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Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

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44th Annual Convention; San Diego, CA; 2018

Event Details

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Panel #354
CE Offered: BACB
CANCELED: Guidance for Clinicians on Navigating Peer Reviews and Appeals for Insurance-Funded ABA
Sunday, May 27, 2018
6:00 PM–6:50 PM
Manchester Grand Hyatt, Seaport Ballroom B
Area: PRA/OBM; Domain: Service Delivery
CE Instructor: Ashley Williams, M.S.
Chair: Nicole Miller (ABACS)
JULIE KORNACK (Center for Autism and Related Disorders)
Abstract: In this presentation, panelists will discuss the content of Papatola and Lustig's (2016) paper on navigating a managed care peer review. The panelists will discuss their responses by providing guidance from both clinical and public policy perspectives that reflect best practices in the field of autism treatment. We will offer health care providers of ABA an essential understanding of some of the laws that govern and support their efforts to secure medically necessary treatment and the mechanisms in place with which to challenge decisions by managed care organizations, health plans, and health insurance issuers that may be contrary to best practices. Finally, suggestions are offered on how to navigate a peer review to ensure optimal outcomes and, when necessary, to lay the groundwork to overturn a funding source decision that does not reflect best practices or the standard of care in ABA-based autism treatment.
Target Audience: The target audience for this panel is practitioners who work in insurance-funded ABA (Master's/PhD level)
Learning Objectives: Participants will identify at least one federal law that provides patient protections for insurance-funded ABA. Participants will identify at least two ways to prepare for a peer review. Participants will be able to describe the peer review process, beginning with submission for authorization through external review.
Keyword(s): insurance appeal, peer review, public policy



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