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| Treatment Goal Development for Insurance Approval |
| Friday, May 26, 2017 |
| 4:00 PM–7:00 PM |
| Hyatt Regency, Agate B |
| Area: PRA/AUT; Domain: Service Delivery |
| CE Instructor: Linda S. Heitzman-Powell, Ph.D. |
| KATRINA OSTMEYER (Integrated Behavioral Technologies, Inc.), LINDA S. HEITZMAN-POWELL (The University of Kansas Medical Center), MIKAYLA M MCHENRY (Integrated Behavioral Technologies, Inc.;
Washburn University) |
| Description: Over the past fifteen years, the forty-three states and the District of Columbia have instituted insurance reforms covering applied behavior analysis (ABA) therapy for individuals affected by autism spectrum disorder (ASD: Autism Insurance Reform, 2015). With these mandates, ABA clinicians are increasingly called to work with third-party payers for approval and ongoing review of ABA treatment plans, a skill set many clinicians have to develop through practice and trial-and-error learning. In this workshop, we will identify many of the difficulties faced by clinicians in working with insurance companies as they work to provide evidence-based interventions for the individuals they serve such as disagreement about appropriate goals, dosage recommended by "medical-necessity," insurance mandate, and best-practices, and what constitutes sufficient progress for continued coverage. Possible solutions and strategies to these challenges will be discussed with a focus on goal development and tracking. Finally, recommendations for successfully working through the appeal process will be discussed. |
| Learning Objectives: At the conclusion of the workshop, the participant will be able to: (1) Identify common problems faced by clinicians working with third-party payers; (2) Identify the core deficits in autism spectrum disorders based on both DSM-IV-TR and DSM-5 criteria; (3) Be able to tie identify goals that map onto the core deficits of autism spectrum disorder without compromising treatment plan integrity; (4) Be able to write goals that meet common "medical necessity" criteria; (5) Identify the steps in an appeals process and strategies for a successful appeal. |
| Activities: During the course of the workshop, lecture will be utilized to convey information prior to moving to guided practice and small group. During guided practice and small-group activities, participants will review treatment goals that have been denied for a variety of reasons and work to rewrite goals for increased likelihood of approval and/or develop rationales for approval without reworking. During guided practice, the group will also work through an appeal. Participants will have the opportunity to share identified goals and plans for feedback on changes to make to increase the likelihood of plan approval. |
| Audience: This workshop is designed for behavior analysts who work with third-party payers to provide ABA services to individuals diagnosed with autism. |
| Content Area: Practice |
| Instruction Level: Intermediate |
| Keyword(s): Insurance, Insurance Appeals, Peer Review |