Applied Behavior Analysis Co-signature Requirements

Best Practices and Legal Considerations

Original Air Date: May 29, 2025

Short title:  Applied Behavior Analysis Co-signature Requirements

CEU offered: 1.0 BACB Learning CEU

Webinar Duration: 60 minutes

Instructors:

  • Mariel Fernandez, MS, BCBA, LBA
  • Dan Unumb, Esq.


Abstract:

Recently, several Medicaid agencies, Medicaid Managed Care Organizations (MCOs), and commercial health insurance payers have introduced co-signature requirements for applied behavior analysis (ABA) session notes. These requirements are often outlined in payer ABA policies or specific documentation guidelines. Other times, requirements emerge as part of feedback during pre- or post-payment claims reviews and audits.

In some cases, payers require an authorized Qualified Healthcare Professional (QHP) to co-sign all session notes for services rendered to any client on their caseload (e.g., for all 97153 or equivalent sessions). In other cases, the requirement stipulates that the parent or legal guardian co-sign all session notes for services provided on a given day (e.g., for all billable services related to the full adaptive behavior code set). CASP's session note templates do not currently include a section for co-signatures.

This webinar will review the Applied Behavior Analysis Co-signature Requirements: Best Practices and Legal Considerations white paper, developed by the Autism Legal Resource Center and the Council of Autism Service Providers (CASP). The presenters will discuss topics such as the requirements for “incident to” services, whether these standards apply to ABA, contractual obligations, the Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), and faulty assumptions regarding the use of co-signatures to prevent fraud, waste, and abuse, or to enhance case management and direction activities.

Learning Objectives

  1. Participants will explain why "incident to" services do not apply to technician-rendered services.
  2. Participants will identify under what conditions a payer may require a co-signature.
  3. Participants will explain how MHPAEA applies to co-signature requirements.


Instructor(s)

Mariel Fernandez, LBA, MS, BCBA

Mariel Fernandez is the Vice President of Government Affairs at the Council of Autism Service Providers (CASP) and a Board-Certified Behavior Analyst (BCBA) licensed in Texas. She earned her master’s degree in applied behavior analysis (ABA) from Auburn University in 2004.  A passionate advocate for improved access to care, Mariel actively supports advocacy, public policy, and legislative initiatives at both the state and federal levels. Since 2008, Mariel has served TRICARE beneficiaries, navigating multiple TRICARE contract and operation manual changes. She draws on these experiences and the relationships she has built through federal advocacy to assist ABA providers in managing T-5 transition challenges across the country. Mariel serves on the Texas Department of Licensing and Regulation (TDLR) Behavior Analyst Advisory Board and is the President of the Texas Association for Behavior Analysis Public Policy Group (TxABA PPG). In these roles, she played a crucial part in the successful passage of behavior analyst licensure and the inclusion of autism services, including ABA, as part of the Texas Medicaid benefit.

Esq., President, Autism Legal Resource Center Dan Unumb

Dan is an attorney and the parent of a child with autism. As President of the Autism Legal Resource Center, a national law and consulting firm, he represents professional associations, autism service providers, and individuals with autism spectrum disorders and their families seeking access to services and has briefed autism issues in state & federal courts, including the U.S. Supreme Court. Dan began his autism advocacy working with his wife Lorri in securing cutting-edge legislation in 2007 mandating insurance coverage for autism treatments in South Carolina. In 2008, Dan and Lorri were named Autism Society of America “Parents of the Year.” Dan graduated from Northwestern University School of Law, and previously practiced with law firms in Boston, Washington, D.C. and Charleston, SC, as well as the Civil Division of the U.S. Department of Justice.