, I was totally ineffective.
Um, but you've clearly channeled this now and, and helped to, to create an ex extraordinary change. And I'm curious, do you have like any sense, for, and I know it's a long process for the state just to develop the guidelines and everything else, but how did the state of Texas determine ABA rates, which I, you know, currently what, like 45 bucks an hour for direct treatment and, and a lot of providers have indicated are unsustainable.
You know, I really wish that I had a good answer to that question. I can tell you what we've kind of heard through the grapevine and what we've heard through, conversations with individuals over at HHSC about this. We know they looked at the Missouri rates which until July 1st of this year were very bad. Missouri recently had a, a fairly substantial rate increase because they really didn't have any providers willing to accept their rates.
we know that they looked at Louisiana because one of the individuals who was instrumental in putting this program together a couple of years ago, had developed the ABA program in Louisiana. And so we know they looked at Louisiana rates. We heard them talk a lot about Florida rates and our rates are pretty in line with the rates in Florida. we also heard them talk a lot about concerns with the Florida, policy and a runaway spend and other issues with Florida.
We really strongly encourage them to look at Oklahoma rates and New Mexico rates, which are, you know, obviously two of the states that border Texas and have quite good, comparably Medicaid rates. we don't know if they ever did. we do know that, you know, 45 bucks an hour for 97153 is not great, but it's a lot better than the $30.32 that we started with and, and that we thought was going to be the rate. So, I don't have a great answer as to why they think that that's an adequate rate.
I do know that HHSC has received a ton of feedback, about it not being adequate, and that that's why a number of ABA providers and licensed behavior analysts aren't proceeding forward.
I wonder if, even if we're not sure how exactly the state came up with those rates. Are there other markers for determining network adequacy? Right? Because ultimately that's what could cause the state or, or a managed medicaid plan to, to change rates, right? Because they need to attract more providers. And I, I'm curious, do you know how many license, so in Texas there is licensure, do you know how many licensed BCBAs in Texas have started versus finished the Medicaid application process?
Or even just how managed Medicaid plans are determining whether their networks are adequate?
I do actually. So in Texas there's about, let's call it 3,500 licensed behavior analysts, plus or minus a little bit. my data is from July, so it's several months old at this point in time. there is a outstanding public record request for some updated data, but as of July, there were, 350 to 400 LBAs who had completed the process and there was maybe another 250 who had started but hadn't finished. we'll say maybe about 600 total out of the 3,500 LBAs in the State.
Wow. So the ones who've completed it, it's just a little bit over 10% of all licensed behavior analysts,
yeah, I should say, when I say completed the process, I mean completed the first step in the process because the way that Texas Medicaid has set up this process, and this is not the process just for licensed behavior analysts, it's the process of contracting and credentialing with the managed care organizations in the state for all providers. but the first step is to go through, TMHP which is the Texas Medicaid Healthcare Partnership.
They're kind of like the gatekeeper to accessing, the MCOs, if you will, the managed care organizations. So it's their job to make sure that you have the credentials that you say that you. That, you don't have, any issues on your background check that would prevent you or prohibit you from being able to do your job. and that if you're providing a center-based service, that your center actually physically exists and is there so that there's a lease that you're physically present.
It's, it's a very minimal site visit, but they do go out and they do confirm that you are who you say you. so the data that I have is just for that first step with TMHP. We don't have any data on the number of licensed behavior analysts that have completed the individual contracting and credentialing process with each of the 16 managed care organizations. so Texas is a big state, obviously. and it's broken down into 13 catchment areas. And each catchment area has their own MCOs.
there's only one managed care organization that serves the whole entire state of Texas, and that's Superior. everybody else has their little pockets and they might serve 2, 3, 4, 10, 11 of those MCO catchment areas, but they don't serve the whole rest of the state.
it's a great clarifying point that those, LBAs who have, completed the process and that's almost like getting to the starting line of then individually getting in network with each of those plans. And to your point, we don't have data around that, so it's gotta be some subset even of that, which to me, screams. inadequate networks, right?
A hundred percent. so regarding network adequacy, there isn't any right now. none of those 16 MCOs can possibly have an adequate network. it's just not possible. I will also say kind of my own soap box. None of the MCOs seem to be moving with any sense of urgency, to get folks through that contracting and credentialing process. So, we know there's general parameters around how long it's supposed to take and there aren't any real consequences if it takes longer than that.
we're not really seeing anybody move with a huge sense of urgency to get LBAs approved so that they can start providing the service. So in terms of network adequacy, there can't possibly be any at this time.
we've again asked for data can you show us with everything protected, redacted, where you have kids that are trying to access care as an mco and where you have LBAs who have actually been approved, and what kids, and again, with Phi redacted, but give us a dot on the map to show us what kids are actually in service and where.
Yeah, that feels important. just anecdotally, at Ascend we are getting calls all the time. We, we are in network with some plans, not all and, and we can't take every single kiddo who comes in. And so we hear from parents how long these wait lists are. So it's, it's this almost like slow motion moving Oh, are we gonna get to network adequacy? but let's talk more about the logistics of providing care across these different, 16 MCOs across the state.
I know that there's been confusion with parents and providers, diagnosing providers and licensed behavior analysts, right? who struggle to understand just the basics of the provider manuals, how those are different from the overall autism program manual. help make sense of this Mariel.
it doesn't really make sense. I think that's the first place to start, is, you know, it's not a simple process. it's been extremely convoluted and complicated unnecessarily. So, I can provide, best practices, some things that all providers should do.
if you're, in the business of behavior analysis and you're interested in taking Medicaid in the state of Texas, the first thing is you really need to review the TMPPM which is essentially the, the Medicaid state rules and specifically the Children's Services Handbook section of that, that's gonna go through what the state plan and the rules are associated with ABA. We thought it was gonna be really simple. this has been 10 years of thinking this was gonna be really simple, right?
And it never turns out to be. So what we learned after february 1st, when services were available is the TMPPM is a set of guidelines and the MCOs are allowed to have slightly different processes, but those processes can be no more restrictive than the state guidelines.
So, for example, the TM PPM, the big instruction book says, use the comprehensive care program prior authorization form, but each MCO can choose to use that, comprehensive care program, prior authorization form, or they can choose to use the Texas standard prior authorization form, or they can choose to use their own proprietary form that they've created, or in the case of at least one mco, so far, they aren't using any form, everything's done in just a portal.
So you need to be familiar with the TMPPM and you need to read it and you need to understand it, but then you need to go, to every single MCO provider manual or ABA resource guide, which they have available readily online. I will say it's really easy to find stuff that you need in the state of Texas compared to other states. and you need to go and you need to read those, and you need to have a clear understanding of what each individual MCO needs in terms of a prior auth form.
Now they're all following the standard rules about referrals. They're all following the standard rules about what must be included within the diagnostic report. but the actual process of getting prior auth, it, it is different for all 16. Which is really overwhelming and really confusing. another thing that I really, really wish that behavior analysts and parents understood is the diagnostic criteria to determine medical necessity. So, whether I agree with what the state has outlined or not.
Right now, I have to follow the rules while I work to change the rules. And we are working to change the rules, but we've gotta follow what we've got in place right now. And part of those rules say that you have to get an updated diagnosis every three years. that it has to be a comprehensive diagnosis, which means it can't just be a doctor who looks at a child and says, yep You've got symptoms of autism, therefore I'm giving you a diagnosis.
you have to do an actual, validated tool to evaluate does somebody have autism? So something like the gars, the cars, the srs, the ADIR, the ados, really important to know that screeners are not considered valid. So if a pediatrician does like an M-chat or a STAT and that's it. That doesn't count with the policy. and then it has to include DSM symptomology. So what part of the diagnostic criteria in the DSM does the child meet?
and then it also has to include, the symptom severity level per the DSM. And this is the thing that has really been the trickiest, for everybody to understand. what does that mean? it means assigning a level, so level one, level two, or level three or the, the language that goes along with that level. So level one is requiring support. Level two is requiring substantial support, and level three is requiring very substantial support.
So it can either say level 1, 2, 3, or that accompanying language. But what it can't say, and this is where it's been a challenge, is mild, moderate, or severe. HHSC, the Health and Human Services Commission has said mild, moderate, and severe are not consistent with the DSM symptomology levels. So we're working to fix that. that's a high priority to get them to accept that, but right now they won't.
And a lot of diagnosing providers historically, especially so for diagnoses before February 1st in Texas, for diagnoses, unless somebody had Tricare have not included, that very specific symptom severity language, they've, you know, everyday language. Instead, they're, you know, mild, they're moderate, they're severe. So that's a big barrier and that's something that I want everybody to know.
right now we've just gotta be really overly nitpicky, and make sure that the diagnostic reports include that information. another, really crucial and really critical thing is who can provide a diagnosis. The policy manual says is that it can be a, pediatrician, it can be a developmental behavioral pediatrician, a neurologist, it can be a psychiatrist or a psychologist, or that the diagnosis can be completed by an interdisciplinary team.
And if it's being completed by an interdisciplinary team, it can include anybody who I just listed, a nurse practitioner, a physician's assistant. It can include a, licensed psychological associate. It could include an occupational therapist, a speech language pathologist, a licensed specialist in school psychology.
and I think a licensed clinical social worker, but it doesn't say it can include a bcba, so I think most professionals in the field in Texas at least, I can't speak for other states, but at least in Texas, we've all seen an ADOS that's com completed by a BCBA that's then been endorsed by a physician. Texas. Medicaid won't accept that because BCBAs are not included on the list of people who can be part of that interdisciplinary team.
Now they will accept a FIE e a full individualized evaluation for school eligibility.
If all of the other required components are included within that FIE, that can be endorsed by a physician because usually the ARD team, Texas calls IEPs ARDs so usually the IEP or the ARD team is made up of a licensed specialist in school psychology, a diagnostician, speech, OT, so those can be endorsed, and those can count as an interdisciplinary team diagnosis if they include all the other things that we mentioned.
Mariel, can I be honest with you, dude? You know, there's like a lot of things in life. You're like, oh, but it's not rocket science. this sounds more complicated than freaking rocket science and there's a lot to unpack it. Let me come back actually specifically on this cuz I'm, I'm gonna get a little fired up. So level 1, 2, 3 versus mild, moderate, severe. Now I get it, the last DSM manual, right? Which came out, what, 5, 6, 7 years ago.
Specifically called that levels 1, 2, 3 versus other terminology. But this seems just like bureaucratic obstruction meant to prevent services. And what I can't help but wonder, and I don't know if you can even answer this, right, if someone gets a cancer diagnosis, do you have to go through that level of bureaucracy in order to ultimately get the intervention you need?
That's a great question and it's a great comparison and I frankly, I don't know that I can answer that for Texas Medicaid. I have no idea. What I can say is that the policy that was written and ultimately approved by CMS at the federal level, because state plan amendments have to be approved by CMS, is far more restrictive than the EPS DT guidelines and allowed under EPSDT so we, we can back up and talk about EPSDT cuz this is really important.
So EPSDT is early periodic screening, diagnosis and treatment, and it is the federal part of Medicaid that says, hey, if you're a kid, so if you're under age 18 and you have Medicaid, you are entitled to more protection and more services than if you're an adult.
so what EPSDT actually says about autism, specifically as of July, 2014 when the CMS director issued a memorandum, is any and all medically necessary services for the treatment of autism spectrum disorder must, must be covered by the state plan. what EPSDT says is any, I'm gonna paraphrase it. treatment must be approved to ameliorate signs and symptoms and prevent regression, right? it doesn't include, but you have to have a level.
It doesn't include, but your diagnosis has to be completed in the last three years. It doesn't include, but it can only be given by x, Y, and Z. and then there's some other things in, the state plan related to hours of service and how those things are gonna be considered. There are huge violations of both EPSDT and MHPAEA, which is the Mental Health Parody and Addictions Equity Act.
which if you don't know what that is and you work in the field of behavior analysis, it's your best friend and you should get real familiar because it will, it will help you win almost any appeal that you need to file and to fight. so when I was saying I don't like the rules, but we have to follow the rules right now, when I think about access to care, I think about it in terms of the continuum, right?
this is absolutely unacceptable and I have to fight and I have to make sure that I fix this right now because it's just not okay, Or, do I follow the rules right now while I put together a dream team of people, including legislators, who are gonna help me fix this long term? But I don't prevent kids from getting access to care today under this more strict, not cool, policy. Right?
So where we are right now is we provided public comment back in 2019 on the proposed rules and said, Hey, MHPHEA concerned, Hey, EPSDT concern, Hey, don't think this is a great idea. The rules came out. It then became do we dig our heels in and say, Nope, I'm gonna die on this mountain and continue to fight and it maybe it's another 10 years and remember it's 10 years of my life, but it's 10 years for kids to have the opportunity to have quality of life, right?
To have the opportunity to learn how to learn and to have the opportunity to learn how to make friends and to learn from their environment and to no longer need skilled intervention. So it becomes the question of do you dig in right now and say Absolutely not. Or do you say, I don't like this but let me work with what I have right now and I'm gonna fix it long term.
And so that's where we are, is let's work with what we've got right now, but let's continuously advocate, and get in front of the right people and say the right things to fix this long term. So some ways that we've done that are, actually getting in front of the Policy Council for Children and Families, which is a committee that's appointed by the governor that helps to advise the legislature on things that need to change.
and they are, the Policy Council for Children and Families right now is finalizing their, their draft. For the legislature on what needs to change with the Health and Human Services Commission, which is Texas Medicaid, and these areas of concern that I've said it's not great, but all of those are included in that language that's gonna go to the legislature that's gonna say here's some things that need to change. These are really limiting access to care.
So the need for an updated diagnosis is in there. The information about the levels is in there. You have to also, when you're working in public policy and advocacy, you can't get greedy, right? You've gotta take what you can get and be like, okay, I convinced them on that one. I'll come back to this other thing next time. So we've got the levels in there, we've got the language about mild, moderate, severe, and we've got the updated diagnosis.
Oh, and the way that the policy is currently written you get your, assessment auth and then you get a 90 day treatment auth, and then you can ask for a 90 day extension. So we also ask them to get rid of that 90 90 and just give us six months of services because I mean, this is hard, right? We've been talking about how complex and challenging this is, and we haven't even talked about physician referrals yet, which are also a bit complex and challenging.
And it's like you're just doing one thing after another, after another, after another. For the first really six months from the time you get a kid in the door until you're six months in it's thing, after thing, after thing, after thing. So we asked, for that as well.
I wanna put a fine point on MHPEA or the Mental Health Parody Act, which you, you are absolutely right. This is a clinician's best friend and what I think was originally passed in, what, 2008 ish. said that, service. I'm going to, botch the exact language, but, mental and behavioral health services, insurance companies cannot pose treatment nor financial restrictions on those that are any more restrictive than, what might be imposed for physical and medical health.
So it brought parity to the insurance benefits. So we'll drop a link in the show notes to that. cuz it's so important. But let me come back to the idea of even having an autism diagnosis. Now there are many states. in which, and Arizona and Colorado are two of those where Medicaid plans, you don't have to have an autism diagnosis to get ABA right. This idea of you can't restrict, ability of a child to access a medically necessary service. But in Texas, you have to have that diagnosis, right?
how did that come about? was it just this intentional restriction or something else?
You know, we had to fight so hard to even get this benefit covered. I mentioned that we don't know quite how they came up with rates, but we heard mentions of other states, and one state we heard mention of was Florida. And Florida, similar to Colorado and Arizona. Same deal, right? You don't have to have a specific diagnosis you just have to have a, a physician who says, this is medically necessary care. We kept hearing references to runaway spend, runaway spend.
We don't want another Florida on our hands. So I am assuming, that they really looked at that and they said, you know what? That CMS directive said autism, so we're limiting this to autism and we're gonna make it maybe a little challenging for folks to get into service and into care. Texas has done exactly what they have to do to follow the letter of the law and nothing more.
Well, Mariel, I think what you've described is this case study and how advocacy and change actually happens. I mean, our country and, and in a whole variety of, of ways. it's an important reminder that we can't let perfect be the enemy of great. Right.
and what's so gutting to your point earlier, is that all the parents who advocated over these last 10 years, chances are their kids are now probably too old even to access services, but they were helping with the next generation of kiddos who can get services and hopefully that then now prompts with all your advocacy work, even more favorable or less restrictive application of services. if you take your crystal ball out, right.
What are some of your predictions for the Texas Autism program and, and how to look different over the next few years?
I think this year really has been, yes, the benefit is present, but it's really laying the foundation and the groundwork for kids to actually get access to care. I really hope in 2023, 2024. certainly 2025 that I don't see on social media parents asking, Hey, has anybody been able to get ABA for their kid through Texas Medicaid yet? I see that every single day when I get on and I see resounding nos. pretty much every single parent saying, Nope, nope, nope, nope, nope, nope, nope. Not possible.
I hope that that changes. I hope that we're able to get rates improved I hope we're able to get adequate networks, at least in the portions of the state, that have more urban settings and have good density of, BCBAs. parts of West Texas are always gonna be a challenge because there just aren't a lot of clinicians out there. and it's, really rural. but I hope at least in the more densely populated parts of the state, we have pretty good network adequacy and kids are able to access care.
I hope our rates are more in line with, what folks would be able to accept on a larger scale. So they're more adequate. we don't want people going out of business like what happened in South Carolina with their rates where folks tried to take 'em and they just simply couldn't afford to. I hope that some of these barriers that we've talked about in terms of the need for an updated diagnosis every three years, the language surrounding the level, I hope those things are resolved.
I'm very optimistic that they will be. I'm also clearly a little bit crazy if I've been working on this for 10 years and haven't given up yet. I think we're gonna get there. I'm optimistic that we will, and I think once more families can get their kids into service and discover the power of their voice, that a lot of these things will happen because yes, there have been providers who've been really instrumental in this process. Yes, there have been advocates.
Yes, there have been lobbyists, but it's really families that have made these things happen.
it's almost like you need the power of David, right? From David and Goliath to make this stuff with the patience of Job thrown in. So that's a hefty sandwich to have to chew on. as an ABA provider, Listening today or practice owner leaders in our field? What could we do today to help influence this for the positive?
You. Have no idea the value of advocacy. Well, I remember 10 years ago when I started this, first I had no interest in politics whatsoever. This was not something that I aspired to do. I had no idea the, the power of advocacy. I had no idea the power of a personal relationship. And I think a lot of us discount who we know and, who the people we know, know, and being able to reach out to somebody and have that conversation, that really open, honest, Hey, here's what's going on.
Conversation is so important. Our legislators, they cannot be an expert in every single issue that comes before them. There's no way. And their staff can also not be an expert in every single issue that comes before them. It's just not possible. And as a field right now, there's a lot of misinformation about ABA out there. We know that, our voice needs to be just as loud as that misinformation. always kind, always respectful, but just as loud.
And I'm not suggesting, that this is done in a confrontational or unkind way to individuals who oppose behavior analysis. that's not gonna get it done. But you can't just sit back and let, that be the, only narrative. there's power in advocacy. One thing that I teach my clinicians and I teach my colleagues when I'm working with em through PPG and also through Blue Spring in our own advocacy committee, is, the squeaky wheel gets the grease, but only if you're squeaking nicely, right?
you cannot come in yelling and throwing a fit and think that people are gonna listen to you and want to do what you're saying. you've gotta be persistent. you can't come in and be told, no, that's not going to happen. And just kind of tuck your tail between your legs and say, oh, they said no, I'm gonna go away. you've gotta find what matters and you've gotta find that hook, and persistence.
being kind is a really good way to figure out what matters to somebody, because if you're always there, you're always having conversations and eventually they're gonna tell you what matters to them. Whether it is, Texas, that's an extremely fiscally conservative state, so they care a lot about the money that they're spending, or, you discover that somebody has a family member on the spectrum. and maybe they've heard not great things about behavior analysis and so they have a preconceived notion.
Invite 'em to your center. spend time with 'em, invite families to go with you on legislative office visits. when we finally got this done back in 2019, cuz then, you know, covid happened and we had power grid issues and some hurricanes. It's just taken a while to really get here. But when we got, the coverage passed back in 2019, in part it was because, a little friend of mine, he's not so little anymore.
He's, I think 16. He wanted to come and he is a self-advocate and he wanted to come and he wanted to talk about what ABA did for him and that every kid should have the opportunities that he had.. And he's a kid who did not have commercial coverage, He got access to care through the HHSC Children's Autism Program, which is a program that the state put in place instead of the full Medicaid plan. and he was able to get access to early intervention and, he's doing amazing.
I still follow his progress and keep in touch with his mom, but, he wanted to come and he wanted. To provide testimony before the Senate, and he did, and he really blew them away. So there's a hook. You just have to find it and you've gotta be effective in your storytelling. and you've just gotta get the message to the right people.
This is so critical. our voices count. and we, there's power in our voices and especially in a democracy where you know that expression like democracy is the, the worst form of government except for all other governments, right? but legislatures and, and their staffers are humans. and they're people like we are.
And what I'd encourage every listener to do is actually a great book I read, just a few months ago, called The Power of Who, in which he says is, Instead of trying to go out to like a whole bunch of different people, just make a list of those hundred people. 100 people whom you know best, who have been important to you over the course of your life. It's a powerful exercise I can imagine for ABA providers or parents or anyone else.
Thinking about that list in the context of whom their representatives are, would go a really long way toward making our voices be heard.
Absolutely.
But let's pivot to. Congratulations, you are the president-elect of TXABA's Public Policy Group, that's been helping to carry this banner for many years now. so thinking about that role, Mariel, like what is wild success in that role look like to you? and tell me about some of your legislative priorities.
Oh gosh. Wild success. PPG has done some really cool things. We got licensure. We got licensure. honestly because of Medicaid, cuz HHSC told us We won't give you Medicaid because you're not licensed. And so we said, cool, let's, let's do that. so we got licensure, we got Medicaid, you know, big priorities. early childhood intervention has been underfunded in Texas. and we know that kids zero to three are that target early intervention group?
one thing that we've tried to do for the last couple sessions, and we haven't quite been successful with yet, is getting kids who are eligible for ECI without a formal diagnosis yet to be covered through Medicaid, but also through commercial insurance. So that'd be wild success. That's also a huge priority that we have. looking at some things that our friends did in Colorado and Florida, the last legislative session with requiring, ABA services to be allowed in schools. We'd love to do that.
We'd love to do that through a combination of SHARS, which is the School Health and Related Services program, which is a Medicaid program, and just through creating some standard rules about when outside consultation can occur. So right now in Texas it's really, district specific, and it's even more campus specific. It's really the campus administrator, so that principal or that vice-principal who can dictate who comes onto their campus. So we'd like that to change.
We'd like there to be standard rules about when outside consultation can happen. under what conditions and how that process goes about because that would allow improved coordination of care and improved outcomes for kids. so that would be wild success. I think for me personally, wild success is just improving the profession. helping people understand the importance of advocacy, right? When you look at our ethics code, it's your job to advocate, To be a good ethical behavior analyst.
You should be advocating for client care and advocacy doesn't happen just on the macro level like we've been talking about today. It happens on the micro level with each individual that we're serving.
So I. One thing that I would absolutely love and I think would be amazing and, and just huge success for the PPG, is to just get more people interested in learning about the advocacy and the public policy process and becoming members and realizing the influence that they have over their community, over their state, over a funder. because again, there's so much power, you have so much power if you can learn how to do this correctly and you can learn how to do this right.
so I would love just to see improved involvement from LBAs around the state. That would be really a huge success.
As those, are phenomenal priorities and can you speak a little bit to behavior analysis and practice in this call for papers and the importance, I know how passionate you are about having public policy groups in. All 50 states. Can you tell, tell me a little bit more about that.
Yeah. so exciting. My colleagues, Gordon Bourland and Berenice De La Cruz, who are here in Texas, they are serving as special editors for a special edition of Behavior Analysis and Practice. call for papers is due March 1st, of 2023. and it's gonna be a complete addition of the journal just focused on the public policy and advocacy works of individuals. so individuals with state organizations, private entities, like what folks are doing to really drive home, public policy and advocacy work.
I'm super excited. Ce and Gordon are both, members of the public policy. Gordon was past president. He really was instrumental with helping to form the ppg and Berenice is our current treasurer. it's a really huge honor that they're serving as these guest editors. And they did a ton of work, to make this special edition happen.
And, really just encouraging folks, if you are doing good public policy work, if you are doing good advocacy with your state organization, with your company, just on your own. Please highlight that cuz that's how we learn and grow as a field. And, it helps create a roadmap, if you will, for how other people can do the same thing.
Uh, I love how much you lean into collaboration and I mean, full disclosure of Blue Spring and Ascend, both CASP members, and you and I met on these monthly Texas Medicaid, advocacy calls that Judith at, CASP was putting on. I always found myself hanging by your every word over the last, year that these have been happening. cuz you know so much. I appreciate your, Your advocacy work and leaning into collaboration.
what's one thing every ABA owners should start doing and one thing they should stop doing?
So I think it's really important to know who your audience is. And one thing that I think owners need to start doing is realizing that folks probably didn't get into this field for the paycheck alone, and really identifying their. So why are people here and how can you really create an environment that's gonna support and motivate them to do really hard work? Because behavior analysis is hard work. so I wish that folks would start doing that.
I. Wish that people on the flip side, this is gonna sound really hypocritical given what I just said, but I wish that people would stop inflating, salaries, To these crazy astronomical, you graduated yesterday and you're being offered six figures, and that's just not sustainable, I think in business we know that the profit margin here is, is slim, very slim. and I don't understand how you plan to stay in business long term. if that is your goal, if that's, your model.
So, all for paying people, a good living wage, I'm not suggesting that we shouldn't pay people well, we absolutely should, but I just wish that folks were thinking a little bit more about the long term and what is really gonna support the field and allow for opportunities for growth and not that quick, hey, let's get somebody in the door and work them to death. Almost always a trade off for that salary. and then spit them out.
And now they're jaded and they hate behavior analysis and they hate the field and they really don't. They hated that experience.
said. Now is now the time to drive people away from our field. We have enough of a, a provider shortage. Well, Mariel, where can people find you online?
so you guys can find me on Facebook if you wanna hunt me down there. I am, relatively selective in who I accept as a friend, and all my stuff is set to private. I am married to an attorney who, is very particular about those things. you can also follow TXABA Public Policy Group on Facebook, on Twitter. And, via our website,
I will definitely drop it in the show notes. and I gotta ask then, are you ready for the hot take questions?
I am ready for the hot take questions.
All right, here we go. So, you're on your death bed. What's the one thing you wanna be remembered for?
This Texas Medicaid This is the one thing, I've actually said several times, if I never accomplished anything else in my career, I did this and this was good enough.
What's your most important self care practice?
I'm very bad at self-care, I'm not good at it. I used to be a competitive equestrian and I used to ride. I'm getting really old though, and falling off really, really hurt. So that used to be my self-care. this year I have tried to make walking a priority, so I walk 10,000 steps a day. how I'm decompressing and forcing myself to step away from everything that's going on
nice 10,000 steps a day. I have my apple watch I have an Amazon halo that like measures my sleep and steps and I'm bad at achieving that goal, but I, I am with you on that. Just walk and clear the brain. It's such a good medicine. your favorite song?
Oh my gosh. Anything nineties alternative probably. Let's do smells like teen spirit from Nirvana, cuz that was like my, my time. I'm old.
that was a defining moment of a music generation,
Absolutely.
I'll never forget when it, came out and, you know what? I hate to say it, like I had zero appreciation for it. And hated at the time. And it, it helped i, yes, well, I was also like, you know, child of the eighties heavy metal hair bands and grunge was literally the death of heavy metal. And so I had that sort of thing going on too. I don't know, I was all kind of confused, but yes. Nineties alt Rock. Yes.
Yeah, actually I've got a second favorite, which is welcome to the Jungle of Guns N Roses. I saw them in concert when they came back and it was awesome. But then it made me really sad because it's the old Guns N Roses, you know?
Yeah. True. At least they're still making or not making music, but they're still touring. I'll say this, I don't know if you've seen, Thor, God of Love and Thunder at, in My Family, were huge Marvel fans, and that's, I think the third edition. It's phenomenal virtually the entire soundtrack is Gnr Guns on Roses and no spoilers, but okay. I'm getting goosebumps. I'm not kidding you, Mariel. We, we watched it front row, my family, all my kids, Kim.
And in the last scene there's a big battle of course, and what comes on. But that unbelievable riff at the end of November Rain and, ugh, that is worth the price of admission alone. I'll leave it at that. I will leave it at that. If you could give your 18 year old self one piece of advice, what would it be?
Don't be in such a hurry.
Yes.
So I graduated from college in three years. I was A BCB A at 23, years old. 23, right? Like it was great. It was amazing. I don't know that I would go back and change that, but I feel like I was just in too much of a hurry to grow up. and I out on some fun. I had a lot of fun. I had a lot of fun, but I could have slowed down a little bit.
I like that. I had a, I had a lot of I, I think probably a lot too um, that, I like that. Slow down. All right. You can only wear one style of footwear, which would it
so you didn't know this about me and I'm loving that you're asking this question. for anybody who knows me that's listening, they're gonna know why. I love that you're asking this question. I have been. to multiple presentations based upon the shoes that I'm wearing. Cause I love shoes so, so much. So, this is gonna be super controversial. I know it's gonna be super controversial. I would wear some ridiculous overpriced, way too expensive. super, super fancy, four inch stiletto heel every day.
If I could,
Really,
though it hurts. I don't care. I love them so much. They're
and there's not a comfort factor or
No. Mm-hmm. Nope. You gotta be in pain sometimes. It's okay.
Uh, hey, that's like, the stress of what A lobster outgrows a shell. It's stress and it's in pain, but then you grow. Okay. I wonder if I need to try those heels as well. Um, but Mariel, this has been an absolute pleasure. Can I just say thank you for all that you're doing to collaborate and for advocacy and for kiddos with autism in Texas. I appreciate you
thank you so much. this isn't about me, right? It's not about whatever organization that we work for. It really truly is about these families. and if the kids win, we all win. And the only way for the kids win to win is for everybody to get on the same page and to understand the rules and how we can effectively change those rules. So thank you for giving me the chance to come on here and share a little bit about where we are and where I hope we're going because that's how we help the kids win.
So I really, really appreciate it.