The Comprehensive Autism Care Demonstration: Solutions for Military Families (2025)
Chapter: Appendix F: Positions on Applied Behavior Analysis of Professional Health Organizations
Appendix F
Positions on Applied Behavior Analysis of Professional Health Organizations
SUMMARY OF REVIEW OF ABA EVIDENCE BASE BY COMMERCIAL PAYORS
Of the policies of commercial payors that the committee reviewed, Anthem, Cigna, UnitedHealthcare, Magellan, and Kaiser Permanente included either background information on applied behavior analysis (ABA) or a rationale for coverage of applied behavior analysis (ABA) in their publicly available coverage policies. Below is an overview of the evidence that is cited in their decision to cover ABA.
Anthem lists 17 peer-reviewed publications on the effectiveness of ABA, including randomized controlled trials (RCTs) and meta-analyses or systematic reviews.1
Cigna notes that early intensive behavioral intervention (EIBI), a comprehensive ABA approach for younger children, is supported by systematic reviews, a few RCTs, and a substantial single-subject literature. Finally, Cigna references a Cochrane review of the evidence for the effectiveness of EIBI in increasing functional behaviors and skills, decreasing autism severity, and improving intelligence and communication skills for young children with autism.2
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1 For a full list of references, see https://web.archive.org/web/20220622035206/https://www.anthem.com/dam/medpolicies/abc/active/guidelines/gl_pw_c166121.html
2 For a full list of references, see https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/en_mm_0499_coveragepositioncriteria_intensive_behavioral_interventions.pdf
UnitedHealthcare has a published section on its rationale for ABA coverage in which it states that ABA is proven for the treatment of autism spectrum disorder in children when the following criteria are met (UnitedHealthcare, 2017):
- The intervention is a systematic approach, based on the principles of comprehensive ABA;
- The intervention targets the core deficits of an autism spectrum disorder, as outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth edition, Text Revision;
- The intervention is delivered in a home center/office or community setting as clinically indicated;
- The intervention is rendered directly by a Board Certified Behavior Analyst, a licensed mental health clinician with additional documented training in ABA, or a paraprofessional under the direct supervision of such professionals;
- The intervention is delivered with an appropriate level of intensity (e.g., per Behavior Analyst Certification Board practice guidelines) and includes ongoing measurement of efficacy: the use of measurement tools and analysis of progress should be continuous, and treatment decisions should be based on objective analysis of assessment results; and
- ABA is provided at the least restrictive and most clinically appropriate level to safely, effectively, and efficiently meet the needs of the individual. ABA is needed for reasons other than the convenience of the individual, family, physician, or other provider. ABA is not more costly than an alternative service, which is at least as likely to produce equivalent therapeutic results for the individual.
Additionally, UnitedHealthcare notes that according to a number of recent systematic reviews and meta-analyses, early intervention based on ABA is associated with positive outcomes for children with autism spectrum disorder.3
Magellan includes an appendix that contains a number of systematic reviews and meta-analyses.4 In addition to the overall large body of research that it draws upon in its determination, it describes its guidelines as being developed in consultation with experts in the treatment of autism spectrum disorders from major research and treatment centers like the MIND Institute at the University of California, Davis; Baylor University; and Duke University. It also notes that “the guidelines rely heavily on known best
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3 For more information, see: https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/bcp/abaBCP.pdf
4 For a full list, see pp. 23–28: https://www.magellanprovider.com/media/45694/mcg.pdf
practices in the treatment of developmental disorders including the requirement for a complete assessment utilizing validated tools and standardized developmental norms; symptom focused interventions; caregiver participation and measurable goals” (Magellan, 2024).
Kaiser Permanente references the National Standards Project’s “Findings and Conclusions: National Standards Project, Phase 2,” which states that “[i]ntervention selection [. . .] should be made by a team of individuals who can consider the unique needs and history of the individual with [autism spectrum disorder] along with the environments in which he or she lives” (Kaiser, 2024, p. 5).
Molina, the payor for which a publicly available coverage rationale was not found, notes across various entries in its definitions of select terms that ABA is as an “evidence-based therapy.”5
SUMMARY OF POSITIONS OF HEALTH PROFESSIONAL BODIES RELATED TO ABA SERVICES
Professional bodies—including the American Psychological Association, the American Academy of Pediatrics, the American Medical Association (AMA), American Academy of Family Physicians, American Academy of Child & Adolescent Psychiatry, the Centers for Disease Control and Prevention, the U.S. Department of Labor, and the U.S. Surgeon General—have issued positions regarding ABA. These statements address pediatric healthcare standards, policy, advocacy issues, and practice recommendations related to ABA.
American Academy of Child & Adolescent Psychiatry
“Behavioral interventions such as Applied Behavioral Analysis (ABA) are informed by basic and empirically supported learning principles. A widely disseminated comprehensive ABA program is Early Intensive Behavioral Intervention for young children, based on the work of Lovaas et al. Early Intensive Behavioral Intervention is intensive and highly individualized, with up to 40 hours per week of one-to-one direct teaching, initially using discrete trials to teach simple skills and progressing to more complex skills such as initiating verbal behavior. A meta-analysis found Early Intensive Behavioral Intervention effective for young children but stressed the need for more rigorous research to extend the findings. Behavioral techniques are particularly useful when maladaptive behaviors interfere with the provision of a comprehensive intervention program. In such situations,
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5 For more information, see https://www.molinamarketplace.com/marketplace/ca/en-us/Providers/-/media/Molina/PublicWebsite/PDF/Providers/common/BI/2024/2024-Autism-Spectrum-Disorder.pdf
a functional analysis of the target behavior is performed, in which patterns of reinforcement are identified and then various behavioral techniques are used to promote a desired behavioral alternative. ABA techniques have been repeatedly shown to have efficacy for specific problem behaviors, and ABA has been found to be effective as applied to academic tasks, adaptive living skills, communication, social skills, and vocational skills. Because most children with [autism spectrum disorder] tend to learn tasks in isolation, an explicit focus on generalization is important.”6
American Academy of Family Physicians
“Early intervention usually includes applied behavior analysis, which focuses on learning and reinforcing acceptable behaviors while extinguishing problematic behaviors. Applied behavior analysis improves cognitive skills and behavior but is an intensive process that typically requires many hours per week of patient participation. Early intervention that includes applied behavior analysis improves cognitive functioning and language skills, with better results from more intense therapy.”7
American Academy of Pediatrics
“Applied behavior analysis assesses and modifies behavior through teaching to increase communication, increase social and functional skills and reduce interfering behaviors. ABA supports skill development in communication, safety, requesting assistance, following directions, reducing self-harm, and reducing aggression. The role of the pediatric clinician should be to understand the basic differences in types of ABA therapy and have resources available for a family/caregiver to make informed decision about types of ABA therapy available, prescribe ABA therapy to support appropriate skill development, review evaluation/progress reports, and discuss progress toward goals with child/family.”8
American Medical Association
The AMA supports all evidence-based interventions for those with autism and acknowledges the controversy surrounding ABA within the autism community.
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6 See Volkmar et al., 2014 “Practice Parameter for the Assessment and Treatment of Children and Adolescents with Autism Spectrum Disorder.”
7 See https://www.aafp.org/pubs/afp/issues/2020/1115/p629.html
8 For more information, see ABA definition and recommendations in table on therapy services at https://downloads.aap.org/AAP/PDF/Approach%201%20Prescription%20Recommendation%20Type.pdf
Of note, in the summer of 2023, the AMA Student Section submitted a draft resolution to the AMA House of Delegates asking it to withdraw its support for ABA. Following consideration, the AMA specifically declined to adopt the proposed resolution and changed the wording of this resolution to express its support for all evidence-based care for neurodivergent individuals, including those with autism spectrum disorder, while acknowledging that certain members of the autistic community view ABA as controversial.9
American Psychological Association
“The principles of applied behavior analysis (also known as behavior modification and learning theory), developed and researched by psychology and competently applied in the treatment of various disorders based on that research, is clearly within the scope of the discipline of psychology and is an integral part of the discipline of psychology. Across the United States, applied behavior analysis is taught as a core skill in applied and health psychology programs. As such, the American Psychological Association affirms that the practice and supervision of applied behavior analysis are well-grounded in psychological science and evidence-based practice. It also affirms that applied behavior analysis represents the applied form of behavior analysis which is included in the definition of the ‘Practice of Psychology’ section of the Model Act for State Licensure of Psychologists. Therefore, the association asserts that the practice and supervision of applied behavior analysis is appropriately established within the scope of the discipline of psychology.”10
Centers for Disease Control and Prevention
“Behavioral approaches focus on changing behaviors by understanding what happens before and after the behavior. Behavioral approaches have the most evidence for treating symptoms of [autism spectrum disorder]. They have become widely accepted among educators and healthcare professionals and are used in many schools and treatment clinics. A notable behavioral treatment for people with [autism spectrum disorder] is called applied behavior analysis (ABA). ABA encourages desired behaviors and discourages undesired behaviors to improve a variety of skills. Progress is tracked and measured.”11
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9 For more information, see: https://www.ama-assn.org/system/files/a23-refcomm-g-annotated.pdf and https://www.ama-assn.org/system/files/a23-706.pdf for amended student draft.
10 See https://www.apa.org/about/policy/applied-behavior-analysis
11 See https://www.cdc.gov/autism/treatment/?CDC_AAref_Val=https://www.cdc.gov/ncbddd/autism/treatment.html
U.S. Department of Labor
“Under the Mental Health Parity and Addiction Equity Act (MHPAEA), group health plans and health insurance issuers that offer mental health benefits must ensure that mental health benefit financial requirements and nonquantitative treatment limitations are generally no more restrictive than those applied to medical/surgical benefits. Many plans often cover benefits for autism as part of their mental health benefits. These benefits, such as those for treatment of Applied Behavior Analysis (ABA) therapy, are protected under MHPAEA. Therefore, we in EBSA [Employee Benefits Security Administration] are focused on ensuring these protections are realized. We do this through vigorous enforcement, compliance assistance and collaboration with other federal agencies.”12
U.S. Surgeon General
The 1999 Surgeon General Report concluded, “Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior.”13
REFERENCES
Kaiser Permanente. (2024). Mid-Atlantic states applied behavior analysis provider reference guide. https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/community-providers/mas/ever/mas-aba-provider-guide.pdf
Magellan Healthcare, Inc. (2025). 2025–2026 Magellan care guidelines. https://www.magellanprovider.com/media/45694/mcg.pdf
UnitedHealthcare. (2017). Intensive behavioral therapy (IBT)/applied behavior analysis (ABA) for autism spectrum disorders. Optum Behavioral Clinical Policy. https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/bcp/abaBCP.pdf
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12 See https://web.archive.org/web/20250101115336/https://blog.dol.gov/2023/04/13/respecting-and-enforcing-autism-benefits
13 See https://profiles.nlm.nih.gov/spotlight/nn/catalog/nlm:nlmuid-101584932X120-doc
