Welcome to Behaviorbabe

ABA Coding Coalition (July 2019)

Announcing the ABA Coding Coalition | The ABA Coding Coalition comprises representatives of APBA, Council of Autism Service Providers - CASP, Autism Speaks, the BACB - Behavior Analyst Certification Board, and its healthcare and billing consultant. They will be developing and sharing resources to support the implementation of CPT codes for ABA services and advocating for their proper usage. All of our resources and important updates will be published here.

Applied Behavior Analysis (ABA) and Health Insurance

From Autism Speaks | Your type of plan determines which health benefits must be covered. Some plan types (e.g., “fully insured plans”) must provide benefits directed by state law while other plan types do not. Forty-eight states have taken government action to require coverage for ABA. Fully insured plans must comply with these laws, but self-funded plans do not. Self-funded plans are regulated by federal law – not state law. Your type of plan impacts how you advocate for a change in benefits. Subject to state and/or federal law, benefits are determined by the employer in self-funded plans but by the insurance company in fully insured plans. If you are covered by a self-funded plan, you would advocate at the level of your employer. If you have a fully insured plan, your employer has no control over plan design. It is usually necessary to advocate for a change in state law. Your type of plan may affect how to appeal denials of coverage and to whom you file complaints if you are not satisfied with implementation of benefits.

Helpful Resources

Trainings and Workshops

New CPT Codes | Adaptive Behavior Services: What Providers Need to Know

Recently, the American Medical Association CPT® Editorial Panel released eight new Category I and two revised Category III (temporary) CPT codes for billing “adaptive behavior” services. These codes will take effect and be available for use January 1, 2019. Adoption of those codes by health plans will directly affect ABA providers, practices, and consumers. This tutorial will provide an overview of the new and modified codes, possible valuation approaches payers may take; differences between the Category III and Category I CPT ABA codes; and information related to navigating various payer implementations of these codes.

Presented by Jenna W. Minton, Esq.

Navigating the 10th Circle of Hell: Ethical Funding for Medical Necessity

Board Certified Behavior Analysts (BCBA®s) are trained in the implementation of procedures that are conceptually systematic and evidence based. Treatment plans containing interventions derived from published research but fail to establish medical necessity will not be funded. This online seminar covers an essential component for creating work products reviewed by insurances: treatment plans based upon medical necessity. Presenters will review strategies for evaluating diagnostic reports and integrating the content throughout the treatment plan. This seminar will also teach providers how to use assessment probes to provide sufficient justification for areas targeted for intervention, and review the professional and ethical compliance code (PECC) as it applies to the medical necessity review process.

About the presenter: Tim Courtney earned a Masters of Science in applied behavior analysis from Florida Institute of Technology (FIT) in 2006 and became a board certified behavior analyst that same year. He has worked as a behavior analyst since 2003 with different organizations across the United States. Tim has presented on writing treatment plans based on medical necessity at numerous conferences including ABAI, APBA, and FABA. In addition to his work as a behavior analyst, Tim has been a co-instructor in the ABA department of FIT since 2007. His research interests include functional assessment, medical and dental avoidance and escape behavior, verbal behavior and dissemination of the science of Applied Behavior Analysis. Tim is currently working on his Ph.D. in special education at Purdue University.