Webinars

Applied Behavior Analysis Co-signature Requirements: Best Practices and Legal Considerations

Thursday, May 15, 2025

1:30 PM - 2:00 PM (EDT)

Hosted on Zoom

Event Details

Abstract

Recently several Medicaid agencies, Medicaid Managed Care Organizations (MCOs), and commercial health insurance payers have introduced co-signature requirements for applied behavior analysis (ABA) session notes. These requirements are often outlined in payer ABA policies or, specific documentation guidelines. Other times, requirements emerge as part of feedback during pre- or post-payment claims reviews and audits.

In some cases, payers require an authorized Qualified Healthcare Professional (QHP) co-sign all session notes for services rendered to any client on their caseload (e.g., for all 97153 or equivalent sessions). In other cases, the requirement stipulates that the parent or legal guardian co-sign all session notes for services provided on a given day (e.g., for all billable services related to the full adaptive behavior code set). CASP's session note templates do not currently include a section for co-signatures.

This webinar will review the Applied Behavior Analysis Co-signature Requirements: Best Practices and Legal Considerations white paper, developed by the Autism Legal Resource Center and the Council of Autism Service Providers (CASP). The presenters will discuss topics such as the requirements for “incident to” services, whether these standards apply to ABA, contractual obligations, the Wellstone-Domenici Mental Health Parity and Addiction Equity Act (MHPAEA), and faulty assumptions regarding the use of co-signatures to prevent fraud, waste, and abuse, or to enhance case management and direction activities.

Learning Objectives

Participants will explain why "incident to" services do not apply to technician-rendered services.
Participants will identify under what conditions a payer may require a co-signature.
Participants will explain how MHPAEA applies to co-signature requirements.

This webinar offers 1.0 BACB Learning CEU.

Cost

CASP Members - free
non-members - $20

Presenter

Mariel Fernandez

Mariel Fernandez is the Vice President of Government Affairs at the Council of Autism Service Providers (CASP), a Board-Certified Behavior Analyst (BCBA), and a Licensed Behavior Analyst (Tx). She earned her master’s degree in applied behavior analysis (ABA) from Auburn University in 2004.

Before joining CASP, Mariel held various leadership roles at a multi-state ABA organization, including regional leadership positions. She later led the Regulatory Affairs Department, where she coordinated across departments to ensure a clear understanding of regulatory and payer requirements and their impact on service delivery.

A passionate advocate for improved access to care, Mariel actively supports advocacy, public policy, and legislative initiatives at both the state and federal levels. During a time when leadership opportunities were limited, she focused on expanding her expertise by working with diverse populations in various settings. She gained a comprehensive understanding of all aspects of ABA service delivery, including clinical care, operations, compliance, regulation, contracting, credentialing, and revenue cycle management.

Mariel currently serves on the Texas Department of Licensing and Regulation (TDLR) Behavior Analyst Advisory Board and is the President of the Texas Association for Behavior Analysis Public Policy Group (TxABA PPG). In these roles, she played a pivotal part in the successful passage of behavior analyst licensure and the inclusion of autism services, including ABA, as part of the Texas Medicaid benefit. Additionally, Mariel chairs the Metro Care Services Intellectual & Developmental Disability Planning Network Advisory Committee (IDD-PNAC).

Dan Unumb

Dan Unumb is an attorney and the parent of a child with autism. As President of the Autism Legal Resource Center, a national law and consulting firm, he represents professional associations, autism service providers, and individuals with autism spectrum disorders and their families seeking access to services and has briefed autism issues in state and federal courts, including the U.S. Supreme Court. Dan previously served as Executive Director of the Autism Speaks Legal Resource Center. Before beginning full-time autism advocacy, Dan was the Director of Litigation for South Carolina Legal Services, a 10-office, statewide legal aid program. He has served as an adjunct professor in Legal Writing and Advocacy at George Washington University Law School and the Charleston School of Law, and as an instructor at the Justice Department’s National Advocacy Center. Dan graduated from Northwestern University School of Law, and previously practiced with law firms in Boston, Washington, D.C. and Charleston, SC, as well as the Civil Division of the U.S. Department of Justice. Dan is co-author of the law school casebook “Autism and the Law,” and has presented on legal topics pertaining to autism at numerous conferences and trainings including the National Legal Aid and Defenders Association, the Autism Society of America, the Autism Law Summit, the Association of Professional Behavior Analysts, ABAI, and the Council on Autism Services. Dan is the 2020 recipient of the Behavior Analyst Certification Board’s Michael Hemingway Behavior Analysis Award for his work in developing public policy related to behavior analysis and increasing access to behavior-analytic services.