Documentation Series

Payer Landscape Insights Part 2: Compliant, Sustainable, and Exemplary ABA Services

Thursday, August 27, 2026

3:00 PM - 4:30 PM (EDT)

Event Details

Abstract

As applied behavior analysis (ABA) continues to integrate into the broader healthcare system, expectations for alignment with medical necessity, documentation standards, and compliance requirements have become more defined. These expectations are shaped by established frameworks, including professional standards of care, payor policies, and applicable licensure and regulatory requirements.

This session presents a payor perspective on the evolving ABA landscape, highlighting how services are evaluated across key domains such as treatment planning, documentation, service intensity, progress monitoring, care coordination, and discharge considerations. Drawing on field observations and payer experience, presenters will outline common areas of variability that can influence authorization decisions, audit outcomes, and overall access to care.

The discussion will also examine how healthcare alignment, consistent application of compliance frameworks, and ongoing innovation in areas such as measurement and data use are influencing expectations for ABA services. Rather than prescribing specific operational approaches, this session will focus on the underlying structures and standards that inform payer evaluation and decision-making. Attendees will leave with a clearer understanding of how these factors intersect to support quality, accountability, and sustainable access within the ABA benefit.

Learning Objectives

Describe how established frameworks such as standards of care, payor policy, and licensure requirements shape the evaluation of ABA services within the healthcare system.
Recognize key areas of variability in ABA service delivery that may influence medical necessity determinations, utilization management, and compliance oversight.
Discuss how broader healthcare trends, including increased emphasis on quality measurement, accountability, and innovation, are influencing expectations for ABA services and access to care.

This webinar offers 1.5 BACB Learning CEU.

Presenters

Rebecca Womack, MS, LBA, BCBA

Rebecca Womack is the Director of Applied Behavior Analysis at Optum. Throughout her career, she has had the privilege of serving both children and adults through applied behavior analysis across a wide range of settings, including facility-based programs, group homes, day centers, clinics, and family homes throughout the United States and internationally.

Rebecca is especially passionate about ensuring that ABA services are effective, efficient, and aligned with generally accepted standards of care. She has extensive experience in healthcare documentation requirements, compliance systems, clinical quality, and the operational realities of delivering ABA services. She was also the lead author of a chapter addressing documentation guidelines for ABA services.

Rebecca previously served as President-Elect and as a Subject Matter Expert for the Association of Professional Behavior Analysts. She also represented the Behavior Analyst Certification Board on the ABA Coding Coalition. Additionally, she has served on the Standards Committee for the Autism Commission on Quality, as a co-chair of the Documentation Special Interest Group, and as a co-leader in the development of the Practice Parameters for Artificial Intelligence Use in Applied Behavior Analysis. Under her co-leadership, the Documentation SIG developed the first standardized session-note templates for ABA services. She currently serves on the BACB Board of Directors.

Rebecca also has extensive experience in public policy and has presented at national conferences on issues affecting ABA service delivery, healthcare documentation, clinical quality, and compliance. She has received multiple awards recognizing her advocacy and her work supporting ABA organizations in delivering high-quality services.

Across every role, Rebecca’s goal is to advance services that are clinically sound, operationally sustainable, and grounded in the science of behavior analysis.

Darren Sush, PSYD, BCBA-D

Darren J. Sush, PsyD, BCBA-D (he/him/his), is a licensed clinical psychologist and a board certified behavior
analyst (doctoral) with close to 20 years of experience developing and providing services based in applied
behavior analysis (ABA) for children and adults diagnosed with autism spectrum disorder (ASD) and
developmental disabilities. Dr. Sush is Head of Autism and Psychology with Evernorth Health Services, a
Cigna corporation, and is the coauthor of A Workbook of Ethical Case Scenarios in Applied Behavior
Analysis: First and Second Editions. He is an Adjunct Faculty member in the Applied Behavior Analysis
program at Pepperdine University, and an Associate Professor in the Applied Behavior Analysis and Clinical
Psychology programs at The Chicago School of Professional Psychology, teaching doctoral and master’s
courses in ABA and psychology. Within his practice, he has specialized in providing therapy for parents of
children with ASD and developmental disabilities. He has also presented at regional and national conferences,
has made appearances on several media outlets and podcasts, and has written for Psychology Today online,
focusing on resources and mental health for parents of children with ASD and developmental disabilities.