防止保险拒绝基于滥用医学上不太可能的编辑 (MUE) 的应用行为分析治疗
Julie Kornack1, Daniel R Unumb2, Ashley L Williams3
1Center for Autism and Related Disorders, Marco Island, FL USA.
Behavior analysis in practice
|July 3, 2025
概括
医学上不太可能的编辑 (MUE) 可以不适当地限制自闭症护理的医学上必要的应用行为分析 (ABA). 保险公司不应该使用MUE作为固定限额,因为它们旨在防止欺诈,而不是限制治疗访问.
科学领域:
- 医疗保健管理部门的管理.
- 行为健康 行为健康
- 自闭症谱系障碍 治疗 治疗
背景情况:
- 保险覆盖对于自闭症护理中医学必要的应用行为分析 (ABA) 服务至关重要.
- 保险公司可以对ABA服务施加人为限制,包括范围,强度,持续时间或受益人.
- 医学上不太可能的编辑 (MUE) 是一个细微但重要的领域,保险公司可以不适当地限制ABA护理,获取和质量.
研究的目的:
- 突出保险公司在应用行为分析 (ABA) 中不适当使用医学上不太可能的编辑 (MUE).
- 为了教育行为分析师和利益相关者,了解MUE的真正目的,以及它们对限制医疗必要的ABA服务的潜力.
- 倡导正确使用MUE,以保护获得ABA治疗的机会,而不影响护理标准.
主要方法:
- 关于应用行为分析 (ABA) 的医学不太可能编辑 (MUE) 的保险行业实践分析.
- 审查医疗保险和医疗补助服务中心 (CMS) 的指导方针和MUE计划的最初意图.
- 审查付款人目前如何应用MUE及其对ABA服务交付的影响.
主要成果:
- 保险公司错误地使用MUE作为ABA治疗的绝对限制,与其预期的目的相反.
- 行为分析师可能会无意中强化这些不适当的限制,将MUE视为不可谈判.
- 一些付款人目前的MUE应用削弱了医疗必要的ABA服务的获取和质量.
结论:
- 医学上不太可能的编辑 (MUE) 由CMS实施用于欺诈检测,而不是限制医学上必要的ABA服务.
- 付款人,监管机构,政策制定者和行为分析师必须解决MUE的滥用问题,以确保适当地访问ABA.
- 正确使用MUEs对于防止威胁自闭症护理和ABA治疗标准的不适当限制至关重要.
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