Introduction

The process for treating severe destructive behavior is based upon well-developed and well-defined procedures grounded in applied behavior analysis (ABA). For various reasons, only a few individuals with severe behavior disorders, however, receive these empirically supported interventions. Only a few programs in the United States provide these services for individuals with developmental disorders who display severe destructive behavior.

Those organizations that have developed and sustained these programs can teach us important lessons about building a successful program.

In what follows, we define and describe the essential components of a business plan for establishing a severe behavior program for the assessment and treatment of severe destructive behavior. We cover many topics, including:

(a) describing common procedural terminology (CPT) codes published by the American Medical Association (AMA) to bill for ABA procedures for assessing and treating severe destructive behavior;

(b) effectively justifying and communicating the need for a severe behavior program to the community, government agencies, and third-party payors;

(c) defining the training and expertise needed for the clinical leadership and staff for a severe behavior program;

(d) delineating the start-up costs and other financial considerations for developing a severe behavior program;

(e) describing admission, continuation-of-care, and discharge criteria for a severe behavior program; and

(f) providing guidance on how to work with third-party payors to obtain prior authorization, to appeal prior-authorization denials, and to negotiate single-case agreements and contracts that will provide adequate reimbursement for such intensive services.