CASP CEU Center

Organizational Support of Clinical Excellence

CASP Organizational Guidelines: Chapter 11

Section: Clinical Operations

Format: online only

Released: January, 31 2022

Chapter Overview:

The increased demand for applied behavior analysis (ABA) services for individuals with autism over the past decade is well documented (Behavior Analyst Certification Board® [BACB®], 2021). This growth is largely due to the availability of additional funding streams that have resulted from advocates’ successful efforts to require commercial health insurance plans to cover ABA services (Barry et al., 2017). Funding for ABA services also increased for many Medicaid beneficiaries after the Centers for Medicare and Medicaid Services (CMS, 2014) clarified Medicaid coverage for services to children with autism spectrum disorder (ASD). As a result, access to treatment has greatly expanded and stakeholders have become more aware of the value of ABA services for ASD. 

In one of their more compelling arguments for expanded health insurance coverage of ABA services, advocates cited research that identifies the substantial lifetime societal costs of autism and the potential savings that can result from timely and effective treatment (Piccininni, Bisnaire, & Penner, 2017; Buescher et al., 2014; Ganz, 2007; Jacobson, Mulik, & Green, 1998). To realize the promise of lifetime cost savings, it is critical not only to affirm the individual ABA provider’s ethical obligation to deliver effective treatment (BACB, 2020, Standard 2.01), but also to identify what is required of ABA provider organizations to support the consistent delivery of excellent clinical services at a systems level. 

Third-party payers are beginning to look at value-based payment models for behavioral health services that reward high-quality, cost-effective care (e.g., Soper et al., 2017). It has proven more difficult, however, to determine how to define and measure high-quality behavioral health care than it is for many medical health care services (Green & Oss, 2020). For those and other reasons, it is important for the leaders of ABA provider organizations and individual providers to understand how clinical indicators of health care quality are developed and implemented, and to ensure that any measures of quality that are used internally, by consumers, or by third-party payers are based on evidence.