SAGE Learning Lab

As many healthcare providers accept insurance coverage for ABA therapy, which is typically funded by most insurance companies, there is a growing need for documentation that supports the medical necessity of ABA services for clients with ASD. Writing complete, accurate, objective, and medically necessary treatment plans is a critical skill for behavior analysts who accept funding from healthcare payors. However, few behavior analysts are trained through a medical model which presents difficulties when documenting medically necessary services. It is likely that insurance companies will start requiring more accurate documentation of medical necessity, and justifications for the level of ABA services requested, before giving prior authorizations. Therefore, it will be important for BCBAs to better understand the range of medical or behavioral health conditions that might impact the client’s ability to participate in ABA services, as well as provide supporting evidence for the level of care requested during the authorization process.