Health plans across the country are now beginning to cover ABA services for their members. Thankfully, at long last, we are seeing similar signs here in California. Coverage by health plans also brings with it some issues that are new to some behavior analysts.

In response, CalABA has formed an Insurance Work Group whose goal is to ensure the integrity of our field and protection of our practice as we take steps to establish ourselves as network providers within the health insurance industry.

Our objectives:

1. serve as a resource to CalABA members working with health plans
   
   
2. develop service standards to protect consumers
   
   
3. be an educational and informational resource to health plans and state regulatory agencies about genuine ABA behavioral health treatments
   
   
4. represent behavior analytic treatments and qualified practitioners in task forces and roundtables so we can ensure that consumers receive high quality ABA Tx

One crucial aspect for all practitioners is the topic of rate structures for ABA services that are sustainable and support the delivery of effective treatment.

Agencies and individual practitioners specializing in ABA within the state of California who work with regional centers, school districts, and families privately have established usual and customary rates for ABA services.

These usual and customary rates, in addition to the consideration of the administrative demands of working with insurance companies (e.g., pre-authorization, claims processing, etc.), should be the basis for negotiating rate structures with insurance companies.

If administrative costs uniquely associated with working with insurance companies are left out of the equation, the ability of ABA providers to deliver quality services to individuals in need and entitled to ABA treatment will be diminished. It may also restrict the pool of in network service providers for the thousands of individuals in California that desperately need and deserve ABA services.

ABA providers must have rate structures that allow them to adequately perform necessary services and avoid being pitted against one another for a race to the bottom that would ultimately compromise the integrity of ABA services. CalABA is here to help its members as we take this important step forward.

Within the next week, you will have the opportunity to participate in an anonymous survey about ABA services and providers in California. We hope you will take this opportunity to provide your data. Make yourself visible in this process.

We will be making information about model fee structures and supervisory arrangements available to CalABA members. There will also be an informational session held near you this fall. Dates, locations, and times to be announced soon.

In the meantime, if you have information to share or are seeking information about working with health plans email us at insurancehelp@calaba.org.

Stay connected. Through our collaboration we will protect and advance the field and of behavior analysis in California.