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.


41st Annual Convention; San Antonio, TX; 2015

Workshop Details

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Workshop #W58
CE Offered: BACB
Negotiating the Health Insurance Process to Deliver Home-Based ABA Services to Families
Saturday, May 23, 2015
8:00 AM–11:00 AM
207B (CC)
Area: PRA/AUT; Domain: Service Delivery
CE Instructor: Steven Woolf, Ph.D.
STEVEN WOOLF (Beacon ABA Services), KELLEY HENRY (Beacon ABA Services), COLLEEN DEMELLO (Beacon Services of CT), CHRISTIAN BENAVIDES (Beacon ABA Services)
Description: This workshop is designed to provide behavior analysts and program administrators with strategies for accessing funding for evidence-based treatment through health insurance. First, the presenters will complete a historical overview and clinical justification of health insurance mandates relative to the treatment of Autism Spectrum Disorder (ASD). Second, the workshop will identify basic advocacy efforts and legal components associated with providing home-based/community-based ABA services supported by health insurance services. Third, strategies for securing and obtaining insurance service authorizations will be addressed using a medical model for treatment (DSM-5/ICD-10) and behavioral assessment exemplars to provide clinical data to support service recommendations. Fourth, problem solving strategies for negotiating with insurance companies will be discussed including how to develop position papers supporting the use of evidence-based treatments. Finally, the workshop will emphasize the use of CPT billing codes for behavior analysts and the scope of documentation required when providing insurance funded services.
Learning Objectives: At the conclusion of this workshop, participants should be able to: (1) name the four key components of federal law and state mandates when assessing ASD treatment legislation; (2) state the three key differences between the DSM-IV and DSM-V relative to the diagnosis of ASD; (3) describe the five key elements to successful negotiation with insurance companies and developing a positional standpoint; (4) identify the differences between procedure and CPT codes used by health insurance providers to fund ABA services; (5) label the sections of behavioral assessment needed to support ABA treatment; (6) write client specific goals/objectives that permit health insurance service care coordinators to approve ABA treatment; (7) identify the process and procedures needed to complete a current review to re-authorize ABA treatment following six months of treatment; (8) model the procedure of speaking with a health insurance service coordinator to identify member co-payments, co-insurance, and deductibles; and (9) identify three procedures used to collect member co-payments, co-insurance, and deductibles.
Activities: Workshop objectives will be met through a various methods including lecture, guided practice, and small and large group discussions. Timeline breakdown: 1 hour of lecture, 1 hour of small group discussion identifying essential elements in behavioral assesments and concurrent reviews required for health provider funding, and 1 hour of whole group of discussion of goals/objectives related based in worksheets and summary cases distributed to the group.
Audience: This workshop is designed for BACB certificants, licensed psychologists, behavior analysts, and supervisors who are currently providing or supervising those who provide home-based or community-based ABA treatment to children and families affected by ASD.
Content Area: Practice
Instruction Level: Intermediate



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