It’s no secret that there is a steep supply-and-demand issue for applied behavior analysis (ABA) services nationwide.
The industry is relatively new, which means the pool of qualified professionals is still small compared to the need. There are less than 70,000 board-certified behavior analysts in the U.S. Still, autism impacts 1 in 36 children, according to the CDC.
Many of those qualified clinicians are prioritizing flexibility in the workplace and turning to telehealth.
“A lot of our clinicians are very young and are of childbearing age. They are getting married and moving around to different areas,” Kathleen Stengel, founder and former CEO of NeurAbilities, said at Behavioral Health Business’ Autism & Addiction Treatment Forum. “If you can capitalize on the virtual interaction, that in of itself allows us to expand access.”
NeurAbilities is a Voorhees, New Jersey-based ABA provider. It has 18 New Jersey and Pennsylvania centers and more than 500 employees.
While virtual care is likely a driving force for the future of ABA services, navigating the complex payer environment can be challenging. Each payer will have its own outlook and requirements on the move to telehealth.
“There are payers that are better leaning in and really pro virtual care and others that aren’t. Generally, I would say Medicaid is more pro than commercial,” Jeff Beck, CEO and co-founder of AnswersNow, said at the event. “But there are no hard and fast rules. I think [payers] will continue to increase adoption, not decrease. I think it would be silly to think that payers want to do less with a type of therapy that’s provided outcome at a lower cost.”
AnswersNow is a virtual autism provider based in Richmond, Virginia. It was founded in 2017 and is focused on matching families with clinicians for virtual ABA therapies. It works with several large payers, including Medicaid, UnitedHealthcare and Cigna. In 2023, it received $11 million in funding.
Advocacy is a crucial part of getting virtual ABA services covered, Beck noted.
For example, last year, CVS Health’s (NYSE) payer arm, Aetna, initially said it would end telehealth coverage for ABA services. Still, later, the payer changed its stance on this policy. Though the payer has never revealed why it changed the policy, several advocacy groups supported telehealth coverage.
“If you’re providing any really good care, then those parents are going to tell their payer that they are getting really good care and the payer will listen to the customer. This is something that we’ve worked with a little bit on internally. But I think at the end of the day, it’s just a different type of service value.”
Beck noted that while virtual may not achieve the same level of intensity that a clinic could right now, there is a subset of the population that is best suited for virtual.
As coverage for ABA services becomes more commonplace, other hurdles could prevent the entire continuum of ABA services from being offered virtually.
“We have not had a problem in the Northeast corridor with getting any of those professional license codes covered via telehealth,” Stengel said. “But the paraprofessionals like RBTs …have been specifically excluded. Having said that, I think there’s been some opportunities for wiggle room to work with some payers and create a case.”
