Testimony
House Bill 1530 – Relating to covered services for medical assistance
Senate Human Services Committee
Senator Judy Lee, Chairwoman
March 14, 2023
Chairwoman Lee and Members of the Senate Human Services Committee:
I am Holly Johnson, Licensed Board Certified Behavior Analyst in Minot, a
founding member and Past President of the North Dakota Association for
Behavior Analysis (NDABA). NDABA’s mission is supporting and growing the
field of behavior analysis in North Dakota and is known for being the top
applied behavior analysis (ABA) resource for ND. I am here testifying on the
behalf of NDABA and its membership relating to the applied behavior
analysis portion of HB 1530.
This bill would give Medicaid beneficiaries access to CPT® codes 97156 &
97157, called ‘family adaptive behavioral treatment and guidance’ or better
known as parent/caregiver training. These medically necessary billing codes
are not currently covered as a reimbursable service, yet skills training for
caregivers is required in current ND Medicaid Autism ABA Service policy and
has been since July 2017. Additionally, HIPAA rules require any health plan
that allows electronic submission of claims to recognize and utilize all
available Category I CPT® codes. These same codes are a reimbursable
service under the private insurance sector; yet we’ve denied this service to
family/caregivers or forced providers to eat the cost of covering this service,
which, as behavior analysts, we are ethically bound to provide. NDABA and
its membership is in favor of this component of HB 1530.
Holly Johnson – Testimony for HB 1530
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The ND Medicaid Medical Advisory Council (MMAC) recommended and
identified a fifth component in the original version of this bill: expansion of
ABA services across the lifespan and with a variety of psychological and
medical expenses. Currently in ND, ABA is only covered for private clinicians
serving children who hold an autism spectrum disorder (ASD) diagnosis. In
April 2022, NDABA and 48 of its individual practitioners petitioned to include
having ABA services in ND covered across the lifespan and across a variety
of diagnoses.
NDABA and its membership is asking that this Committee amend HB 1530
back to include, as in the original version:
‘Applied behavioral analysis to provide coverage to both assess and
treat common behavioral problems across the lifespan of individuals
with a variety of psychological and medical diagnoses.’
While the original fiscal note had a seemingly hefty price tag for this fifth
component of the bill, realistically it would not be as costly as predicted:
• Paying for ABA services now will make more severe and intense
behavioral problems less burdensome in the future, by giving
thousands of North Dakotans access to an additional source of
evidence-based clinical practices to habilitate, rehabilitate, and
improve their quality of life.
• This expansion would not be identifying any new populations of
individuals needing behavioral health services. Rather, those needs are
already identified, and there are lengthy waitlists of citizens seeking
counseling services, psychological services, and the like. ABA would be
an additional group of professionals who can provide behavioral health
services; and thus, could alleviate the overload felt by other groups of
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 professionals, while giving struggling citizens access to treatment while
they wait for waitlists to open up.
• ND Health Tracks (EPSDT) specifically allows medically necessary
treatment or care, that includes preventative measures, to reduce or
ameliorate mental, developmental, or behavioral effects of an illness,
condition, injury, or disability, whether or not such services are
covered under the state Medicaid plan. ABA fits all of the EPSDT
criteria, yet limiting our practice contributes to higher costs long-term.
• Not all behavior analysts are trained specific to ASD. At a national
level, approximately 72% of Board Certified Behavior Analysts practice
primarily in the autism service sector (www.bacb.com). In ND, that
equates to approximately 68 of our 94 licensed behavior analysts
practicing in the autism service sector, leaving 26 of us practicing in
other sectors. We can apply the same scientific behavior principles to a
myriad of areas such as: behavioral gerontology, brain injury
rehabilitation, education, sustainability, public health, or the treatment
of substance abuse disorders, to name a few (see more here:
https://www.bacb.com/about-behavior-analysis/#ABAFactSheets).
I have worked collaboratively with individuals, their caregivers, and their
teams of professionals for clients with acute and chronic mental illness (e.g.,
mood, anxiety, personality, and psychotic disorders) as well as acute and
chronic medical illness (e.g., severe seizure disorders, rare chromosomal
abnormalities, feeding disorders and post-surgical rehabilitation), all of
which occur comorbidly with developmental and/or intellectual disabilty. I
am fortunate to be able to serve people of any age with those diagnoses, but
I’m only able to do this if the person holds an Intellectual Disability diagnosis
and/or an ASD diagnosis. I can’t even begin to tell you the number of times
over my professional career that I’ve been asked to consult for people with
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dementia in nursing homes, for a child diagnosed only with ADHD who is
disrupting the entire classroom, or an adult with anxiety which prevents
them from going grocery shopping. In all of those instances, I must decline
to provide services because ABA in ND isn’t currently covered across the
lifespan for a variety of diagnoses. And that’s not fair to our citizens, and it’s
not fair to limit and silo a professional discipline who ultimately wants to help
people.
In summary, NDABA and its membership is:
1) in favor of including family adaptive behavioral treatment
(parent/caregiver training) as a reimbursable service under ND
Medicaid; and,
2) asks that you please consider re-amending HB 1530 back to include
expansion of ABA services across the lifespan for a variety of
diagnoses.
All opinion expressed here is my own and is on behalf of NDABA. These
opinions in no way represent the Department of Health & Human Services or
the Life Skills and Transition Center, all of which I am actively involved with,
adding to my unique perspective contained in this testimony. This testimony
has been provided on my personal time.
Thank you for your time and consideration of this testimony. Please contact
me at holly.johnson.bcba@outlook.com, if I can be of assistance. This
concludes my testimony. I’d be happy to answer any questions.
Sincerely,
Holly Johnson, MS, BCBA, LBA
Board Certified Behavior Analyst #1-14-15198
ND Licensed Behavior Analyst #L15
Holly Johnson – Testimony for HB 1530
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