Speaking the language of funders: Aligning goals with medical necessity and funder requirements

Obtaining insurance authorization for applied behavior analysis (ABA) services has become a routine job expectation for many board certified behavior analysts (BCBA^®s). Navigating insurance authorizations can be daunting for BCBA^®s because it requires them to write goals that align with medical necessity and each funder’s unique requirements. Failure to write goals in this manor can lead to partial or full denials for authorization for services, resulting in less access to care for clients. This presentation will focus on understanding funder-specific requirements for ABA services, tying the core deficits of autism to those requirements, and writing treatment goals that are individualized to the client and that are likely to be authorized by funders. We will review how to write goals for activities of daily living, practical functional assessment and skills-based treatment, and leisure skills. Participants will be guided through case examples and practice describing medical necessity, writing treatment goals, and requesting authorization for services from funders.

Learning Objectives

1. Articulate the core deficits of autism
2. Find and interpret funder requirements
3. Describe how to write goals and collect data that algins with funder requirements