Direct service providers rally for more money in the 2022-23 state budget at the Pennsylvania State Capitol on Tuesday, May 24, 2022 (Photo by Amanda Berg, for the Capital-Star).
By Dennis M. O’Brien
In an Oct. 3 Capital-Star article, Rep. Thomas Mehaffie, R-Dauphin, discussed the value of applied behavior analysis (ABA), an approach to assist individuals improve their social behaviors and prevent the loss of skills and functions. This approach is known to help people living with autism spectrum disorder.
But Rep. Mehaffie is advocating for legislation, HB19, that would hold Pennsylvania back rather than move us forward.
Serving people with autism spectrum disorder and behavioral health needs is a complex challenge. Ensuring access to good behavioral health supports and ABA was central to my work when I served in the House and remains so in my continuing work as an autism advocate.
While I believe that ABA is the gold standard, I oppose Mehaffie’s proposal because it will threaten Act 62 of 2008, Pennsylvania’s Autism Insurance Law, and restrict the providers who can use ABA to those with a specific certificate issued by a singular out-of-state board.
First, we need to accept that ABA is not a treatment intervention, rather it is a holistic therapeutic approach practiced by a large community of providers and individuals beyond those that hold the board certification. We also need to be aware that ABA applies to many practice areas, not just autism. ABA may be employed more broadly to treat substance abuse as well as other mental and behavioral health needs.
The access to this broad range of professionals, and the accompanying coverage, is because Pennsylvania is our country’s pioneer in the field of treatment for autism spectrum disorders. Act 62 which passed when I was speaker in 2008 guarantees services and coverage for individuals under 21.
Mehaffie claims that Pennsylvania has no oversight of the ABA discipline. That is simply not true. Pennsylvania’s Medical Board currently licenses more than 80,000 professionals, all of which are covered under Act 62. This includes 3,500 Licensed Behavior Specialists (LBS) who design, implement, and evaluate behavior modification interventions, including those based on applied behavior analysis. Board Certified Behavior Analysts should have no problem meeting the requirements to obtain the existing behavior specialist license.
Any attempt to restrict the practice of ABA to a certain group of individuals and carve out a separate licensure, as is proposed in HB19, without considering Pennsylvania’s existing law is shortsighted and dangerous for families who already have well-qualified ABA providers and those who would benefit from access to this support.
As of April 2021, only 1,482 professionals in Pennsylvania held the out-of-state certification required in HB19, meaning there are simply not enough board-certified behavior analysts in Pennsylvania to cover the needs of our state. This challenge will be even tougher on families in rural areas where finding a nearby provider will be more difficult.
The state’s Department of Human Services and Department of State oppose this bill out of concern that it will impede access for individuals in need of ABA support.
The harmful effects of this legislation are endless. Delays in accessing support from professionals who are able to provide ABA supports results in missed opportunities for children and youth who would otherwise developmentally benefit from this support. This leads to lifelong deficits for the people who are affected. Not only does that outcome burden Medical Assistance programs, but it will also be much more costly for taxpayers.
Creating this new licensure will compromise existing coverage for children requiring ABA supports and give insurance companies an excuse to discontinue reimbursement to professionals who are currently licensed as Behavior Specialists under Act 62. What will result is children and youth waiting for services and a greater strain on the Medicaid system.
Furthermore, this new licensure will cost more for individuals seeking the new credential as they will have to pay the costs and fees required by a California-based board which, again, is the only board that currently offers the certification.
It is evident – this is a complicated issue.
Given the countless professionals weighing in on HB 19 and the life-saving skills and coverage that are at stake, the Senate should postpone voting on the bill. The treatment needs of Pennsylvania’s children, and their families, should be our primary objective – not arbitrarily limiting their access to highly qualified professionals to appease an out-of-state board which will inevitably benefit from professionals seeking their credential.
Dennis M. O’Brien, a Republican, is the former speaker of the state House of Representatives. He is a long-time advocate for autism spectrum disorder issues.
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