ABA The Mobile Workforce: Managing the Risk of Employee Drivers

This article is based upon a recent webinar presented by Daniel Law, of The Liberty Company Insurance Brokers. Over the past 14 years, Dan has focused on the design and implementation of insurance and risk management programs for clients on a global basis.

Applied Behavior Analysis (ABA) providers face very unique challenges with the clients they serve and the practice they run. These issues are often related to operations, clinical data collection and practice management. However, while ABA providers understand a variety of techniques that effect their clients, sometimes the hurdles that come with managing a business and its employees are difficult to navigate and they need to rely on experts.

One of these challenges is risk management. Far too often it is only understood as a reactive measure when ABA providers and their employees face issues that affect a business financially or in practice. However, there are strong benefits to including the right risk management approach in proactive initiatives, like establishing policies for employees who drive.

According to risk expert Daniel Law, of The Liberty Company Insurance Brokers, ABA providers across the country rarely think about the risks associated with employees who drive duringdriving company hours. In many cases, ABA providers have a very young workforce and employees may commute to and from work sites via a car or public transportation. For those who drive and work in a wide variety of environments, there are different levels of exposure. This can include everything from weather to traffic and by helping clients get from one destination to another.

“The general rule,” says Law, “is if you provide a mileage reimbursement, you have an employee driving on company and your business is at risk if the employee is involved in an accident.” But every case is unique. In fact, employees who have a specific location or work site that they travel to and from on a consistent basis may use a car for the commute, which wouldn’t be classified as company time.

In order to understand the risks, experts like Law say ABA providers should critically analyze guidelines for when an employee is considered to be driving on company time.

When are Employees Driving on Company Time?

  • Driving in between sessions or client homes during work hours
  • Going from a school-based session to a client’s home in the evening

These are just two examples of when an employee may be driving on company time and each practice will determine their own policies that correspond with how their business operates. In order to implement the risk management approach for employees who drive, each company should first know the fundamentals of the three-step process.

What is the Risk Management Approach?
The risk management approach is a three-step process that centers on identifying, analyzing and responding to risks. Each environment poses different hazards, so ABA providers must first identify, in their specific operations, where they have risks and analyze how they might impact the business and then formulate a response.

Identifying Areas of Risks
Some risks can be mitigated with appropriate policies, while others cannot. The risk management approach suggests that those areas of risks that can be avoided should be avoided, like when employees allow clients or children to enter their car. Exposure in a situation such as this can be tough to manage. So if ABA providers don’t know the maintenance of a car or are not providing a company car, Daniel recommends businesses prohibit employees to drive clients in their own vehicles.

Analyzing Risks
Like all other business, providers should always analyze risks prior to events. This is a great way to mitigate risk for a business and establish a precedent that is flexible to implement when employees enter or leave the company. For example, ABA providers can look at Human Resource policies to determine if they already have a structure in place to require employees to have higher personal auto insurance limits. If it is a requirement for employees to drive on company time, ABA providers can also require employees to provide regular information on the condition of their vehicles and allow for random or scheduled inspections.

Responding to Risks or Accidents
Some accidents or events are unforeseen and can’t be avoided or overlooked once they occur. So if an employee does drive on company time and is involved in an accident, one of the first things that will be looked at is who is at fault. The term “at fault” is generally used to define a point in time when injury or damage occurs to someone or something else, better known as third-party exposure. It is rarely cut and dry. A simply allegation of fault can force a business to step in and defend the company, even though the allegations may not have a basis in reality.

The key to handling these situations is staying calm and controlling the situation by formulating an appropriate response at the right time. Injury to occupants and employees are often an integral part of the response process. So understanding the limitations of auto insurance policies and following the rules and procedures associated with the Workers’ Compensation process is essential. Obtaining a great business auto insurance plan can be a big help.

Each month, Rethink Behavioral Health hosts a webinar with ABA  specific business experts that offer support and guidance for providers. So be sure to check out the next webinar and arm your practice with the right information to succeed!

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform offers both Clinical and Practice Management tools along with RBT Training, VB-MAPP licenses, and more than 1500 resources/materials as curriculum pieces. Schedule a demo today at your convenience!

Translating Medically Necessity Criteria (MNC) for ABA Providers Working with Health Plans

This piece was based upon a recent webinar presented by Tim Crilly, BCBA. Tim spent 3 years as Director of Autism Services for a major national health plan and an additional 10 years for a provider group in California.

Conceived more than 50 years ago out of the idea that positive gains can be made in an individual’s behavior by applying principles of learning and techniques, the scientific practice of Applied Behavior Analysis (ABA) is a relatively new concept in the healthcare industry.

Although the process has many different elements, health insurance managers and teams often receive only a snapshot of the type of care being offered to individuals in need of treatment. Health insurance organizations use this snapshot and medical necessity criteria (MNC) to define the benefits they cover for their members. However, not all snapshots or MNC are created equal.

Medical necessity criteria can vary greatly from organization to organization. The guidelines help to determine levels and types of care that are considered medically necessary for an individual’s behavioral health. Many health insurance companies also opt to create their own MNC or LOC guidelines, although there are commonalities.

How Managed Care Teams Use Medical Necessity Criteria
Below are three common phases of interpretation for MNCs:

  • Initialization of care: Set of criteria that determines if care is needed and at what level treatment should be authorized for.
  • Maintenance of ongoing care: Set of criteria that determines if care should continue at current level.
  • Change or termination of care: Set of criteria that determines if care should change.

While the criteria most organizations use was originally meant to simplify the interpretation process, ABA is still widely misunderstood. The challenge that insurance management teams face when reviewing care is that MNC and LOC guidelines don’t offer interpretations for appropriate levels of care. Additionally, the lack of consistency in care within the ABA community only makes this challenge greater for insurance management teams, as they review a wide range of care requests that carry different recommended programming levels.

Challenges for Applied Behavior Analysis Providers
ABA providers also face challenges in providing care. They include:

  • Struggling to align programming approaches and goals with requirements for MNCs
  • Requesting hours for ongoing services that are not instep with MNC/LOC guidelines
  • Pairing reduction behaviors with replacement behaviors
  • Creating caregiver involvement and goals and following through

To help solve the challenges for both insurance management teams and providers, it is important to start with one common element: The MNC. In order to get through the metaphorical “front door” or past the initiation of care phase, providers should look at medical necessity criteria for every funding source they have to gain a better understanding of what’s expected at the initial intake phase. Proceeding with the right level of care in the beginning of the process can also result in a decrease in denials later down the line.

If the original treatment is determined to be an appropriate type of ongoing care for an individual, it should then be clearly justified. As health care definitions continue to expand, clear and concise justifications for ABA care are more necessary now than ever before. Insurance care teams often look for the most cost-effective solutions for their business and their members. Once ABA services become an ongoing offering, health insurance organizations calculate them as new lines of costs that they will attempt to reduce if possible.

How Care Management Team and Providers Measure Success
To ensure clinically appropriate levels of care, providers must do a better job in gathering information and providing evidence for types and levels of care. Doing so will help redefine the limitations for care and reduce instances when ongoing care is inappropriately changed or terminated at the expense of those who need it most.

Being smart about goal alignment also makes a difference when insurance management teams review reports. Providers should ask themselves if they are sending in goals that are representative of what is outlined in an MNC while considering whether their goals are appropriate for funding through an insurance process.

Any behavior plans should be closely aligned with what is determined in an MNC. Caregiver programming is perhaps one of the areas with the most inconsistency when it comes to who is being placed in an environment and how much caregiver support is being provided. This is a big factor for health plans, as an insurance management team evaluates care and wants to see it in programming. Although goals should align with the MNC as much as possible, providers should also at times focus on additional services that are not outlined in the MNC if doing so will meet the overall needs of their clients.

With the vast majority of providers using digital data systems today, technology should help to make challenges easier to overcome. Every ABA provider should analyze whether their technology platforms work hand in hand with health plans to ensure they are taking clinically, socially significant and ethical actions in programming and care that align with health plan values. The technology platform a provider uses should also offer the right tools and benefits for providers to share with individuals and families as care continues.

Ultimately, the success of health care plans should be measured by titration of care over time; transitions to less intensive care when appropriate; caregiver empowerment and consumer protections for member groups.

However, the measures of provider success are still being defined. Over the next few years, it will be imperative for providers in the healthcare industry to come together in a cohesive manner to avoid regulations imposed by insurance management teams that miss the mark.

Providers should be upfront and coherent in their communication with each other, so everyone can appear on the same page to insurance management teams. Clinically integrated networks, which can negotiate collectively with health insurance organizations, may be an opportunity for providers work together to protect the quality and consistency of care in the future.

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform offers both Clinical and Practice Management tools along with RBT Training, VB-MAPP licenses, and more than 1500 resources/materials as curriculum pieces. Schedule a demo today at your convenience!

Thinking “Big Picture”: Promoting Quality in ABA Services

This piece was authored by Kathleen Bailey Stengel, Sr. Vice President ABA at Aveanna Healthcare.Think-Big

The “gold standard” for effective treatment for individuals with autism has always been Applied Behavior Analysis (ABA). However, as ABA services are increasingly sought after and provided to large groups of individuals, new clinicians are being trained and certified at a rapid pace. Because of this, a true “standard” for these ABA programs is difficult to define in the marketplace.

Where the Difficulty Lies
A quick scroll through social media sites can highlight complaints from both consumers and clinicians regarding poor programming, lack of evidence based treatment plans, and ineffective data collection. Part of this difficulty lies in the individualization of programs as ABA programs are typically designed for each individual, which results in certified and credentialed providers not developing standards of care across the board rather than the individual client. While many individual practitioners are experiencing success at their practice, providers and funders often run into issues when scaling practices toward large populations and across many practitioners to obtain (effective) outcomes expected by stakeholders and clinicians. Ongoing supervision and training of staff, standard documentation practices, and consistency of clinical interventions and outcomes are enormous challenges faced by clinical organizations as they grow and move into community-based integrated service models. Though challenging, there are methods to smooth this transition.

Setting up for Success
As a behavioral health provider across many states, we maintain large waiting lists for clients and are constantly hiring new clinicians at a rapid pace in order to keep up. One of the most difficult tasks we’ve experienced is maintaining appropriate clinical and operational checks and balances while providing services to families who are in dire need of them. This need for effective monitoring and supervision of clinical programs is essential in assuring the ABA programs we provide remain the “gold standard”. Therefore, it is a priority to hold all our clinical programs to the high standards that ABA has demonstrated and knows so well.

At Aveanna, creating and maintaining organizational quality indicators has been a priority over the last 3 years. As part of this initiative (and given the larger size of our programs), it has been imperative to have a partner electronic platform that allows us to continue providing excellent ABA case management services, while reducing time costs related to supervision and training, information storage and data collection, and management at the individual and aggregate levels. Rethink Behavioral Health, a division of Rethink First, has been this partner for Aveanna. The Rethink platform has provided us with tools to standardize our clinical documentation and data management, while allowing an efficient way to access and review all of the clients’ records.

With these features in place, we have been able to identify and monitor clinical quality indicators that will give us the opportunity to standardize and shape the clinical skills of our staff to reach the services and outcomes that we expect for all of the individuals we serve. As an example and a baseline point, we identified the following essential quality indicators that will be at the core of each and all programs offered. These quality indicators are the backbone of our standard performance expectations and will continue to pave the road for further development of all our clinical staff and the achievement of consistently valuable treatment outcomes.

Key Quality Indicators:

  1. Individual goals clearly match the assessments
  2. Goals are measurable
  3. Data collection systems selected match the stated goals
  4. Lesson plans for each goal are completed
  5. Positive Behavior Support plan is written and in place
  6. Graphs for each and all goals are up to date and complete
  7. Graphs reflect changes in interventions as needed
  8. Intervention protocols are evidence-based
  9. Follows up with supervision round recommendations

Thanks to Rethink Behavioral Health, we are able to audit the program integrity remotely to assure compliance with basic clinical standards. Our goal with standardizing and reverse engineering clinical outcomes at the clinician level is twofold: to create a basic standard of care while allowing the clinician to individualize treatment as well as to work toward creating a baseline for measuring large population aggregate results in the future.

When we can finalize and control the variables for treatment implementation across our national program, we will then move toward aggregating the data from Rethink on the children’s plans and measure full programmatic integrity. This data will then drive decisions from the child level all the way up through executive decisions. With Rethink as a partner in data collection and treatment integrity, the collected data will allow us in the future to make changes to our clinical and organizational structure that have direct and meaningful impacts on client outcomes across locations.

Rethink Behavioral Health provides an intuitive and comprehensive solution to scale your ABA business and ensure client success. Our one-stop-shop platform offers both Clinical and Practice Management tools along with RBT Training, VB-MAPP licenses, and more than 1500 resources/materials as curriculum pieces. Schedule a demo today at your convenience!

Terminating Employees: Best Practices and Red Flags To Consider

Did you know it’s best practice to prepare for your next termination during the hiring process?

Take a look at our latest installment published on Behavioral Science in the 21st Century discussing best practices & red flags to consider when terminating employees!filice

Terminating an employee is an interesting time for the entire office and can affect productivity and culture. Read the full article to discover how to avoid termination problems at the point of hire and understand stipulations such as “employment at will”!

Rethink Behavioral Health and bSci21 publish a new article every month, stay tuned for the next installment!

[Webinar] Translating Medical Necessity Criteria (MNC) for ABA Providers Working with Health Plans

Rethink Behavioral Health invites you to participate in our upcoming webinar, Translating Medical Necessity Criteria (MNC) for ABA Providers Working with Health Plans!

With a lack of consistency in the industry and guidelines that don’t offer interpretation of what an appropriate level of care is, this is an important topic to understand.

Expect to discuss:

  • MNC/LOC guidelines
  • Socially Significant Programming and MNC
  • Defining success and limitations

This live webinar will be held on Thursday, November 9th at 1pm EDT/10am PDT, register now!

Our guest presenter will be Tim Crilly, BCBA, Senior Director at Rethink Behavioral Health. Before Rethink, Tim spent 3 years at Magellan as the National Director of Clinical Services Autism and also 10 years for a provider group in California.


Rethink Behavioral Health holds a monthly webinar series entitled Entrepreneurship in ABA. This targeted set of presentations will focus on the business aspects of running an ABA provider group. Whether you are just getting started, or in high growth mode, this series will offer insights and best practices for helping your business succeed.

Eligibility and Benefits: Understanding Eligibility For ABA Coverage Through Insurance

Check out our latest installment published on bSci21.org, Eligibility and Benefits: Understanding Eligibility For ABA Coverage Through Insurance!

aba-billingDo you know the difference between self funded and fully funded insurance policies? What about the relationship between these policies and state laws mandating ABA coverage? Find out!

Recently, Rethink Behavioral Health hosted a webinar with guest speaker Emily Roche, Director of Services for ABA Therapy Billing and Insurance Services. Emily provided insight on two critical topics dealing with insurance laws which can help ensure a successful business.

Read the full article!

Rethink Behavioral Health and bSci21 publish a new article every month, stay tuned for the next installment!

[Webinar] Affordable Care Act: How It Affects Your Business

Rethink Behavioral Health invites you to participate in our upcoming webinar, Affordable Care Act: How It Affects Your Business!

Signed in 2010, the Affordable Care Act (ACA) is entering the final stages of implementation. What opportunities or risks does the ACA represent to you? Join us to find out!

Our guest presenter, Liliana Salazar, Compliance Officer/HUB International, Insurance Services, who has over 20 years of experience in the insurance industry and insider information from Washington D.C..

This live webinar will be held on Thursday, October 19th at 1pm EDT/10am PDT. Click here to register.

P.S. Interested in a FREE VBMAPP license? Take advantage of our limited-time promotion for new and existing clients!

Rethink Behavioral Health holds a monthly webinar series entitled Entrepreneurship in ABA. This targeted set of presentations will focus on the business aspects of running an ABA provider group. Whether you are just getting started, or in high growth mode, this series will offer insights and best practices for helping your business succeed.

[Webinar] Terminating Employees: Best Practices and Red Flags to Consider

Rethink Behavioral Health invites you to participate in our upcoming webinar, Terminating Employees: Best Practices and Red Flags to Consider!

It’s always a stressful time for everyone when an employee is leaving the company. Besides worrying about how employees and clients will be affected, you need to ensure this process is compliant and legal. Save your seat now!

Our guest presenter, John Engers, Compliance Counsel/President of Filice Tri-Valley, will be discussing red flags to keep an eye out for when considering terminating an employee!

This live webinar will be held on Thursday, September 21st at 1pm EDT/10am PDT. Click here to register.

Rethink Behavioral Health holds a monthly webinar series entitled Entrepreneurship in ABA. This targeted set of presentations will focus on the business aspects of running an ABA provider group. Whether you are just getting started, or in high growth mode, this series will offer insights and best practices for helping your business succeed.

5 Steps To Positive Leadership

Check out our latest installment published on bSci21.org, 5 Steps To Positive Leadership!

leadershipWhat is leadership from a behavior analytic perspective and what responsibilities to leaders hold? Find out!

Recently, Rethink Behavioral Health hosted a webinar with guest speaker Manny Rodriguez, M.S., Vice President of ABA Technologies. Manny provided extremely helpful tips such as setting clear expectations and goals, how to monitor performance, and providing feedback and coaching.

Read the full article!

Rethink Behavioral Health and bSci21 publish a new article every month, stay tuned for the next installment!

[Webinar] A Profession Coming of Age: Issues and Emerging Ideas for Behavior Analysts & ABA Business Owners

Rethink Behavioral Health invites you to participate in our upcoming webinar, A Profession Coming of Age: Issues and Emerging Ideas for Behavior Analysts & ABA Business Owners!

It’s no secret that ABA business owners and behavior analysts face unique issues when compared to other healthcare providers. With the industry still developing, there is also a wave of new ideas in regards to how things should be done. Save your seat now!

Our guest presenter, Matt McAlear, Executive Director, California Association for Behavior Analysis (CalABA) and ABA business owner, will be discussing these issues along with emerging ideas to combat these concerns!

This live webinar will be held on Thursday, July 20th at 1pm EDT/10am PDT. Click here to register.

Rethink Behavioral Health holds a monthly webinar series entitled Entrepreneurship in ABA. This targeted set of presentations will focus on the business aspects of running an ABA provider group. Whether you are just getting started, or in high growth mode, this series will offer insights and best practices for helping your business succeed.