Practice Implications of Narrow Networks for Board Certified Behavior Analysts (BCBAs) in the Affordable Care Act Market becomes clinically important the moment a team has to turn good intentions into reliable action inside clinical documentation, payer communication, supervision records, and leadership review. In Practice Implications of Narrow Networks for Board Certified Behavior, for this course, the practical stakes show up in service continuity, accurate reporting, and defensible clinical decisions, not in abstract discussion alone.
Provider: BehaviorLive — via Council of Autism Service Providers
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Join Free →There is no question that health insurance reform over the last two decades, coupled with the growing profession of behavior analysis, has resulted in more children with autism receiving ABA services than in years past. Yet significant barriers to access persist, especially when it comes to the number of providers available (see Yingling et al., 2022). To improve network adequacy across health services, defined as a sufficient number of providers in a health plan's network to "ensure reasonable and timely access to care", in 2023 the Centers for Medicaid and Medicare Services published time and distance standards for health plans (CMS, 2023). To date, however, ABA practitioners rely on anecdotal evidence that network adequacy is a barrier; no research has evaluated network adequacy of these providers. Thus, applying CMS distance standards, we created a unique dataset using the supply of Board Certified Behavior Analysts in U.S. counties, the proportion of Affordable Care Act plan enrollees younger than 18, and the CDC-estimated autism prevalence data of 1 in 36 children. Findings suggest that only a handful of U.S. counties have adequate networks of providers for ABA services. This presentation will include discussion of important policy and practice implications of low network adequacy across the country for behavior analysts.
| Certification Body | Credits | Type |
|---|---|---|
| BACB® | 0 | — |
| APA | 0 | — |
| COA | 1 | — |
Jim Hamilton is a dedicated parent to a 9-year-old son with autism, who has been receiving ABA therapy for the past 7.5 years. This personal journey has fueled Jim's passion for improving the quality and accessibility of ABA services and made him a fervent advocate for the autism community. Jim holds a Master of Applied Statistics from Colorado State University and a Master of Science in Computer Science from the University of Chicago. For the past 20 years, Jim served as a quantitative analyst for a high-frequency options trading firm in Chicago. Currently, Jim is the CTO and co-founder of Atlas Medical Data Group, a leading company dedicated to assisting ABA clinics nationwide in leveraging Transparency in Coverage data to negotiate higher rates with payors.
Dig into the research behind this topic — plain-English summaries written for BCBAs.
280 research articles with practitioner takeaways
279 research articles with practitioner takeaways
258 research articles with practitioner takeaways
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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.