Applied behavior analysis services by psychologists: Do you know your state law?

This brief overview highlights insurance and licensure laws throughout the U.S.

The delivery of applied behavior analysis (ABA) by providers other than psychologists has increased exponentially over the past decade. With the creation of the Behavior Analyst Certification Board, a new profession has arisen and is gaining recognition across the country under state insurance and licensure laws. The APA Practice Organization (APAPO) has been working with other health professional groups, and with state psychological associations, to ensure that psychologists are not excluded from providing or supervising providers of ABA services. This article offers a snapshot of relevant state laws. 

Insurance Laws

Until the middle of the last decade, families in need of services to treat autism spectrum disorder (ASD) were forced to pay out-of-pocket, as insurance companies would not cover treatment. Now, many states have changed their laws to require insurance companies to cover services for insureds diagnosed with ASD. As of September 2014, 36 states require insurance companies to cover services related to the treatment of autism or ASD. Treatment includes ABA as well as other care (for example, psychological, pharmacological and speech therapy).

When ABA coverage started appearing in state laws, the language recognized that these services would be covered if provided by Board Certified Behavior Analysts (BCBA). One of the unintended consequences of that language was that licensed psychologists who provided ABA were not being reimbursed. APAPO met with other stakeholders to address this problem in 2011. As a result, no states have passed laws since 2011 that deny reimbursement to psychologists providing ABA.

The following states do not have language mandating coverage for treatment of ASD:

District of Columbia, Georgia, Hawaii, Idaho, Maryland, Minnesota, Mississippi, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, South Dakota, Washington and Wyoming.

Most recently, TRICARE has implemented coverage for ASD services. APAPO has met with TRICARE officials and other stakeholders to ensure that psychologists who provide or supervise providers of ABA are covered by the plan.

Licensure Laws

Several groups throughout the country have been advocating for the licensure of behavior analysts at the state level, and legislatures have been implementing laws to regulate these providers. The laws vary widely in detail, but all require that licensees first have earned a certification from the Behavior Analyst Certification Board.  

As of Sept. 16, 2014, 18 states have passed a form of licensure law for behavior analysts. Six states license them under a separate behavior analyst licensing board, seven states license them within the board of psychology, and five regulate them under another state agency or board. 

Here is the breakdown of the licensing structure:

Alabama: Behavior Analyst Licensing Board
Alaska: Business and Professions
Arizona: Board of Psychologist Examiners
Kansas: Behavioral Sciences Regulatory Board
Kentucky: Behavior Analyst Board
Louisiana: Behavior Analyst Board
Maryland: Behavior Analyst Advisory Committee under the State Board of Professional Counselors and Therapists
Massachusetts: Board of Allied Mental Health and Human Services Professions
Missouri: Behavior Analyst Advisory Board under State Committee of Psychology
Nevada: Board of Psychological Examiners
North Dakota: Board of Psychologist Examiners
Ohio: Psychology Board (They call it certification)
Oklahoma: Developmental Disabilities Services Division of the Department of Human Services
Oregon: Behavior Analyst Regulatory Board
Rhode Island: Applied Behavior Analyst Licensing Board
Tennessee: Applied Behavior Analyst Licensing Committee of the Board of Examiners in Psychology
Virgina: Advisory Board on Behavior Analysis under the Board of Medicine
Wisconsin: Behavior Analyst Board

We anticipate additional legislation in several states during their 2015 sessions. We will continue to work with state psychological associations to ensure that proposed language does not exclude psychologists from providing ABA or negatively impact the practice of psychology in other ways.

Please note: Legal issues are complex and highly fact specific and require legal expertise that cannot be provided by any single article. In addition, laws change over time and vary by jurisdiction. The information in this article does not constitute legal advice and should not be used as a substitute for obtaining personal legal advice and consultation prior to making decisions regarding individual circumstances.