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RBT in Public School Covered by Insurance

Jessica W.


Anyone had any luck with getting a private RBT approved by solely private insurance while in a public agency?


I'm in the process of doing this and at my recent annual, got no pushback on my request. I'm reading the notes from the proposed IEP that covers the details from our meeting and it's listed as 'a need in order to access FAPE and that public agency has no concerns regarding parent's request for private RBT services while in a school setting'. I just want to be prepared on how to handle the situation in case something changes.

Background: student is currently eligible for IEP under ID (moderate), OHI & LSI. Currently undergoing re-eval for ASD. In second grade. Retained for kindergarten. Has been in school for 4 years. Has had 1:1 paraprofessional for 4 years while in GenEd setting. In an 80%/20% setting with most of his day in a GenEd classroom. The purpose in requesting RBT services was to help teach the student the necessary skills to regulate, focus, control impulsivity rather than just having a para with him. I know getting a para can be hard and I'm very thankful for having one for a long as we have (he's had one since his very first day of kindergarten), but I'm wanting him to learn the skills needed to reduce/eliminate behaviors, and that's going to take someone with skills/training in behavioral intervention.

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I am in PA & I see this all the time.  Insurance/Medicaid covers an RBT at 100% so it is at no cost to parents - which is the F (free) in FAPE.  Some insurances - this would be employer insurance - do not cover 'school' as a place of service.  In this case, the school should pick up the cost.  If they are paying, they might also want to pick the RBT just like they picked your child's para.

When the RBT comes from a 3rd party like an agency that takes Medicaid, when the RBT is out, it's the agency that needs to send a sub and that doesn't happen in PA.  RBTs are in such short supply, waitlists are common & the wait can take many, many months & sometimes as long as a year.  When something is in the IEP, like a para or RBT, the school is obligated to provide a sub.  Also, the child would need to stay home when their helper is out & there is no sub because the school cannot follow the IEP & doesn't want to be out of compliance.  (It does get complicated.)

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