Model Health Insurance Coverage Policy for Adaptive Behavior Services

An Introduction for Providers

Original Webinar Date: September 17, 2020

CEU offered: 2.0 Learning CEU

Short Title:  MCP for Adaptive Behavior Services  

Webinar Duration: 2 hour

CE Instructors:

  • Gina Green, Ph.D., BCBA-D
  • Jim Carr, Ph.D., BCBA-D
  • Jenna Minton, Esq
  • Lorri Unumb, Esq

Abstract:  

After the American Medical Association’s CPT Editorial Panel issues CPT codes for a healthcare service or set of services, it is common for one or more specialty societies to develop a model coverage policy to foster appropriate, consistent coverage of the services by health plans. The ABA Coding Coalition (representatives of the Association of Professional Behavior Analysts, Autism Speaks, Behavior Analyst Certification Board, Council of Autism Service Providers, and their CPT consultant) has developed a model coverage policy for adaptive behavior (applied behavior analysis; ABA) assessment and treatment services.

The Coalition comprises most of the individuals and organizations who authored the application that was submitted to the AMA CPT Editorial Panel in 2016 to obtain the Category I and modified Category III CPT codes for those services. The new and modified codes went into effect in 2019. In this webinar, members of the Coalition will preview the model coverage policy for providers. Indications, limitations, billing codes, provider qualifications, and documentation requirements for adaptive behavior services will be highlighted and described briefly.

Instructor(s)

Ph.D., BCBA-D Gina Green

Gina is the Chief Executive Officer of APBA. She has developed and evaluated ABA interventions for people with autism and other developmental disorders, trained and supervised ABA practitioners and students, consulted to several ABA service programs, worked on many licensure and funding laws, and held leadership positions in several professional and parent-professional organizations. Dr. Green serves as APBA’s principal representative on the ABA Coding Coalition.

Esq Jenna Minton

Jenna W. Minton, Esq. is the President of Proactive Strategies (formerly Minton Healthcare Strategies). Proactive Strategies specializes in guiding clients through Medicare and Medicaid regulatory processes. Specifically, Jenna focuses on the development of CPT Codes. Jenna also assists in valuing medical services through the AMA Relative Update Committee. From 2016 through the end of March 2019, Jenna guided and contributed substantially to the efforts of the ABA coding work group, including the development of the 2019 ABA CPT code set and generation of subsequent educational materials aimed at their implementation. Jenna also serves as the Director of Operations at Residential Options, Inc. (ROI). She oversees audit, contracting, and reimbursement issues for ROI which employs almost 350 people and services around 300 clients with ASD or a developmental disabilities. Jenna is licensed to practice law in Maryland and is a member of the Maryland State Bar Association.

Esq., CEO of CASP Lorri Unumb

Lorri became the Chief Executive Officer of CASP in June 2019 after having served for more than a decade as the Autism Speaks Vice President for State Government Affairs. In her role with Autism Speaks, she spearheaded the autism insurance reform movement that has resulted in all 50 states adopting laws that require certain health plans to cover ABA and other services for people with autism. Prior to that, Lorri was an appellate litigator with the U.S. Department of Justice and a professor at the George Washington University Law School and the Charleston School of Law. She and her husband Dan founded the nonprofit Autism Academy of South Carolina and wrote the academic textbook Autism and the Law.