Association for Behavior Analysis International

Commercial insurance companies and state Medicaid agencies are starting to deny prior authorization requests because Applied Behavior Analysis (ABA) providers are not adequately documenting the medical necessity of the service they are requesting. The problem is that ABA services for individuals with Autism Spectrums Disorder (ASD) have been traditionally viewed as habilitative or educational and not rehabilitative; therefore, a diagnosis of ASD may not be sufficient for an insurance company to adequately document the medical necessity of ABA services. Few behavior analysts are trained through a medical model, which can limit their understanding of what is needed to fully document medically necessity of ABA services. The panelists will help review standards on how to: 1) determine if ABA services are medically necessary, 2) document a clients level of care based on medical necessity, 3) develop and reflect treatment goals that address the medical necessity of services, and 4) present a prior authorization that fully documents the medical necessity of ABA services for your clients.