What Is a Treatment Plan?
A treatment plan is a report submitted to insurance companies to explain the needs of an individual and why ABA services are warranted. This plan often includes information about the individual’s school, medical history, a comprehensive assessment of skills and behaviors, and much more. A treatment plan also includes all the goals that will be targeted during ABA services with a clear objective or purpose for each of them.
The goal of a treatment plan is to identify behaviors that interfere with learning and daily life and replace those behaviors with functionally appropriate behaviors that promote independence.
When Is a Treatment Plan Needed?
A treatment plan is needed when initiating ABA services for the first time or when the authorization is expiring. An authorization is the time frame in which ABA services are approved. Typically, an authorization will expire every six months, which then requires an updated treatment plan. However, there are some cases where authorizations may be shorter, for example, three months, or longer, such as nine months.
Insurance companies require an updated treatment plan because the goal for all learners receiving ABA is to make progress toward their goals and overall independent functioning in their daily lives. An updated plan allows insurance companies to track the progress and effectiveness of ABA services.
What Does Participating in the Treatment Plan Process Mean?
Those who are required to participate in the treatment plan process include the Board-Certified Behavior Analyst (BCBA) and the clients’ caregivers. BCBAs are required to administer assessments to evaluate progress on goals and develop recommendations based on progress.
Parents are also valuable sources of information and are crucial to the success of the client and the treatment planning process. Through parent interviews and behavior assessments, new information can be used for the treatment plan and to develop effective ABA strategies that work for all parties.
Why Is the Process and Requirements Strict?
Every insurance company is different and has specific policies related to ABA services. Some insurance companies are stricter than others, but the process was created to ensure all relevant medical information as it relates to autism and ABA services are included in the plan.
Research from Choi et al. (2020) analyzed insurance requirements across the United States and found that requirements vary greatly. It is important to abide by the insurance requirements to avoid any lapse in services or denial of services. If requirements are not fully met, it will often result in a denial.
Why Is the Process So Long?
There are a few reasons why the treatment plan process can take a long time. It is important to keep in mind that a treatment plan has all the information and requirements that the insurance company needs.
Assessments needed to assess communication, social skills, and interfering behaviors can be lengthy to administer. In these cases, the assessment is often broken up into smaller portions and is then administered.
Once the assessment is completed, the next step is to begin writing the treatment plan. This part of the process can also be lengthy since providers need to input all data, gather observation notes, and record assessment scores.
What Is the BCBA’s Responsibility?
During this process, it is the BCBA’s responsibility to follow the insurance company’s requirements and to keep the BCBA ethical code in mind. Having open lines of communication with all involved parties and maintaining appointments of the assessment are key responsibilities for BCBAs.
Ensuring that these things are met usually means that the process will remain smooth and timely. The development of an effective plan encourages a more fruitful intervention and most often results in positive client outcomes (Quigley et al., 2018).
What If My Treatment Plan Is Rejected?
There are instances where an insurance company may offer feedback to the BCBA on a treatment plan. Typically, it is delivered by medical doctors and BCBA-D’s who work for the insurance companies. When this feedback is passed along, it is usually fueled by a specific funder requirement that is not being met.
Don’t stress if this happens! Simply remain receptive and open to feedback. If you disagree with the feedback, ensure the treatment plan is revised to reflect why the feedback is not appropriate for this learner. Review the insurance companies’ policy handbook before resubmitting.
What Should I Do If the Insurance Company Wants to Set Up a Call About the Case?
Medical doctors reviewing treatment plans will sometimes have follow-up questions about the treatment plan. In these cases, they will reach out to the BCBA to discuss the case. There is no need to stress over these calls as they are usually just looking for clarification. The clinical support team can prepare you and support you to complete these calls.
Who Do I Reach Out to at Applied ABC for Treatment Plan Support?
At Applied ABC, the authorization department has a whole team of reviewers who help to ensure treatment plans have everything they need prior to being submitted. This team will deliver feedback to BCBAs that correlate to the insurance company’s requirements.
Task Analysis of the Treatment Plan Process
Below are the steps taken to conduct a task analysis as part of the treatment plan process at Applied ABC.
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Schedule direct observations: for an initial assessment, two direct observations are required, and if it’s a reassessment, one direct observation is needed.
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Complete a records review and parent interview.
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Conduct a skills and behavior assessment and score to generate graphs.
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Add information to the treatment plan from the assessment.
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Analyze the assessment to determine appropriate goals.
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Submit the completed treatment plan to the authorization department at Applied ABC.
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Complete any requested revisions.
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Treatment plan gets submitted.
Resources for Providers Writing Treatment Plans
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Creating Life Outcomes: How to Write Effective Objectives for Successful Treatment Plans https://www.citepro.com/courses/objectives
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This CEU offered by Cite Pro dives into the essential elements of writing an effective treatment plan for learners with autism. This offers 3 general CEU’s at an affordable rate!
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Detecting and Troubleshooting Treatment Failures: A Crucial Component of Evidence Based Practice of ABA https://foxylearning.com/product/detecting-and-troubleshooting-treatment-failures-aba/
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This is another affordable option to help you learn more about self-reflecting on interventions that were not successful and how to determine ineffective components of the intervention using ABA strategies.
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The Council of Autism Service Providers is a helpful organization to rely upon for resources and general guidance for ABA services. Many insurance companies also will refer to resources from CASP and can be used to cite and support claims when refuting denials.
References:
Choi, K. R., Knight, E. A., Stein, B. D., & Coleman, K. J. Autism Insurance Mandates in the US: Comparison of Mandated Commercial Insurance Benefits Across States.
Quigley, S. P., Ross, R. K., Field, S., & Conway, A. A. (2018). Toward an Understanding of the Essential Components of Behavior Analytic Service Plans.
