It’s no secret that the demand for applied behavior analysis (ABA) services is growing rapidly across the United States, especially in autism treatment. According to the CDC, autism now impacts 1 in 36 children, highlighting the urgent need for effective therapeutic interventions like ABA. Telehealth ABA services are emerging as a valuable solution to bridge the gap, but the supply of qualified ABA professionals is still not growing fast enough, creating a significant supply-and-demand challenge.
As of today, fewer than 70,000 board-certified behavior analysts (BCBAs) are practicing in the United States. This small number of professionals is being asked to meet the needs of an ever-growing population, putting immense strain on both providers and families seeking services. While the shortage of qualified professionals is challenging, there are new approaches emerging to help bridge this gap. One of the most promising solutions is the adoption of telehealth to provide ABA services remotely.
Telehealth: A Game-Changer for ABA Providers and Families
Telehealth, or virtual care, is increasingly being recognized as a vital tool for expanding access to ABA services. This shift is largely driven by the flexibility that telehealth offers both clinicians and families. For clinicians, the ability to provide care remotely can be a lifesaver. Many ABA professionals are in their prime childbearing years, often getting married, moving for personal reasons, and starting families of their own. Telehealth allows them to work from anywhere, providing much-needed flexibility in a field that traditionally requires in-person interaction.
Kathleen Stengel, the founder and former CEO of NeurAbilities, a provider of ABA services in New Jersey and Pennsylvania, discussed this shift in her keynote at Behavioral Health Business’ Autism & Addiction Treatment Forum. Stengel noted that many clinicians in the ABA field are young professionals who are often relocating or juggling personal and family commitments. “A lot of our clinicians are very young and are of childbearing age. They are getting married and moving around to different areas. If you can capitalize on the virtual interaction, that in itself allows us to expand access,” she said.
NeurAbilities operates 18 centers across New Jersey and Pennsylvania, with over 500 employees. The adoption of telehealth has allowed the organization to scale its services and serve a broader population. By incorporating virtual care, they have been able to meet the demands of a growing number of families seeking ABA therapy for their children, without having to rely solely on in-person visits.
Overcoming the Challenges of Payer Coverage
While the benefits of telehealth are clear, there are still significant hurdles to overcome in terms of payer support. The payer environment in the U.S. is complex, with different policies across private and public health insurance providers. Some payers are more willing to support virtual ABA services, while others remain hesitant or slow to adopt new practices.
According to Jeff Beck, CEO and co-founder of AnswersNow, a virtual autism provider based in Richmond, Virginia, some payers are more inclined to support telehealth than others. “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,” Beck said. “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 connects families with clinicians for virtual ABA therapy and has successfully partnered with large payers, including Medicaid, UnitedHealthcare, and Cigna. The organization’s success highlights the growing acceptance of telehealth as a cost-effective solution that can deliver outcomes comparable to in-person services.
However, not all payers have embraced telehealth for ABA services. Advocacy is a critical part of the process for pushing insurers to expand their coverage for virtual care. For instance, CVS Health’s payer arm, Aetna, initially announced that it would end its coverage for telehealth ABA services. This policy shift drew backlash from both providers and advocacy groups who emphasized the value of virtual ABA care. In response to this pressure, Aetna reversed its decision, continuing to cover virtual services. While Aetna did not publicly share the reasoning for this change, the role of advocacy in influencing payer decisions is evident.
“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,” Beck emphasized. This reflects the broader trend of consumer-driven advocacy, where families advocating for the services they find beneficial can push payers to re-evaluate and adjust their policies.
Addressing Barriers to Full Telehealth Adoption
While telehealth has proven to be a useful tool for ABA services, there are still some significant barriers to full virtual care adoption. One such barrier is the issue of paraprofessional coverage. Registered Behavior Technicians (RBTs) play an essential role in ABA therapy, providing direct services to clients under the supervision of a BCBA. However, despite the success of telehealth for professional clinicians, RBTs are often excluded from telehealth coverage by insurance payers.
Kathleen Stengel provided insights into this challenge during the forum. “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.”
This issue highlights a gap in the current payer policies, as the role of paraprofessionals is crucial in providing effective ABA therapy. While clinicians can work virtually, the exclusion of RBTs from coverage under telehealth policies can prevent families from receiving the full spectrum of care they need. To address this issue, providers will need to continue advocating for the inclusion of paraprofessional services in telehealth coverage.
The Future of ABA Services: Expanding Access Through Innovation
As the ABA industry continues to grow and evolve, telehealth will likely play an increasingly important role in expanding access to care. The flexibility that virtual care offers will enable providers to reach families in underserved or remote areas who may otherwise face barriers to accessing traditional in-person services. Additionally, telehealth allows ABA providers to leverage technology to streamline operations, reduce costs, and improve patient outcomes.
However, the shift to telehealth is not without its challenges. Navigating payer policies, securing reimbursement for paraprofessional services, and ensuring that virtual care is accessible to all families are key hurdles that must be overcome. As the industry matures, continued advocacy and collaboration between providers, families, and payers will be essential to ensure that virtual ABA services are fully integrated into the healthcare system.
Despite these challenges, the future of ABA services looks bright. By embracing telehealth, ABA providers can expand their reach, increase the efficiency of their services, and ultimately improve the lives of more children with autism. As more families embrace virtual care, the pressure on payers to cover these services will only increase. The combination of innovative care delivery models and strong advocacy will help ensure that every child who needs ABA therapy has access to it, regardless of location or circumstances.
In conclusion, telehealth is reshaping the landscape of ABA services, offering a powerful tool for meeting the growing demand for treatment. While obstacles remain, the continued adoption of virtual care, coupled with ongoing advocacy efforts, will likely drive the expansion of telehealth services in the ABA field. As this transformation continues, the ultimate goal remains clear: ensuring that every child with autism has access to the high-quality care they deserve through Telehealth ABA services.
