Portal Submission:

Relevant background: An RBT newly hired as a case supervisor submitted a concern regarding the onboarding and training practices at their new agency. The concern centers on trainees—some of whom are not yet RBT certified—being scheduled to provide direct therapy services with clients during their first week of training. The submitter reports that some individuals have not completed the 40-hour RBT training, have not passed the competency assessment, and may not have met the child’s BCBA before beginning services. The submitter questioned whether this practice is legal or ethical and whether billing 97153 for such sessions is permissible.

Possible solutions: The submitter contacted their trainer, who explained that the agency follows a structured 40-hour training program and that it is common for staff to work with clients prior to RBT certification. The trainer indicated that services during this period are supervised internally, though trainees may not meet the client’s BCBA directly at the start. The submitter remained concerned that these early sessions may not meet ethical or billing standards and asked whether continuing employment at this agency is advisable.

Credentialing: Reporter is an RBT

Committee Input (e.g., considerations for pathways forward, potential barriers, potential solutions):

Disclaimer: This guidance is not intended as legal advice.

Based on the information provided, the committee recognizes the submitter’s thoughtful inquiry and commitment to ethical practice.

Whether the practice of billing 97153 without an active RBT credential is legal or billable depends entirely on the payor contract. While the BACB does not require certification for someone to implement behavior-analytic services under supervision, some funding sources do.

From an ethical and clinical best practice perspective, the committee emphasizes the importance of:

• Ensuring that new staff are adequately trained and assessed for readiness before being left alone with clients
• Confirming that supervision is in place and appropriate to the staff’s skill level
• Billing accurately based on staff qualifications and payer expectations
• Maintaining transparent communication with clients and stakeholders about who is providing services

If the organization is knowingly billing for 97153 while employing staff who do not meet the payer’s stated credentialing requirements, or if they are misrepresenting staff qualifications to the funder or client, that would likely constitute both an ethics violation and potential fraud.

Considerations for exploration:

In accordance with the Ethics Code, the committee recommends:

• Request clarification from the agency’s leadership or compliance officer regarding payor requirements for each client served.
• Ask to review or receive confirmation that all funder contracts and supervision requirements are being met before beginning independent sessions.
• Observe whether staff are being adequately trained, supported, and supervised before being left alone with clients.
• If there is evidence that the company is billing for services delivered by individuals who do not meet the funder’s credential requirements, document the concern and consider consulting with the Arizona Board of Psychologist Examiners or the funding agency’s compliance department.
• If supervision is occurring and training is structured, there is no evidence of a reportable violation at this time.

Ethics Codes (specific standards that could apply to support/oppose):

• BACB Ethics Code for Behavior Analysts:
  1.02 – Conforming with Legal and Professional Requirements
  1.04 – Practicing Within a Defined Role
  2.01 – Providing Effective Treatment
  2.06 – Accuracy in Service Billing and Reporting
  2.08 – Communicating About Services
  2.19 – Addressing Conditions Interfering with Service Delivery
  3.01 – Responsibility to Clients
  4.01 – Compliance with Supervision Requirements
  4.04 – Accountability in Supervision
• A.R.S. § 32-2091.12:
  (a) – Incompetence in the practice of behavior analysis
  (b) – Gross negligence or repeated negligent conduct
  (o) – Engaging in conduct likely to deceive, defraud, or harm the public

Additional Resources:

●        BACB Ethics Code for Behavior Analysts (08/2024)

●        Arizona Behavior Analyst Licensure Statute A.R.S. § 32-2091

●        BACB Supervision Requirements

●        BCBA Handbook – Fieldwork & Supervision

●        BACB Reporting Guidance

Council of Autism Service Providers (CASP) ABA Practice Guidelines