To ensure we offer contemporary continuing education opportunities, the CE credit associated with this video is no longer available, however, the video remains available for viewing.
With applied behavior analysis (ABA) joining the mainstream of medically necessary treatments, insurers and managed care organizations have moved to introduce policies intended to influence treatment decisions – critical decisions about how many hours of ABA are medically necessary, which locations are allowable, and who must participate in treatment. Arbitrary policies that constrain behavior analysts from designing and implementing the most effective treatment plan are often indicative of an overreach by the funding source. Behavior analysts are in a position to shape funding practices by understanding the laws and regulations that underpin patient rights in the determination and funding of medically necessary treatment. This workshop will teach participants how to challenge improper payer policies, stand by their clinical recommendations, and ensure that behavior analysts – not funding sources – set the standard of care for ABA. Participants will learn the variables that should and should not contribute to their determination of medically necessary ABA and how to appeal an insurance carrier’s decision to ABA. During the workshop, participants will have the opportunity to complete an actual appeal of an insurance carrier’s denial.Workshop participants will receive an exclusive toolkit via their ABAI portal at the conclusion of the conference.