Prior authorization denials for ABA services represent one of the most consequential yet underaddressed challenges in behavior-analytic practice. Survey data indicate that many denials go unchallenged, creating a cascading negative impact that extends far beyond the individual client whose services were denied.
Provider: BehaviorLive — via Council of Autism Service Providers
Take This Course →Including ethics, supervision, and topics like this one. New live CEU every Wednesday.
Join Free →Members of CASP's Insurance and Medicaid Special Interest Group (SIG) will offer their expertise related to appealing prior authorization denials for ABA services. Survey data indicate that many denials go unchallenged, which has a negative impact both for that specific client as well as for the larger field of ABA. When clinicians accept partial denials, they are communicating to payers that their original request was not medically necessary, and the services approved by the payer are adequate for this client, undermining their own clinical expertise. Discussants will provide an overview of the appeals process, answer participant questions related to appealing full and partial denials, and review specific examples regarding denials of ABA treatment for adult clients that emphasize improving daily living skills. Panelists will share resources that attendees can use to support their own appeals, including those that comprise the industry's generally accepted standards of care, and discuss the importance of appealing adverse determinations. Panelists will discuss lessons learned and their success stories in advocating for their clients to access medically necessary services.
| Certification Body | Credits | Type |
|---|---|---|
| BACB® | 1 | Ethics |
| APA | 1 | — |
| COA | 1 | — |
Craig Domanski, Ph.D., BCBA-D is the Director and Founder of DATA Group Central, an NJDOE-approved agency providing ABA services to families impacted by Autism Spectrum Disorders. Dr. Domanski has also served as the Chair for the NJABA Service Delivery Committee and previously served as the co-chair for the Insurance, Medicaid, and Business Practices Workgroup, which aims to disseminate information about providing services through health insurance plans to the behavior-analytic community. Dr. Domanski received his Ph.D. from Caldwell University and has served as an adjunct lecturer at Georgian Court University. His research interests include training conditional discrimination skills, the assessment and treatment of maladaptive behaviors, and parent-training.
Dig into the research behind this topic — plain-English summaries written for BCBAs.
256 research articles with practitioner takeaways
233 research articles with practitioner takeaways
189 research articles with practitioner takeaways
You earn CEUs from a dozen different places. Upload any certificate — from here, your employer, conferences, wherever — and always know exactly where you stand. Learning, Ethics, Supervision, all handled.
No credit card required. Cancel anytime.
All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.