Homeostasis: Ethical Guidance for Navigating Payer Policy Adjustments   

Original Webinar Date: December 2018

CEU offered: 2.0 Ethics CEU

Short Title:  Homeostasis: Navigating Payer Policy Adjustments

Webinar Duration: 1 hour 52 minutes 

CE Instructors:

  • Rebecca Womack, BCBA
  • Michele Silcox


This recorded webinar was originally presented by the Behavior Analysis Advocacy Network (BAAN).  Upon BAAN's dissolution in June 2020, its CEU course library was transferred to CASP.    

Abstract: 

The Defense Health Agency, providing oversight of the TRICARE military benefit, released information on changes to the Autism Care Demonstration program. The modifications will require providers to make significant adjustments across the landscape of service delivery with clinical integrity. The Behavior Analysis Advocacy Network (BAAN) will share ways to ethically address concerns with funding sources, and effective processes to support this transition. Guidance will be given on methods for implementing practices associated with Category I CPT codes pertaining to applied behavior analysis (ABA) therapy. Recommendations will be aligned with the Behavior Analyst Certification Board (BACB) Compliance Code standards. Attendees will be equipped with ways to address concerns with this funding source, strategies for aligning business practices with the new requirements, and suggestions for maintaining the necessary supervision associated with the Registered Behavior Technician (RBT) certification.

Participants will receive:

  • A review of challenges being posed by the implementation of policy changes
  • Ethical guidance for conflict resolution with funding sources
  • Attendees will learn ways to apply TRICARE Operation Manual requirements to their session content and subsequent documentation
  • Examples and discussion about how to implement the recommendations

Instructor(s)

MS, BCBA, LBA Rebecca Womack

Rebecca several years of experience rendering services via telehealth as well as researched this topic when advocating on behalf of providers and military families in DC regarding the TRICARE ABA benefit.
 Rebecca has been privileged to serve adults and children using ABA in a variety of capacities. From facility-based care, to working in group homes, daycare centers, schools, and family homes, her experience includes implementing evidence-based therapy across multiple settings. As part of this, she has traveled across the United States and overseas to provide consultation for families with children and adults who have autism. Rebecca currently serves as the Director of Clinical Compliance for Blue Sprig Pediatrics, Inc. There she works collaboratively with a team of interdisciplinary professionals to create quality assurance policies and ensure that related processes are ethically and contractually aligned with health plan standards.

CMRS Michele Silcox

Michele Silcox, has a 25-year career in Accounting. For the last nine years, Michele has focused her career in ABA Therapy billing and insurance funding sources, founding ABA Therapy Billing and Insurance Services, a nationally recognized Autism Services billing, consulting, and credentialing company, supporting the provider just starting out through the large ABA agency flourishing with multiple providers, clients, and funding sources. Additionally, her software background puts her in a position to help providers maximize the use of the practice management software they have chosen. As a Certified Medical Reimbursement Specialist (CMRS) and her studies in auditing, she can provide an in-depth risk assessment for providers to support compliance and profitability of their practice. Michele is coauthor of Revenue Cycle Management for ABA Therapy.