Applied Behavior Analysis (ABA) therapy has proven to be highly effective for children with autism and related developmental disorders. Within the past decade, more health plans have begun covering the treatment. That means practitioners must often demonstrate a medical need for the treatment and prescribe a specific level of intervention. But there has been a lack of standardization for determining this.
Jamie Pagliaro and his team at Rethink Behavioral Health researched the issue. They determined the lack of standardization meant some children were being over-prescribed treatment hours, while others were under-prescribed. Though unintentional, either scenario risked having a negative impact on a child with autism. It also increased risks that a health insurer might deny approval of a treatment plan.
As a result, Rethink Behavioral Health developed a Medical Necessity Assessment (MNA) analytic to help practitioners of ABA therapy ensure that more patients are receiving clinically appropriate levels of care. It was developed with an expert panel and tested in more than 6,000 individual patient assessments with providers nationwide. Rethink announced the MNA analytic in the past week.
Pagliaro can discuss the research and analytic tool developed. He is executive vice president and chief learning officer for Rethink Behavioral Health as well as a member of its Scientific Advisory Board. Previously he was executive director of the nationally recognized New York Center for Autism Charter School and earlier in his career worked directly with individuals with disabilities. He has an MBA from Villanova University and a BA with honors in psychology from Wesleyan University. He speaks nationally, serves on several professional advisory boards, and has authored articles on the use of technology in special education.
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