Navigating the 10th Circle of Hell: Ethical Funding for Medical Necessity

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*Attendees, please use the following link to access the resources discussed in the training:
http://littlestarhub.org/registration/

Board Certified Behavior Analysts (BCBA®s) are trained in the implementation of procedures that are conceptually systematic and evidence based. Treatment plans containing interventions derived from published research but fail to establish medical necessity will not be funded. This online seminar covers an essential component for creating work products reviewed by insurances: treatment plans based upon medical necessity. Presenters will review strategies for evaluating diagnostic reports and integrating the content throughout the treatment plan. This seminar will also teach providers how to use assessment probes to provide sufficient justification for areas targeted for intervention, and review the professional and ethical compliance code (PECC) as it applies to the medical necessity review process.

BENEFITS FOR PARTICIPANTS

All participants will receive:

  • 4 Learning BACB® CEUs that count towards ethics requirement
  • A template for writing treatment plans based on medical necessity
  • Opportunity to request access to a WikiPage with more resources related to insurance and medical necessity

COURSE OBJECTIVES

  • Define Medical Necessity
  • Create goals and objectives directly related to symptoms and impairments related to an autism diagnosis
  • Describe the necessary components of a comprehensive treatment plan, to include background, progress, transition, discharge, and recommendations
  • Discuss factors to consider when determining the intensity of ABA services
  • Review the PECC as it applies to the medical necessity review process

ABOUT THE PRESENTER

Tim Courtney earned a Masters of Science in applied behavior analysis from Florida Institute of Technology (FIT) in 2006 and became a board certified behavior analyst that same year. He has worked as a behavior analyst since 2003 with different organizations across the United States. Tim has presented on writing treatment plans based on medical necessity at numerous conferences including ABAI, APBA, and FABA.

In addition to his work as a behavior analyst, Tim has been a co-instructor in the ABA department of FIT since 2007. His research interests include functional assessment, medical and dental avoidance and escape behavior, verbal behavior and dissemination of the science of Applied Behavior Analysis. Tim is currently working on his Ph.D. in special education at Purdue University.

The Behavior Analysis Advocacy Network (BAAN) advocacy efforts have been focused on promoting access to care for military parents and TRICARE providers during the past several years. While gains have been made for some individual providers, more progress must be made. BAAN will share methodologies employed to equip attendees with the tools necessary to access solutions for common challenges. They will also receive ethical guidance on what to do when they are unable to make their desired progress. Options for providers and families to self-advocate are not always clearly laid out. Attendees will receive strategies for handling conflict resolution that emphasize both professional conduct and optimal outcomes. Recommendations will be aligned with the Behavior Analyst Certification Board (BACB) Compliance Code standards and effective communication processes. 

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