Portal Submission:

Relevant background: I was recently informed that my former employer is billing for caregiver training when they send a video training series (no staff present): I left this company because of ethical concerns, but I continue to hear of concerns from current staff.

Possible solutions: I have spoken with their lead BCBA (recent graduate) as well as encouraging her to ask questions or seek other employment (as I did).

Credentialing: Reporter is an LBA, supervisor is an LBA

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

Disclaimer: The following guidance is based on relevant experience and resources and may differ by payor. This guidance is not intended as legal advice.

In regards to a BCBA billing email correspondence as caregiver training, it is first important to understand payer contracts. Regardless of the payer in this circumstance, both CPT® (97156)  and HCPCS (S5110) code billing for caregiver training require face-to-face contact to meet the threshold as a billable service. According to the ABA Coding Coalition (2024), to meet “face-to-face” criteria, “... the provider is actively engaging the patient or caregiver in assessment or treatment.”  Additionally, as further clarified by the ABA Coding Coalition (2019),

“There is no CPT code for reporting the indirect services separately, so they must be bundled with direct services for payment unless the contract with the payer includes a HCPCS or other code for reporting indirect services. As used here, bundled payment refers to payment for the work done prior to face-to-face time with the patient or caregiver (e.g., reviewing records), the work done with the patient or caregiver (e.g., delivering the treatment), and the work done after the face-to-face time with the patient or caregiver (e.g., writing a progress note). When payment is bundled, the face-to-face time is reported, but the work done prior to and after the face-to-face time is factored into the reimbursement rate.” 

Emailing documents would be considered an indirect service that is supplemental to the medical service code of caregiver support and would not stand alone as a billable service. Under no circumstances is it permissible that a BCBA bill any direct service CPT or HCPCS code that they were not physically engaged with the client and/or caregiver.

The Centers for Medicare and Medicaid Services (CMS) defines fraud as “intentionally submitting false information to the Government or a Government contractor to get money or a benefit.” It is the responsibility of the supervising Licensed Behavior Analyst to ensure compliance with appropriate use of the CPT® and HCPCS codes as outlined by the payer contract, American Medical Association, CMS and National Correct Coding Initiative (NCCI). Regardless of the organization policies, the Licensed Behavior Analyst, through their provider agreement to participate in a health plan, must comply with all applicable state and federal laws.  Practitioners who are unable or unwilling to align with applicable laws are subject AZBoPE and BACB disciplinary action.

While the original submission  was related to billing practices, the Ethics Committee does have additional concerns regarding the LBA/organization’s current caregiver support model.  While emailing support videos as supplemental exemplars would not be considered billable, these email correspondences should in no way serve as the only caregiver support provided by the BCBA. Follow-up information regarding standardized agency practices surrounding caregiver support would be warranted to determine if the organization/LBAs are indeed meeting their treatment requirement in this area.

The committee would like to acknowledge the reportee’s commitment to ethical practices and continued support of other Arizona behavior analysts. As a Licensed Behavior Analyst, the committee also reminds you that you are required to take action either by supporting your colleague in reporting these practices or doing so yourself.

Considerations for exploration:

In accordance with Ethics Codes 1.01, 1.02, 1.03, 2.06, 3.11, and 3.12, the committee recommends that the author attempt again to reach out to the overseeing BCBA(s) in question to discuss their concerns, if it is safe to do so and it is likely that a resolution can be reached.  It may be unlikely based on your description of events that a change in behavior will occur.  The committee would encourage the author to explore the following steps as options; this should not be considered legal employment advice:

1.    If you have not already done so, write a formal letter to your colleague and/or to the executive administration, educating them on and outlining our ethical codes of conduct surrounding accuracy in service billing and reporting. 

a.    Documentation of your concerns can provide a clear statement for follow-up. It also demonstrates action on your part following the identification of an ethical concern, safeguarding your license and ability to practice. 

2.    If meaningful change is not made to satisfy the ethical code of conduct, the LBA should consider following the complaint guidelines for the Arizona State Licensure Board. The Committee would encourage the reportee to explore filing a complaint with the licensure board against the Licensed Behavior Analyst in the organization who is inappropriately billing if mediation using other, more informal methods does not yield an improved result.

a.    Information on the complaint process can be found here: https://psychboard.az.gov/investigations

3.    Report the concern and/or any additional findings directly to the payer or health plan’s Fraud, Waste and Abuse Hotline as soon as possible. If multiple health plans are involved, a single report to the AHCCCS Fraud Waste and Abuse portal, or the Arizona Attorney General’s office can be made.  This can be done anonymously.

4.    For additional support navigating billing rules, please visit abacodes.org. 

5.    For additional information on previous ethics submissions regarding billing, please visit: https://azaba.org/page-18090/13359153 and  https://azaba.org/page-18090/13371102

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

●        1.01 Being Truthful

●        1.02 Conforming with Legal and Professional Requirements 

●        1.03 Accountability

●        2.01 Providing Effective Treatment

●        2.06 Accuracy in Service Billing and Reporting

●        3.01 Responsibility to Clients

●        3.11 Documenting Professional Activity

●        3.12 Advocating for Appropriate Services

●        ARS 32-2091.12(a), (e), (p), (z), (dd)

ABA Coding Coalition. 2024.  Frequently Asked Questions - ABA Coding Coalition. ABA Coding Coalition. https://abacodes.org/frequently-asked-questions/

ABA Coding Coalition. 2019. “Supplemental Guidance on Interpreting and Applying the 2019 CPT Codes for Adaptive Behavior Services.” https://abacodes.org/wp-content/uploads/2019/06/CPT_SupplementalGuidance190109.pdf

Potential Violation of Ethics Code: 1.03 - Accountability, 1.15 -Responding to Requests, 4.04- Accountability in Supervision, and 4.11 - Facilitating Continuity of Supervision

Relevant background: According to my records through an online fieldwork tracker I have completed the necessary supervised hours to be eligible to request sitting for my BCBA exam. I have completed my hours with two different employers. I contacted the initial employer l had started my hours with and was put in contact with the BCBA who completed supervision.  This BCBA reported they would happily sign off on my hours once I submit my final verification form to them. I informed the BCBA I would follow up in a few days with the completed form. 

I sent the verification form to the BCBA 7 working days ago and I have not received a response. I followed up the next working day to ensure it was sent correctly. The response I received to this second contact was an out of office reply with no context or end date reported. I waited 5 working days and followed up with the BCBA and the company they are employed with, to request a response. I have not received a response to this third request. I would like to know if this is a complaint which I should bring to the BACB.

Possible solutions: I have made three attempts to contact the BCBA and the company they work at.

Credentialing: Reporter is an RBT, supervisor is an LBA

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

Note: Before considering if a potential violation exists, it must be noted that it does not appear the reportee contacted the supervisor in a verifiable manner. It is encouraged that BCBAs are contacted  through the official BACB® portal. The BACB®s requires all certified individuals to register a contact method that is consistently monitored and required to be responded to.  Steps for using the portal are outlined below. 

The committee suggests that there is no official definition of "timely" in Arizona statutes or the BACB® policies, therefore, a timeframe of 30 days is often implied for submitting paperwork, including monthly verification forms (2024, pg. 22). Throughout the BCBA® Handbook, the BACB® suggests a reasonable timeframe across various response requirements: response can range from 14 to 45 days depending on potential risks (2024).

In order to determine if a complaint is warranted, the reportee should first take the following steps:

1.      Review the supervision contract for any agreed-upon stipulations regarding final verification hours including how and when final forms will be provided. It is recommended that all final verification forms be completed at the end of a supervised experience but required that the documentation is retained for at least seven years (2024, pg. 21-22).

2.      Reach out to the supervisor through the BACB® directly using the “Find a BCBA®” tool and document that attempt. It is important to use the supervisor’s BACB®-registered email through the portal as that is the email address the BACB® expects to be checked on a regular basis  (2024, pg. 41). Because it is unknown the status of the BCBA even having access to the email address of the agency, the email through the BACB® may likely count as the onset (i.e. day one) of attempting to retrieve a signature. 

3.      Where possible, provide the supervisor additional time (i.e up to 30 days) to respond. During this time, sending reminders would be appropriate. This demonstrates the reportees ability to provide compassionate and responsive considerations to the context and circumstances of the supervisor’s needs as a core principle of professional ethics.  Reminders should also be sent through the BACB® email tool directly as well and must also be clearly documented.

4.      Gather all supervision documentation, including monthly verification forms, as the online tracker alone is not sufficient evidence of completed supervision (2024, pg. 21). This documentation will be needed if the situation is escalated to step 5.

If there is still no response or signed verification after the above steps, it is encouraged that the reportee documents communication outlining both the ethical concerns and also requests for remedy to avoid reporting the potential ethical violation. If the situation has not resolved, proceed to step 5:

5.      Complete and submit a Contested Fieldwork Form to the BACB® (2024, pg. 2024).

 

At this point, the reportee may consider reporting concerns to the Arizona Board of Psychologist Examiners for possible violation of 32-2091 (12) (dd).

Considerations for exploration:

The BACB® suggests that speaking to the alleged violator of the ethics code before filing a complaint in an attempt to remedy the grievance.  It is important to try to work on issues together, where appropriate.  Because this supervisor appeared to be willing to complete forms, it is assumed that the supervisor is not intentionally withholding verification and may instead not have access to their work email. 

The committee suggests that when completing fieldwork hours, it is necessary to have a supervision contract that outlines expectations for all parties involved in how hours will be collected, verified and approved.  Per the BACB® Handbook (2024), each monthly verification form “...must be signed by the last day of the calendar month following the month of supervision,” while the Final Verification Form should “..be signed at the end of a specific fieldwork experience” (p 22).  Since the reportee notes that supervision was completed with a previous employer, the Final Verification Form should have been completed prior to or immediately following employment departure.  While records should be maintained for at least seven years, the supervisor and supervisee should prioritize getting verification forms signed before one of the parties terminates their supervision and/or employment relationship with their employer..

As a note: when looking for an appropriate supervisor, it is important to openly review process concerns and also have a way to contact each other outside of work emails in the event that one of the parties discontinues their employment. 

Although timeliness is of the utmost importance, especially with regard to Arizona’s immediate need for licensed and credentialed Behavior Analysts, it does not appear that the supervisor meets the threshold of an ethical violation.  Per the anonymous submission, it appears that the original request for signed forms had gone without response for only 7 working days - of which 6 of those days it is believed the supervisor did not have access to the company email. 

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

●       1.15 Responding to Requests

●       ARS 32-2091 (12) (dd)

Additional Resources:

●       BACB® Handbook:

Behavior Analyst Certification Board. (2024). Board Certified Behavior Analyst Handbook. https://www.bacb.com/wp-content/uploads/2022/01/BCBAHandbook_240426-a.pdf

●       Reporting to the Ethics Department Guidelines: https://www.bacb.com/ethics-information/reporting-to-ethics-department/

●       Contested Fieldwork Form: https://www.bacb.com/contested-experience-fieldwork-form/

Portal Submission:

I have encountered a situation where I believe there is fraudulent billing, or at least untruthful behavior. The situation consists of RBTs billing for services that they are not present for (typically for 30 minutes) and other RBTs were billing under names that were not their own. For example, RBT 1 has Client 8:30- 12:00 on their schedule and will bill for this entire time. However, RBT 1 is only present from 8:30 – 11:30. RBT 2 comes in with the client 11:30- 12:00. At the end of the day, RBT 1 writes their billing note as if they were present from 8:30-12:00. Nowhere in the record is it stated that RBT 2 took over for any duration of time. (1.01 Being Truthful, 2.06 Accuracy in service billing and reporting).

I have brought this up to my supervisor and the chief of staff at the company I work for. Both are BCBA's. I was told not to worry about it and that there is no ethical violation and that the BCBA has done this at other companies. I am still not comfortable with this practice, so I am not having any RBTs that I supervise engage in this behavior. However, I know it is still being conducted across the company in their other locations. I was told that because the BCBA cosigns the note that it doesn't matter what RBT is present for the services and that it can be all billed under one regardless of if they were not present for 30 minutes of the time they are billing for.

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

Under no circumstances is it permissible that an RBT or BCBA bill any CPT codes that they were not present for.  The Centers for Medicare and Medicaid Services (CMS) defines fraud as “intentionally submitting false information to the Government or a Government contractor to get money or a benefit.”  Based on the description provided it is possible, if not likely, that fraud is occurring.  Additionally, when an RBT or BCBA signs a session note that contains purposeful/intentionally inaccurate information, they are falsifying medical records.

It is the responsibility of the supervising Licensed Behavior Analyst to ensure compliance with appropriate use of the CPT® codes, as outlined by the payor contract, American Medical Association, CMS and National Correct Coding Initiative (NCCI). Regardless of the organization policies, the Licensed Behavior Analyst, through their provider agreement to participate in a health plan, must comply with all applicable state and federal laws.  Practitioners who are unable or unwilling to align with applicable laws are subject AZBoPE and BACB disciplinary action.

The committee commends the reportee on identifying that these practices are unethical.  It is important to note that most provider contracts, as well as 32-2091, require any licensed behavior analysts who becomes aware of, or suspects, fraudulent activity to report such activity to the appropriate regulatory organization (i.e. funder, AZBoPE).

As a Licensed Behavior Analyst, you are now required to take further steps to either educate or hold others accountable for their behavior. 

Considerations for exploration:

In accordance with Ethics Codes 1.01, 1.02, 1.03, 2.06, 3.11, and 4.04, the committee recommends that the author attempt again to reach out to the overseeing BCBA(s) in question to discuss their concerns, if it is safe to do so and it is likely that a resolution can be reached.  It may be unlikely based on your description of events that a change in behavior will occur.  The committee would encourage the author to explore the following steps as options; this should not be considered legal employment advice:

1.      If you have not already done so, write a formal letter to your supervisor and to the executive administration, including HR, educating them on and outlining our ethical codes of conduct surrounding accuracy in service billing and reporting. 

a.      Documentation of your concerns can provide you protection against wrongful termination and provides a clear statement for follow-up. It also demonstrates action on your part following the identification of an ethical concern, safeguarding your license and ability to practice. 

2.      If meaningful change is not made to satisfy the ethical code of conduct, the LBA should consider following the complaint guidelines for the Arizona State Licensure Board. The Committee would encourage the reportee to explore filing a complaint with the licensure board against the licensed behavior analyst in the organization who is supervising the inappropriately billing, and/or engaging in the inappropriately billing themselves if mediation using other, more informal methods does not yield an improved result.

a.      Information on the complaint process can be found here: https://psychboard.az.gov/investigations

3.      Report the concern and/or any additional findings directly to the payor or health plan’s Fraud, Waste and Abuse Hotline as soon as possible. If multiple health plans are involved, a single report to the AHCCCS Fraud Waste and Abuse portal, or the Arizona Attorney General’s office can be made.  This can be done anonymously.

4.      If resolution cannot be achieved, the author may need to explore ethical and values-aligned employment opportunities.

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

●       1.01 Being Truthful

●       1.02 Conforming with Legal and Professional Requirements 

●       1.03 Accountability

●       2.06 Accuracy in Service Billing and Reporting

●       3.11 Documenting Professional Activity

●       4.04 Accountability in Supervision

●       ARS 32-2091.12(a), (e), (z),

Submission:

I am an RBT in a clinic setting. Recently, we have had too many clients and not enough staff. As a result, the clients are scheduled for group ABA sessions with other clients to fill the necessary gaps. Clients are grouped together for clinic ease rather than by program fit. I wanted to reach out to see if this is a potential ethical violation. The staff that are providing group therapy services often have not been trained on how to run group sessions and there is limited support because analyst trainees have also been utilized for direct sessions frequently.

We have RBTs that are creating the schedule at the moment. The RBTs make the direct therapy sessions for everyone that provides direct services.

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

First, in addition to compliance with all CPT® code descriptions, services rendered must be based on the individual medical necessity needs of the person receiving services. Group services are an excellent practice to ensure natural contingencies are being trained and supervised.  These services should only be rendered to benefit the client to include appropriate pairing, supervision, compliance with the treatment plan, and observation to allow for quick changes if the setting or pairings are not good fits.  Under no circumstance should grouping happen in the event that staff is not trained, or pairings are not appropriate, solely to aid the company with staffing issues.  Children receiving group ABA must receive the same amount of diligence for setting targeted group goals, data collection, and treatment planning.

Additional concerns of group billing  include (1) this may encourage the business to inflate the requested medically necessary service units needed to be able to bill for things that are otherwise non-billable, which includes billing for a service that is not indicated or appropriate as a medical necessary service, like pairing children who do not have the same type of goals, (2) engaging in this practice they may be potentially taking away opportunity for medically necessary sessions that should be provided directly to your client with proper pairings and goals, (3)  the organization response appears to indicate that this is occurring as a standard of practice across multiple clients. This may leave many vulnerable individuals and their families without access to medically necessary ABA services should their benefits be exhausted. If the service is not meeting medical necessity standards and is instead serving the need of childcare, no medical billing should be occurring.

In accordance with Ethics Codes 1.03, 2.01, 2.06, 2.14, 2.16, 2.19, 3.01, 4.01, 4.04, and 4.06, the committee recommends that the author reach out to the overseeing BCBA(s) in question to advocate for the level of supervision of technicians and clients that is commensurate with ethical standards. The committee would encourage the author to explore the following steps as options; this should not be considered legal employment advice:

1.       Write a formal letter to your supervisor and to the executive administration, including HR, educating them on and outlining our ethical codes of conduct surrounding RBT supervision and training, caseload size, and accuracy in service billing and reporting.  Provide suggestions to them on ways in which they can support BCBAs in your agency that are more conducive to best practices in supervision and quality care for clients.

a.       Documentation of concerns can provide you protection against wrongful termination and provides a clear statement for follow-up. It also demonstrates action on your part following the identification of an ethical concern, safeguarding your license and ability to practice. 

2.       If meaningful change is not made to satisfy the ethical code of conduct, the BCBA should send their letter to the ethics committee at the BACB and/or the Arizona State Licensure Board and follow complaint guidelines.

It is the responsibility of the Licensed Behavior Analyst to ensure compliance with appropriate use of the CPT® codes, as outlined by the payor contract, AMA, CMS and NCCI. Regardless of the organization policies, the Licensed Behavior Analyst, through their provider agreement to participate in a health plan, must comply with all applicable state and federal laws.  Practitioners who are unable or unwilling are subject to BACB and AZBoPE disciplinary action.  

Considerations for exploration:

The committee acknowledges that any breach in the BACB Ethics Code is reportable to the Arizona State Licensure Board. The Committee would encourage the reportee to explore filing a complaint with the licensure board, against the party in the organization who is inappropriately allowing clients to be put into groups that are not otherwise indicated.  supervising a client, if mediation using other, more informal methods does not yield an improved result.

●        Information on the complaint process can be found here: https://psychboard.az.gov/investigations

If resolution cannot be achieved, the author may need to explore ethical and values-aligned employment opportunities.

●        While the BCBA has a responsibility to provide adequate supervision for a client, they are also responsible for providing adequate supervision for the RBTs they oversee. If this BCBA is overseeing RBTs, it is advised that the RBT ensure appropriate documentation of supervision is available to them.

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

●      1.03 Accountability

●      2.01 Providing Effective Treatment

●      2.06 Accuracy in Service Billing and Reporting

●        2.14 Selecting, Designing, and Implementing Behavior-Change Interventions

●        2.16 Describing Behavior-Change Interventions Before Implementation

●        2.19 Addressing Conditions Interfering with Service Delivery

●      3.01 Responsibility to Clients

●      4.01 Compliance with Supervision Requirements

●      4.04 Accountability in Supervision

●      4.06 Providing Supervision and Training

●      ARS 32-2091.12(e),(o)

Potential Violation of Ethics Code: Double Billing Concern from Providers  

Relevant background: “When approving session notes for my child's ABA, I noticed what looked like double billing. Both the newly assigned BCBA and the student analyst (who has been the primary case manager) submitted sessions for the same parent meeting. This meeting did occur, but it is my understanding that only one of them should be billing 97156 for this appointment. However, they both have billed the same code for the same time and date. When I reached out to the organizations billing department, this was the response "They can when one is shadowing, it happens quite often.  And as long as our billed units stay within what our authorization is for, it has not been a problem with Insurances.”

Possible solutions: “I am looking for confirmation either way before proceeding as I do not feel comfortable signing off these sessions.”

Credentialing: N/A, reporter is a consumer

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

Disclaimer: The following guidance is based on relevant experience and resources and may differ by payor. This guidance is not intended as legal advice.

It may be important to consider circumstances in which multiple appointment notes may be submitted to the family for documentation, but billing may only be completed by one provider.  To verify what has been submitted to your funder, review your Explanation of Benefits (EOB) documentation (commercial insurance) to confirm if duplicate billing was submitted. The student analyst model is only allowable in Arizona for AHCCCS plans. AHCCCS plans are not required to supply EOBs, therefore families are recommended to contact member services on the back of your insurance card for specific claim information.

If both appointments are indeed being billed to your insurance plan, this is an unacceptable use of 97156. Under both the American Medical Association (AMA) CPT® coding description, as well as the National Correct Coding Initiative (NCCI) policy, 97156 is to be billed when a single provider is rendering a service.

In addition to compliance with all CPT® code descriptions, services rendered should be based on the specific medical necessity needs of the individual receiving the services. Services such as shadowing, training, and employee supervision are considered organizational costs and not allowable justifications for billing any of the CPT® codes to a payor. 

Therefore, the agency’s statement that it’s acceptable as long as it falls within the authorization is misaligned with policy and legal considerations associated with health plan’s prior authorization processes and therefore may be a direct violation of their payor contract. Additional concerns include speculation that the business is inflating hour requests to cover non-billable activities and/or that the business is taking away the opportunity for medically necessary sessions that are available to the family.

It is the responsibility of the Licensed Behavior Analyst (assigned as your provider) to ensure compliance with appropriate use of the CPT® codes, as outlined by the payor contract, AMA, CMS and NCCI. Regardless of the organization policies, the Licensed Behavior Analyst, through their provider agreement to participate in a health plan, must comply with all applicable state and federal laws.

We recommend that the reportee review ARS 32-2091.12 which outlines, “Unprofessional Conduct” to include:

·        (a) Obtaining a fee by fraud or misrepresentation;

·        (e) Gross negligence in the practice of a behavior analyst; 

·        (o) Providing services that are unnecessary or unsafe or otherwise engaging in activities as a behavior analyst that are unprofessional by current standards of practice.

Considerations for Explorations: 

It’s recommended that the reportee consider taking the following actions:

• 1.      As the client representative/caregiver, consider declining consent to allow for the duplicate billing.
• 2.      Consider gathering additional consumer documentation available to you as it relates to any other potential concerns related to duplicate billing (i.e., EOB, member services) to determine the extent to which this has occurred.
• 3.      Report the concern and/or any additional findings directly to your child’s specific health plan’s Fraud, Waste and Abuse Hotline as soon as possible. This can be done anonymously.
• 4.      If after you have gathered sufficient information to determine that a violation has occurred, consider filing a complaint with the Arizona Board of Psychologist Examiners. 

Applicable BACB® Ethics Codes and Arizona Revised Statute (identified by the committee)

BCBA® Codes:

1.02 Conforming with Legal and Professional Requirements

2.01 Providing Effective Treatment

2.06 Accuracy in Service Billing and Reporting

2.07 Fees

3.01 Responsibility to Clients

3.05 Financial Agreements

3.12 Advocating for appropriate services

ARS:

ARS 32-2091.12 (a) (e) (o)

Scenario: Agency director (LBA) resigned at the same time as the only other LBA at the agency. LBA tendered resignation with six weeks’ notice. Following resignation notice, the agency is insisting on LBA submitting prior authorization and completing ABA assessments for new clients. Agency is requesting that the LBA complete assessment and hand off data collected to a future, unspecified behavior analyst to develop treatment recommendations and continued care. No additional BCBAs or LBAs are currently employed or credentialed with funders at the agency.

Relevant background: The BCBA and director expressed concerns regarding obvious inability to guarantee services for clients given lack of available provider. Agency has also delayed communication with current clients’ families regarding BCBA’s departure and possible disruption of services. Director and BCBA have expressed verbally and in writing the importance of timely notification of families. Agency owner is licensed in another field and has their own ethical code of conduct to uphold.

Possible solutions: Delay intake of additional clients until new LBA is on board and credentialed as a provider. Refer all waitlist clients to other agencies. Immediately communicate staffing changes to all current clients/families and provide other agency recommendations.

Credentialing: LBA’s supervisor is not a BCBA and is not bound by BACB ethical code of conduct.

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

Ethics Code 3.03 describes the parameters in which a behavior analyst would accept clients including but not limited to available staffing.  Without a clear pathway for transition personnel identified, and evidence that those personnel have the requisite credentialing, we advise caution in accepting and assessing new clients. 

Ethics Code 3.04 requires a clear service agreement to be completed before services begin – the service agreement requires the roles and responsibilities of all necessary parties be outlined – it is unclear based on the provided information if that would be possible given the circumstance.  The LBA should exercise caution for new/additional service agreements and ensure that their role is defined clearly, including their exit timeline for the client/stakeholders. 

Ethics Code 3.16 and 3.13 outline the LBA’s obligation for transitions of care and referrals to other providers = ensuring that families avoid disruptions in services.  This would be the recommendation should no additional behavior analyst be identified in the time available for LBA. 

Considerations for Explorations: 

It is recommended that the reportee explore the following steps, if they haven’t been completed to date, including documenting all actions taken and the eventual outcomes:

• Communicate, per the ECBA, the requirements for client acceptance, service agreements, and transitions of care to agency leadership as mentioned.
• Educate families on options for other providers, and support navigation/transition, if desired. Consult the Continuity of Services Toolkit provided by the BACB. 
• The LBA may consider a review of the ethics code/code of conduct subscribed to by organizational leadership and determine if standards relating to assessment, coordination of care, or transition of services are indicated. 

Applicable Ethics Codes and ARS (identified by the committee)

• 3.03 Accepting Clients
• 3.04 Service Agreements
• 3.13 Referrals
• 3.16 Appropriately transitioning services
• ARS 32-2091.12(v)

Additional Resources:

• Continuity of Services Toolkit (https://www.bacb.com/wp-content/uploads/2022/01/Continuity-of-Services-Toolkit-230124-a.pdf) 

Possible Ethics Issue: “2.15, 2.16, 2.01, 3.01”

Relevant background: “I was told by an employee of a company that an RBT has been sitting on a client in order to prevent SIB/elopement. CPS has been notified and the employee states that the RBT has been taken off the case. Do I have any obligation to report to the az psychology board if I did not witness the incident?”

Possible solutions: “Followed up to ensure the client is no longer being harmed, mandated reporter alerted proper authorities.”

Credentialing: Reporter is an LBA; Supervisor is an LBA

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

The committee agrees with the identified ethics codes by the reportee, particularly 3.01 Responsibility to Clients, which explicitly outlines that behavior analysts do no harm and are bound to always protect the best interests of the client. 

The Arizona Board of Psychologist Examiners (AZBoPE) do not regulate or have any jurisdiction over RBTs, or their credentialing as such.  However, the reportee has an obligation to report this incident to the BACB who does hold power over the credentialing of the RBT in question. 

The supervising LBA of this case, is subject to board licensure requirements, particularly ARS 32-2091.12(e) Gross Negligence and 32-2091.12(o) providing services that are unsafe.

Considerations for Explorations: 

The reportee should explore the following actions, as soon as possible, in the interests of consumer safety:

• The reportee, and/or the employee witness, should attempt to contact the LBA who is supervising the case, or if that information is unknown a supervising BCBA at the organization, to alert them that a report is pending, both with the AZBoPE and BACB.  The contact made should provide them with an opportunity to respond with additional actions that have been taken.
• The reportee and/or employee witness should ensure that the following actions have been taken.  If confirmation does not come from the original supervising LBA and/or organization, the reportee and employee should consider taking the following actions:
• • Support/coach the employee who witnessed the behavior to contact the BACB and file a report of the incident that they witnessed, providing at minimum the RBT certification number.
  • Determine if a report needs to be made to AZBoPE for the supervising LBA per licensure regulations for gross negligence and providing unsafe behavior analytic services.   It may be that the LBA and organization are undertaking appropriate reporting and education to remedy the situation, and in this case an additional report to the AZBoPE may not be necessary. 

Applicable Ethics Codes and ARS (identified by the committee)

ECBA Codes:

2.15, 2.16, 2.01, 3.01

ARS

ARS 32-2091.12(e) Gross Negligence; ARS 32-2091.12(o) Providing Unsafe Services  

Scenario: Should the BCBA be allowed to practice if we do not know what caused the drop from the insurance? Are there any additional supervision steps that should be taken with this provider?

Relevant background: We have a BCBA on staff who has been dropped by Medicaid in a state other than AZ which has led to an AZ insurance company also dropping her. What obligations do we have as a company to investigate, and what steps are recommended moving forward. All current clients are in network. The clients affected have been transferred. State license for dropped state is no longer active and BCBA reports they have not practiced in that state in years. Additional steps if any need to be taken to ensure we have done our due diligence?

Possible solutions: Aftertalking to the BCBA they reported they had no idea and did not know what was going on. We have reached out to state Medicaid that dropped. They will not disclose due to the company not practicing in the state. We have further reached out to AZ based insurance that dropped; they will also not disclose. BCBA does not have any pending investigations etc. that are public.

Credentialing: Person is a credentialed behavior analyst/LBA

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

Based on provided information, it does not appear that the company has any additional obligations to investigate and is left with the determination of keeping the BCBA on staff.  It would be valuable and responsible for the agency to look through the Medicaid Fraud Registry through the Office of the Inspector General for all current employees.  This resource may be able to provide information on the matter. 

As far as the BCBA with the claim, there are many regulations that would point to continuing to investigate this matter.

Ethics code 2.06 describes ethical standards for billing accurately, though the rules and regulations for what is considered “ethical” in terms of who can bill what billing codes varies per insurance contract. It is the BCBA’s responsibility to ensure all billing conducted under their license is occurring according to the accepted standards for that specific insurance company and plan. Ethics code 1.01 explains that BCBAs have an obligation to remain truthful and honest with those involved in their practice, and should make all attempts to conform to professional standards (1.02). This should include standards provided by the insurance companies.

Arizona Revised Statutes 32-2091 12 outlines “unprofessional conduct” as gross negligence (12e), violating state or federal law (12k), actions in another jurisdiction resulting in censure or probation (12n), and abandoning or neglecting clients without a transition plan (12v).

It is recommended that the BCBA do the following:

• Obtain documentation from the insurance company as to why they were dropped as a provider. This information should then be shared freely with the employer. It is possible that this action of transparency would result in the company being unable to retain the BCBA as a provider altogether. For example, if the company only contracts with UHC, for instance, and this provider has been permanently banned as a provider with UHC, this would mean the BCBA may be unable to bring in revenue to support their continued employment. Though this may be a very unwanted outcome for all parties, it is important the employers have this information so they can ensure their clients/families can continue care with a licensed and credentialed provider who is able to provide services within their available resources (i.e. insurance-paid treatment).

Considerations for Explorations:

• As the Ethics Code states, BCBAs should remain knowledgeable of requirements from governing entities (funders) and should self-report where relevant.  This should include reporting any fraudulent billing, criminal history or investigations that should be disclosed to the BACB, AZ Board of Psychologist Examiners and funders with which they are attempting to credential.  The Ethics committee believes the BCBA should self-report where necessary to ensure all licensing bodies are aware of any complaints to avoid future misconduct.

Applicable Ethics Codes and ARS (identified by the committee)

• 2.06 Accuracy in Service Billing and Reporting
• 1.01 Being Truthful 
• 1.02  Conforming with Legal and Professional Requirements
• 1.16 Self-Reporting Critical Information
• ARS 32-2091 12. "Unprofessional conduct" includes the following activities, whether occurring in this state or elsewhere: Obtaining a fee by fraud or misrepresentation.
• ARS 32-2091 12(e) Gross negligence in the practice of a behavior analyst.
• ARS 32-2091 12 (k) Violating any federal or state law that relates to the practice of behavior analysis or to obtain a license to practice behavior analysis.
• ARS 32-2091 12 (n) Unprofessional conduct in another jurisdiction that resulted in censure, probation or a civil penalty or in the denial, suspension, restriction or revocation of a certificate or license to practice as a behavior analyst.
• ARS 32-2091 12 (v) Abandoning or neglecting a client in need of immediate care without making suitable arrangements for continuation of the care.

Additional Resources:

• OIG: https://exclusions.oig.hhs.gov/

Portal Submission/Scenario

Possible Ethics Issue: “Transition of Services”

Relevant background: “Put in a 30 day notice, new bcba starting and can transition my cases over. Employer is forcing me to stay for 90 days due to credentialing.”

Possible solutions: “Contacted a lawyer, lawyer stated I can leave however wondering if my license would be affected even if I put a 30 day notice in”

Credentialing: Reporter is “an LBA, I’m not credentialed”, My supervisor is not bound to the BACB Ethics Code (e.g., they are not an LBA, and no other comparable supervisor is an LBA)

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

We recommend that the reportee review ‘Section 3- Responsibility to Clients and Stakeholders’, in the Ethics Code for Behavior Analysts, particularly codes 3.14 Facilitating Continuity of Services and 3.16 Appropriately Transitioning Services for guidance on what to do when leaving an organization and the clients/stakeholders therein.

We also recommend that the reportee review ARS 32-2091.12(v) (found here: https://www.azleg.gov/ars/32/02091.htm) which outlines, “Unprofessional Conduct” to include, “Abandoning or neglecting a client in need of immediate care without making suitable arrangements for continuation of the care.”

Considerations for Explorations: 

There are to our knowledge no specific requirements within the Arizona Licensing Statutes or Ethics Code for Behavior Analysts, for the length of a transition given the many circumstances and variables that exist within our therapeutic environments. 30 Days’ Notice is a field standard of practice that is generally considered to be sufficient to facilitate successful transitions.

Without more information on what is meant by ‘credentialing’, we can only assume that Funder credentialing is being referred to here.  We are not able to provide detailed guidance on navigating the vast number of funder requirements, and instead encourage the reportee to review the ARS and Ethics Code guidance above.  We affirm that the reportee is not responsible for ensuring the credentialing of a new Behavior Analyst taking their place, but recommend that the reportee take reasonable steps to understand the funder requirements for which they are credentialed and do their best to inform and collaborate accordingly.

Applicable Ethics Codes and ARS (identified by the committee)

ECBA Codes:

3.14 Facilitating Continuity of Services

3.16 Appropriately Transitioning Services

ARS

ARS 32-2091.12(v)

Scenario

An RBT has a court date for a DUI to get the final charges and wants to know if this should be reported to the BACB now or after charges.

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

In accordance with the BACB’s RBT Handbook  (https://www.bacb.com/wpcontent/uploads/2022/01/RBTHandbook_230407-a.pdf), the following would apply as reportable to the Board:

1. public health and safety tickets, citations, or fines greater than $750 (USD or equivalent) or of any amount if the situation involved or occurred in the presence of a client (page 26).
2. criminal or civil suits in which you have been found guilty, have entered a plea of no contest, or have otherwise been sanctioned related to a misdemeanor or felony involving public health and safety or the delivery of behavior analytic, health-care, educational, or other human services (this must be reported within 30 days of becoming aware of the criminal or civil suit) (page 26). 

Once a decision from the court is made, the individual can follow the BACB’s guidance on whether this is reportable or not to the BACB.

It is advised that the RBT reach out to their supervising BCBA or HR department to discuss potential barriers to completing services and notify them if client sessions will need to be canceled or transitioned to another technician to account for loss of ability to get to/from place of employment.

Applicable Ethics Codes and ARS (identified by the committee):

• RBT Ethics Code 2.0 (https://www.bacb.com/wp-content/uploads/2022/01/RBT-Ethics-Code-230120-a.pdf)
• • 3.04: RBTs are aware of the events they need to self-report to the BACB and any other required entities (e.g., employer, supervisor). They self-report to the BACB within 30 days of the event or within 30 days of becoming aware of the event. RBTs are required to self-report to the BACB any event that might impact their ability to effectively carry out their behavior technician services or comply with BACB requirements, including:  
  • • legal charges and subsequent related actions;  
    • investigations by employers, governmental agencies, educational institutions, or third-party payers naming the RBT;  
    • disciplinary actions by employers (including suspensions and terminations for cause), governmental agencies, educational institutions, and third-party payers; OR  
    • physical conditions, mental conditions, or substance abuse that may impair the RBT’s ability to safely provide behavior-technician services. 
• 1.09:  RBTs are aware that their personal biases or challenges (e.g., mental or physical health conditions; legal, financial, marital/relationship challenges) may impact their ability to effectively carry out their behavior technician services. If their biases or challenges may impact services, they take steps to resolve the issue (e.g., developing an action/care plan, reporting to their supervisor, refraining from working with clients until the issue is resolved, reporting to the BACB) and document these actions.