Science over Cynicism: The Race to Preserve Best-Practice Applied Behavior Analysis through Expanded Awareness, Advocacy, and Enforcement of the Mental Health Parity and Addiction Equity Act

Abstract

Widespread insurance funding of applied behavior analysis (ABA) as a medically necessary mental health benefit in the treatment of autism spectrum disorder (ASD) has placed behavior analysts in the role of health-care providers, and the race is on to see whether best-practice ABA will be defined by the insurance industry or behavior analysts. Behavior analysts who work with insurance and/or Medicaid have increasingly encountered payor guidelines that interfere with their efforts to implement treatment plans that reflect generally accepted standards of care. When these arbitrary limits are integrated into ABA practices, payors—not science—are shaping how ABA is implemented. Many common payor guidelines, such as location exclusions, caregiver participation requirements, and age and hour limits, violate the federal Mental Health Parity and Addiction Equity Act (MHPAEA). For the first time since MHPAEA became law, federal agencies are scrutinizing payor guidelines and practices through the lens of MHPAEA and working to increase compliance. In this new climate of MHPAEA enforcement, behavior analysts are uniquely positioned to identify, reject, and report improper guidelines that constrain their ABA practices and promote best practices to optimize patient outcomes. This review of MHPAEA in the context of ABA highlights common violations and current advocacy and aims to equip behavior analysts with the tools to free their practices from improper limits.