By Whitney J Detar, Ph.D., BCBA-D, ABA Therapy Utilization Management Reviewer
As demand for autism services continues to surge, health plans, payers, and PBMs face mounting pressure to balance timely access to medically necessary ABA care with stronger oversight of benefit utilization. Recent federal audits have made this challenge urgent, and traditional medical utilization review approaches simply weren't built to evaluate highly individualized behavioral interventions. The answer isn't stricter utilization management. It's better utilization management.
In our latest whitepaper, Beyond Denials: How ABA Utilization Management Can Improve Care, Strengthen Program Integrity, and Protect Access, you'll find:
Why traditional medical review frameworks fall short for ABA.
Key findings from recent federal OIG audits, including tens of millions in improper Medicaid ABA payments and what they reveal about documentation and oversight gaps.
The core components of an evidence-based ABA utilization review program.
How the right UM approach can simultaneously improve care quality, protect members, and strengthen program integrity without sacrificing access.
Access the whitepaper by completing the form below.