document review

The Importance Of Reading More Than Just Journal Articles

An area that we really encourage behavior analysts and others involved in the delivery of therapy for individuals with autism is to read some documents that may not be as entertaining and interesting as journal articles. Students in behavior analysis are often told to make sure that they are “evidence-based” and to stay on top of the current interventions by reviewing journals, such as the Journal of Applied Behavior Analysis. Readings that are often overlooked are insurance mandates, contracts with insurance companies, and medical necessity definitions.

Fast forward to today and it is absolutely imperative to make sure that a behavior analyst is reviewing these types of documents, and that they know what to look for. Tim Courtney, LittleStar COO, has started conducting trainings throughout the country with Dan Unumb of Autism Legal Resource Center, an attorney well-versed on the essential language and issues that readers should look to spot within these documents. A part of the training is to “issue spot” an insurance mandate. 

The two speakers will usually select the insurance mandate based upon the current state in which they are presenting. Recently, they looked at the Colorado mandate and noticed something very interesting within the mandate language. The mandate indicated:

(g)  A carrier may not deny or refuse to provide otherwise covered services, refuse to issue, renew, or reissue, or otherwise restrict or terminate coverage under a health benefit plan because the individual or his or her covered dependent is diagnosed with an autism spectrum disorder or due to the individual’s or dependent’s utilization of services for which benefits are mandated by this subsection  

This language would allow providers to recommend the level of service that is medically necessary without concern due to the availability of the patient. 

Often, they are asked during the workshop if the utilization of hours could be used against them for future authorizations. In the Colorado mandate, the language gives something that providers could reference upon encountering this type of challenge. The workshop also addresses other types of challenges.

If you have challenges related to this or are interested in finding out more about the workshop that Tim and Dan will be hosting next, visit Autism Legal Resource Center. The next workshop is a two-day workshop addressing several different areas related to navigating the ever-changing medical necessity landscape.

Association for Science in Autism Treatment (ASAT)

The Association for Science in Autism Treatment (ASAT) is a non-profit autism organization that was founded in 1998. Based in Hoboken, New Jersey, their aim is to “promote safe, effective, science-based treatments for people with autism by disseminating accurate, timely, and scientifically sound information”.

Autism Speaks Hails Landmark Federal Decision Calling Key Autism Therapy a ‘Medical’ Service Eligible for Insurance

Autism Speaks Hails Landmark Federal Decision Calling Key Autism Therapy a ‘Medical’ Service Eligible for Insurance, Autism Votes, An Autism Speaks™ Initiative, May 30, 2012

The Economic Impact of Autism on Families

The Economic Impact of Autism on Families, by Laura McKenna, The Atlantic, May 31, 2012

Behavior Analyst Certification Board® (BACB)

The BACB is a non-profit corporation “established to meet professional credentialing needs identified by behavior analysts, governments, and consumers of behavior analysis services,” with a global mission to “We protect consumers of behavior analysis services worldwide by systematically establishing, promoting, and disseminating professional standards.”

Indiana Resource Center for Autism (IRCA)

The IRCA “conducts training, consultations, engages in research, and disseminates information to build local community capacity to support children and adults on the autism spectrum.” Website resources include articles, visual supports, workshop and event listings, and services available in the state.

Association for Behavior Analysis International (ABAI)

This global association for behavior analysis professionals focuses on the “philosophy, science, application and teaching of behavior analysis” and promotes awareness of its field. ABAI also sets accreditation standards for educational programs.

Autism Society of Indiana (ASI)

The ASI vision is to be “a leading resource in Indiana for connecting people who live with autism, and those who care about them, with resources, support, advocacy and information tailored to their unique needs. ASI strives to create communities throughout the state in which people on the autism spectrum and their families are empowered, supported and fully embraced by their community.”

Insurance Advocacy Resource Center (IARC)

The Arc Insurance Advocacy Resource Center (IARC) helps “families of a loved one with a developmental disability navigate their private insurance policies and increase knowledge of basic health insurance issues, including the Affordable Care Act,” with a commitment to “all people with intellectual and developmental disabilities realizing their goals of learning, living, working and fully participating in the community.”

About Special Kids (ASK)

ASK is an Indiana-based parent-to-parent organization that works throughout the state to “give support, answer questions and provide information and resources” to families with special-needs children. Their staff parent liaisons, who are parents of special needs children and extensively trained, help families “anticipate child and family needs, identify appropriate resources, and access community systems to help them meet the needs of their children.”