The Misclassification of Behavior Analysts: How National Provider Identifiers (NPIs) Fail to Adequately Capture the Scop
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DISCUSSION AND REVIEW PAPER
The Misclassification of Behavior Analysts: How National Provider Identifiers (NPIs) Fail to Adequately Capture the Scope of the Field Erick M. Dubuque 1
&
Marissa E. Yingling 2 & R. Allan Allday 3
# Association for Behavior Analysis International 2020
Abstract To remain in compliance with the Health Insurance Portability and Accountability Act of 1996, U.S. health care providers are required to register for a National Provider Identifier (NPI). When applying for an NPI, providers must select the Healthcare Provider Taxonomy Code(s) that most closely describes the services they offer. Three distinct taxonomies describe the services offered by behavior analysts. Two of these codes, the Behavior Analyst (103K00000X) and the Assistant Behavior Analyst (106E00000X) taxonomies, specify that the health care provider must hold either a certification from the Behavior Analyst Certification Board or a state-issued credential to practice behavior analysis. The purpose of this study was to investigate the concordance between health care providers who utilize these behavior-analytic NPI taxonomy classifications and health care providers who meet the credential qualifications specified in the code descriptions. Results indicated that there are potentially more than 20,000 U.S. health care providers who do not hold the behavior analyst credentials specified in the taxonomy descriptions linked to their accounts. The implications of providers being mistakenly classified as credentialed behavior analysts and credentialed assistant behavior analysts in federal data and how the field should respond are discussed. Keywords Applied behavior analysis . Health insurance . HIPAA . NPI . Taxonomy
Over the last two decades, the demand for highly qualified behavior analysts in the United States has increased substantially. Behavior analysts have become valued health professionals recognized for their work addressing a range of health issues, from treating substance use disorders, to improving the lives of people with developmental disorders. Based on the current trajectory, it is likely that the contribution of the field of applied behavior analysis (ABA) to health care services will only increase. Appropriately, the rules, regulations, and guidelines that influence the scope and quality of practice are constantly developing. Among these developments are the
* Erick M. Dubuque [email protected] 1
Department of Special Education, Early Childhood, and Prevention Science, University of Louisville, Woodford R. & Harriett B. Porter Building, 1905 South 1st Street, Louisville, KY 40208, USA
2
Kent School of Social Work, University of Louisville, Louisville, KY 40208, USA
3
Department of Early Childhood, Special Education and Rehabilitation Counseling, University of Kentucky, Lexington, KY, USA
Healthcare Provider Taxonomy Codes established by the Centers for Medicare and Medicaid Services (CMS) that directly relate to the practice of ABA. To improve the U.S. health care system, the 104th Congress
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