The landscape of behavior analytic practice has undergone a fundamental transformation with the widespread adoption of insurance funding in the United States. Behavior analysts, historically trained as scientists with backgrounds in psychology, education, or related fields, are now expected to operate as medical professionals within healthcare systems that require medical necessity determinations for authorization and continued funding of services.
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Join Free →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 and comprehensive 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. Additionally, the presenters will discuss how medical necessity is conceptualized in practice, including specific strategies when making medical necessity determinations. Review literature related to behavior analysis and medical necessity determinations. Describe the difference between focused and comprehensive models of treatment. List three factors to consider when making medical necessary determinations.
| Certification Body | Credits | Type |
|---|---|---|
| BACB® | 2 | Ethics |
Dr. Amanda N. Kelly, also known as Behaviorbabe, is a leading figure in behavior analysis, celebrated for her unwavering commitment to professional development and advocacy. As one of the first social media influencers in behavior analysis, Dr. Kelly embodies a tireless pursuit of innovation and excellence throughout her career, now spanning over two decades. Her scholarly pursuits include teaching ethics courses at several reputable academic institutions and co-authoring the influential textbook, "Back to Basics: Ethics for Behavior Analysts." Dr. Kelly's advocacy has been pivotal in advancing legislative reforms, notably in autism insurance reform and behavior analyst licensure in both Massachusetts and Hawaii. In 2016, after serving as President of the Hawaii Association for Behavior Analysis, Dr. Kelly became the first behavior analyst licensed in Hawaii. Over the past 15+ years, Dr. Kelly has provided freely available resources for students, practitioners, and consumers of behavior analysis. In addition to offering online resources, in-person events, and social media engagement, Dr. Kelly also hosted a popular podcast, where she shares insights and interviews with experts in the field. Her work has earned her numerous awards, recognizing her contributions to the field and her advocacy efforts to expand access to care for autistic individuals. Through her steadfast dedication to the community and commitment to excellence, Dr. Kelly continues to set new standards and lead the way in ABA advocacy and the autism community. Discover more about Dr. Kelly by visiting www.behaviorbabe.com and following @Behaviorbabe on social media.
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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.