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A Response to Papatola and Lustig’s Paper on Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis in the Treatment of Children on the Autism Spectrum

Behavior Analysis in Practice volume 10, pages 386–394 (2017)Cite this article

Abstract

In their 2016 article, “Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis [ABA] in the Treatment of Children on the Autism Spectrum,” Papatola and Lustig provide an overview of the managed care process, discuss the medical necessity of ABA, and offer guidance to clinicians on how to navigate the managed care peer review process. Given that the authors are employed by a large international health insurance carrier and conduct peer reviews on behalf of that organization, this response seeks to provide guidance from both the clinical and public policy perspectives that reflect best practices in the field of autism treatment. This response is not written with the intention of providing or replacing legal advice; rather, this paper offers health care providers of ABA an essential understanding of some of the laws that govern and support their efforts to secure medically necessary treatment and the mechanisms in place with which to challenge decisions by managed care organizations, health plans, and health insurance issuers that may be contrary to best practices. Finally, suggestions are offered on how to navigate a peer review to ensure optimal outcomes and, when necessary, to lay the groundwork to overturn a funding source decision that does not reflect best practices or the standard of care in ABA-based autism treatment.

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Author information

Affiliations

  1. Center for Autism and Related Disorders, 21600 Oxnard Street, 18th floor, Woodland Hills, CA, 91367, USA

    Julie Kornack

  2. ABACS, LLC, 10 Gill St., Suite J, Woburn, MA, 01801, USA

    Brandon Herscovitch & Ashley L. Williams

Authors
  1. Julie Kornack
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  2. Brandon Herscovitch
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  3. Ashley L. Williams
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Corresponding author

Correspondence to Julie Kornack.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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No funding was obtained in completion of this manuscript.

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The authors declare that they have no conflict of interest.

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Kornack, J., Herscovitch, B. & Williams, A.L. A Response to Papatola and Lustig’s Paper on Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis in the Treatment of Children on the Autism Spectrum. Behav Analysis Practice 10, 386–394 (2017). https://doi.org/10.1007/s40617-017-0192-x

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  • DOI: https://doi.org/10.1007/s40617-017-0192-x

Keywords

  • Peer review
  • Applied behavior analysis
  • Managed care
  • Mental health parity
  • Fail first
  • Autism