|Considerations for Medical Necessity Determinations|
|Saturday, September 3, 2022|
|10:30 AM–11:20 AM |
|Meeting Level 1; Liffey A|
|Area: AUT; Domain: Service Delivery|
|CE Instructor: Amanda N. Kelly, Ph.D.|
|Chair: Amanda N. Kelly (BEHAVIORBABE )|
|LARA BOLLINGER (Bouer Law)|
|IVY CHONG (May Institute)|
|KIM MACK ROSENBERG (Bouer Law)|
Behavior analysts have historically been trained as scientists, often with backgrounds in psychology, education, or a related field. However, with the adoption of insurance funding in the United States, behavior analysts are now expected to operate as medical professionals. While the original Lovaas study, and later replications, have evaluated the effects of focused (15-25) and comprehensive (25-40+) treatment models, making medical necessity determinations is not often taught or discussed in many University programs. This presents numerous challenges and places the responsibility of teaching how to make clinically sound, medically necessary treatment recommendations on ABA organizations and agencies who employ behavior analysts. This presentation will include a brief literature review on the topic of medical necessity as well as a brief history of autism insurance reform in the US. Additionally, the presenters will discuss how medical necessity is conceptualized at their organization, including specific tools developed for supporting analysts who are tasked with making medical necessity determinations.
|Instruction Level: Intermediate|
|Target Audience: |
Behavior analysts who have practiced in the field.
|Learning Objectives: 1. Review literature related to behavior analysis and medical necessity determinations. 2. Describe the difference between focused and comprehensive models of treatment. 3. List three factors to consider when making medical necessary determinations.|
|Keyword(s): Insurance Funding, Medical Necessity, Treatment Recommendations|