Welcome to Behaviorbabe

Ethical Advocate for Accurate Application & Dissemination of Behavior Analysis

 Timeline Illustrating Notable Moments in Accessing
Applied Behavior Analysis in Hawai'i 

2014

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Proposed Autism Insurance Legislation comes close

There was autism insurance legislation introduced that had a very good chance of succeeding. However, in the last two minutes of the session our dreams were crushed. Technically, the bill passed, but it was whittled down to a $50,000 actuarial study to evaluate the cost of applied behavior analysis (ABA) in the state.

Medicaid Lawsuit Filed

Federal CMS Guidance (7/2014) was released. A Medicaid class action lawsuit was filed against our state for failure to provide adequate access to applied behavior analysis for children with autism. Watch the Hawai'i News Now Exclusive about the class-action lawsuit filed against the Department of Human Services (DHS/MedQUEST).

2015

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Luke's Law
Autism Insurance becomes Law!

We successfully pass "LUKE'S LAW"! On July 2, 2015, Governor Ige signed autism insurance into law. Hawai'i became the 42nd state to pass autism insurance reform. Effective 1/1/2016, commercial health plans must provide coverage ABA for children with an autism diagnosis, up to age 14, and up to $25,000 annually.

Licensure for Behavior Analysts becomes Law!

In 2015, the Hawai'i Association for Behavior Analysts also advocated for the passage of the Behavior Analyst Licensure law. There are several other states that regulate behavior analysts right to practice (28, as of 7/21/2017). In Hawai'i, we did one thing differently than all other states that came before us. We included the DOE in our law, meaning they need to employ LBAs (Licensed behavior analysts) and RBTS (registered behavior technicians) when providing behavior analysis (defined as functional behavior assessments, arranging of environmental stimuli, etc.).

2016

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DOE Challenges ABA Licensure Law

The DOE challenged the ABA Licensure law when it went into effect. The Hawai'i Association for Behavior Analysis (HABA) and Hawai'i DOE Administrators met to identify a compromise. At the end of the session, there was an agreed upon carveout for Registered Behavior Technicians (RBT) in the DOE (and DOH 1915c waiver services) until 1/1/2019. Against the guidance of HABA, the Department of Education requested a FULL exemption from the ABA licensure law. Luckily, our legislators upheld the expectation that the DOE must employ Licensed Behavior Analysts (LBAs) to conduct functional behavior assessments (FBA) and when providing ABA in the school setting.

Medicaid Lawsuit Settled
Courts rule in favor of families!

The Medicaid lawsuit was won on the basis that Medicaid failed to inform families that applied behavior analysis (ABA) was authorized and now available. Medicaid ABA services are offered for individuals up to age 21. The publicly available reimbursement rate for BCBAs is incredible and competitive at $125 per hour. Medicaid services are only reimbursed before or after school or when school is not in session (2016).

FREE 40-hour RBT Course Offered 

FREE 40-hour course needed for the RBT credential (Registered Behavior Technician), open to the public. Sponsored by Keiki Educational Consultants and the University of West Florida. Hosted on Assets Elementary School campus. Attendees were from several islands (Oahu, Maui, and Big Island).

UWF Hawai'i ABA - Classes begin!

University of West Florida (UWF), Office of Applied Behavior Analysis (ABA) - Hawai'i Cohort formed. Accepted first students (all Hawai'i residents) in July 2016. Program taught on HST, primarily by professors who live and work in the state. Scholarships available, students offered 50% off tuition costs!  

Telehealth becomes Law!

The Hawai'i Association for Behavior Analysis (HABA) attended the signing of SB2395, Relating to telehealth, which requires Hawaii's Medicaid managed care and fee-for-service programs to cover services provided through telehealth! VERY important, especially to those living on neighbor islands and in remote locations across our state!

2017

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Missing DOE Legislative Report

The DOE was expected to submit an update to the Legislature on their efforts to recruit appropriate staff for the provision of behavior analysis services. No report is listed on the DOE legislative website.

Commercial Plans Remove Age & Dollar Caps

Commercial health plans in our state (Kaiser and HMSA) have voluntarily removed age and dollar caps. This is not reflected in our existing state law. But, health plans have updated their policies to reflect this change, citing the Affordable Care Act as the reason.
Psychologists claimed restricting direct support workers (DSW) who implement ABA to Registered Behavior Technicians (RBTs) limits their right to oversee tiered delivery of ABA services. Psychologists may provide ABA if it is in their scope of training and experience (Chapter 465-D). In the Hawaii psychologist law (Chapter 465), there is no tiered model for service delivery. Hawai'i state  legislators upheld the existing language of the ABA Licensure Law law. RBTs (supervised by Licensed behavior analysts (LBAs) are still required (by 1/1/2019 for DOE and DOH 1915c waiver services). There are now 185 licensed behavior analysts and over 575 RBTs throughout our state

Medical Necessity

Taking a medical approach to daytime ABA hours, we have been able to get health plans (Kaiser, HMSA, TRICARE) to authorize ABA services during the day (for their commercial plans). When families and providers have contacted the DOE, we have been told "medical" services cannot occur on school campuses or during the school day (specifically by Debra Farmer, Special Education Autism Director and Suzanne Mulcahy, Assistant Superintendent). The schools are saying the health plans and their providers are not welcome. And yet the schools also do not provide a fungible service.

Status of Medicaid / MedQuest

Medicaid ABA services continue to be offered for individuals up to age 21.  However Medicaid services are still only reimbursed before or after school or when school is not in session (5/31/2017). This is believed to be a violation of federal EPSDT: Early Periodic Screening Detection and Treatment

Class-Action Lawsuit on the horizon

The Hawai'i DOE has failed to have licensed behavior analysts (LBA) conduct functional behavior assessments (FBA). The lawyers at Alston, Hunt, Floyd and Ing are contemplating filing class-action lawsuit against the DOE. For more information, please contact Maile Osika

Where we are now... July 2017

It seems the real area of deficiency here in Hawai'i is that our children are not receiving access to ABA services during the school day. Students who cannot contact the full dosage recommended by their providers and their physicians, will not achieve the most optimal outcomes possible. We need to continue to unite and work together. Together we will impact meaningful, systemic change!

Q & A About ABA in Hawai'i 

What is applied behavior analysis (ABA)?

ABA is a scientific problem-solving approach aimed at producing socially significant behavior changes for the purpose of improving quality of life for individuals, families & communities. Learn more here and here and here and here and here 

What support exists for applied behavior analysis (ABA)?

Who is qualified to DESIGN and OVERSEE ABA services in Hawai'i?

A licensed behavior analyst and psychologists who have applied behavior analysis (ABA) in their training, experience and scope of practice may design and oversee ABA services in Hawai'i, in accordance with ones own ethical code. Chapter 465-D, Hawai'i ABA Licensure Law does allow some provisions for those who may IMPLEMENT, but not design ABA services.  

What is a BCBA (Board Certified Behavior Analyst)?

"The Board Certified Behavior Analyst® (BCBA®) is a graduate-level certification in behavior analysis. Professionals who are certified at the BCBA level are independent practitioners who provide behavior-analytic services. In addition, BCBAs supervise the work of Board Certified Assistant Behavior Analysts, Registered Behavior Technicians, and others who implement behavior-analytic interventions (BACB)."


"Applicants who meet the degree, coursework, and supervised experience eligibility requirements described in the next section are permitted to sit for either the BCBA or BCaBA examination (see gure below). Each examination is professionally developed to meet accepted examination stan- dards and is based on the results of a formal job analysis and survey. In addition, all BACB examina- tions are offered under secure testing conditions and are professionally administered and scored (BACB Treatment Guidelines)."

What are the requirements to become a Hawai'i licensed behavior analyst (LBA)?

"BACB certication credentials or standards are currently the basis for licensure in the U.S. states where Behavior Analysts are licensed. Basing licensure on BACB credentials is cost effective and ensures that critical competencies regarding practice and research are periodically reviewed and updated by practitioners and researchers. Whether it is used as the basis for licensure or as a “free-standing” credential, BACB certification credentials are recognized in those states where insurance reform laws have been enacted and in other states as well" (BACB).

A Hawai'i licensed behavior analyst (LBA) is someone who has completed advanced masters level courses in applied behavior analysis (ABA). They have obtained field supervision and have passed a board examination. In Hawai'i the requirement for becoming a Licensed behavior analyst (LBAs) is possession of Board Certification as a Behavior Analyst (BCBA). BCBA's are certified by the Behavior Analyst Certification Board (BACB). Licensed behavior analysts (LBAs) are supervisors for all ABA programs in Hawai'i, as required by ABA Licensure law (Chapter 465-D). Learn more about BACB credentials here | Learn more about Hawai'i licensed behavior analysts here

How can I find out if someone is a Board Certified Behavior Analyst?

How can I find out if someone is Licensed in Hawai'i as a Behavior Analyst?

What are the requirements to become a Registered Behavior TechnicianTM?

The RBT® credential requires applicants to meet minimum age and education standards, obtain 40 hours of acceptable training, successfully complete a competency assessment, and a criminal background check. Learn more here.

How can I find out if someone is a Registered Behavior Technician?

What is the difference between a licensed behavior analyst and a registered behavior technician?

My child's DOE Care Coordinator tells me the DOE does not have to hire LBAs or RBTs. Is this true?

As of 7/1/2016, by not having licensed behavior analysts (LBAs) conduct Functional Behavior assessments (FBAs), which are required whenever a behavior support plan (BSP) is developed, the DOE is violating existing ABA Licensure Law (Chapter 465-D) and possibly federal I.D.E.A. (2004). The DOE has until 2019 to credential all Skills Trainers, working with children with ASD (or those who need ABA) in the school setting. However, we now have health plans saying they will cover ABA services by LBAs and RBTs, during the school day and on school campuses. The DOE (Debra Farmer and Suzanne Mulcahy) however has said they will not partner with health plans or ABA providers so children can access the level of ABA services recommended by their physicians and LBAs.

Does my health insurance cover ABA services?

As of 1/1/2016, commercial health plans in Hawai'i have offered applied behavior analysis (ABA) services. Medicaid/MedQUEST services are also currently being provided. Some self-funded plans do not have to cover the benefit, though many voluntarily choose to do so. Need help with a self-funded plan? Refer to this Autism Speaks Self-Funded Employer Toolkit. In 2017, federal health plans (1/1/2017) and plans for Hawai'i state employees (including teachers) began offering coverage of ABA services (7/1/2017).  

Does the Hawai'i DOE provide ABA services?

Short answer? No. Not usually. In the past the Hawai'i DOE has contracted with agencies such as Hawai'i Behavioral Health and BAYADA to meet needs for behavior intervention support specialists (BISS) and paraprofessional/Skills Trainer (1:1) positions. For the 2017-2018 school year, it seems that a significant amount of these contracts have been discontinued or reduced. In some areas, such as on Maui, the DOE has hired several Hawai'i licensed behavior analysts (LBAs), looking to build internal capacity. Windward district also offers access to licensed behavior analysts (LBAs) through a grant-funded project (The A Team), under the supervision of Dr. Aletha Sutton. Traditionally, the DOE has stated that they do not put applied behavior analysis in IEPs. In one situation, the IEP team wrote: "Mrs. xxxxx would like Applied Behavior Analysis to be identified in the Supplementary Aids and Services, Program Modification and Supports for School Personnel section, however, it is not our practice to name specific sciences and/or programs (9/2016)."

Can ABA services funded through health plans be provided on school campuses? 

When families and providers have contacted the DOE, we have been told "medical" services cannot occur on school campuses or during the school day (specifically by Debra Farmer, Special Education Autism Director and Suzanne Mulcahy, Assistant Superintendent). The schools are saying the health plans and their providers are not welcome. And yet the schools also do not provide a fungible service.

How many clients should a licensed behavior analyst be responsible for overseeing?

Behavior Analysts should carry a caseload that allows them to provide appropriate case supervision to facilitate effective treatment delivery and ensure consumer protection. Caseload size for the Behavior Analyst is typically determined by the following factors:

  • complexity and needs of the clients in the caseload

  • total treatment hours delivered to the clients in the caseload

  • total case supervision and clinical direction required by caseload

  • expertise and skills of the Behavior Analyst

  • location and modality of supervision and treatment (for example, center vs. home, individual vs. group, telehealth vs. in vivo)

  • availability of support staff for the Behavior Analyst (for example, a BCaBA)

How many clients should a registered behavior technician be assigned?

Caseloads for the Behavior Technician are determined by the:

Advocates and Allies of the ABA and ASD Community 

Lorri Unumb
Parent | Autism Speaks

Luke Pinnow
Self-Advocate

Louis Erteschik
HRDC | Lawyer

Rep. Della Belatti
State Representative

Geri Pinnow
Parent | Teacher

Dan Unumb
Parent | Legal Advocacy

Amanda N. Kelly
LBA | Behaviorbabe

Mitzie Higa 
 Teacher | HSTA

Lara Bollinger
LBA | Law Student 

Kristen Koba-Burdt
LBA | HABA

Naomi Tachera
Parent | RBT | HABA

Paul Alston
Lawyer | Legal Counsel

The Hawai'i Association for Behavior Analysis | Legislative Committee