COVID-19 FAQs for ABA Providers

The recent spread of the novel Coronavirus (COVID-19) has caused ABA providers to become increasingly concerned about the future of their business and the services they provide. Below are some answers to frequently asked questions (FAQs) about the latest developments on the virus and guidance from federal agencies. All recommendations below are subject to change and should not be considered legal advice. Always consult an attorney prior to making any legal or business decisions.

Should my practice remain open?

There’s no simple answer to this question. Each state and city releases their own guidelines regarding the severity of COVID-19 in your area. It is imperative you stay aware of these guidelines and follow the specific requirements pertaining to your location.

The current CDC guidelines can be found here:

Steps Healthcare Facilities Can Take Now to Prepare for Coronavirus Disease 2019 (COVID-19)

Guidance for School Settings

Checklist for Homes

Community Mitigation Strategies

Is ABA an essential service?

Each state is issuing their own guidance regarding which services are considered essential. For example, in California, the Governor has listed the following as essential services:

  • therapeutic technicians and technologists
  • clinics, home health care, hospices
  • behavioral health workers

Consider the risk not only to only to your clients, but also to your staff. If you have employees who have a compromised immune system or are over the age of 65, it is recommended that they self-quarantine.

Overall, it’s important to carefully balance the responsibilities to your patients with the safety of your staff and the greater community.

What should I do if a patient cancels their session?

If a patient cancels their session and you believe they should continue receiving services, notify them of the risks associated with disruption in treatment.

It is recommended that you let them know the precautions your staff is taking to reduce the spread of the virus. You may also advise them of telehealth opportunities, if available.

Where can I look or guidance on my state procedures or best practices?

It is imperative you reach out to your state ABA chapter for guidance on this matter. We encourage you to meet with other business owners or owners during this time to collaborate. For a list of ABA state chapters, click here.

How can I assess whether my staff are willing to work?

You cannot ask an employee to disclose if they have a compromised immune system or a chronic health condition that may place them more at risk for infection. You can ask the following ADA compliant questions. The survey is provided by the ADA and can be given to each employee prior to a pandemic declaration. Based on each response you can assess the impact on key job roles:

Pre-Pandemic Employee Questionnaire

If a pandemic occurred in our area, would you be unable to come to work because of any ONE of the following reasons:

  • If schools or day-care centers were closed, you would need to care for a child;
  • If other care or services are stopped, you would need to care for a dependent;
  • If public transport is not regular or unavailable, you are unable to travel to work; and/or,
  • If you or a member of your house are in any one of the following categories the public health department may advise that you should not to come to work (e.g., pregnant women; persons with compromised immune systems due to cancer or other medical conditions; people less than 65 with underlying medical conditions; or people over 65.

Workers may answer Yes/No and you may use this information to determine their ability to work.

Should I consider telehealth services?

(Updated 3/17)

Check your state-specific law regarding the allowance of telehealth. You can find a summary guide from prior to COVID-19 here.

Research your health plan’s policies regarding telehealth. It is recommended that all authorizations from payers, especially changes to currently existing programs, are clearly documented for future reference. Ensure you meet technology requirements and that you have received training on proper implementation of telehealth services prior to delivering them.

Be sure to read the recent Notification of Enforcement Discretion for telehealth remote communications during COVID-19 nationwide public health emergency.

How can I ensure my staff are safe?
Any employee who has traveled to severely impacted area and has had direct contact with a person diagnosed with COVID19 must self quarantine for a period of no less than 14 days.

During this quarantine the company may permit staff to work remotely. Otherwise, staff may use available vacation and/or sick leave as appropriate.

How can we prevent the spread of germs at our clinic or center?

As with most communicable diseases, common hygiene practices are the foundation for avoiding the spread of germs. See this poster provided by the Society for Human Resource Management.

Can I tell employees if a co-worker has tested positive for the coronavirus or other communicable disease?

No. The Americans with Disabilities Act (ADA) privacy rules restrict employers from sharing personal health information of an employee. Employers should inform employees that possible exposure has occurred in the workplace without disclosing any identifying information about the individual who tested positive.

Can I require an employee to go home (or stay home) if he or she is sick?

Yes. Employees who show signs of respiratory illness can be asked to leave the workplace and stay at home until they are symptom free.

Can an employee refuse to report to work due to fear of contracting the coronavirus?

Under the Occupation Safety and Health Act (OSH Act), employees are only entitled to refuse to work if they believe they are in imminent danger. See Workers’ Right to Refuse Dangerous Work.

The company that I work for insisted that I visit patients in their homes. I live with an at-risk family member and cannot risk bringing the virus into the household. Because of this, my employer has notified me that I am being laid off. Do I have any options?
It is recommended that individuals who are facing these challenges speak with an attorney if you have more specific questions. Current Federal law takes into consideration the size of the company, length of time employed and the employers current policies.
Can RBT’s in the state of Florida who work with children with autism, be asked to come to work? Should they be asked to choose between a paycheck or their health?
If my employee's hours are reduced because of cancellations, and they apply for partial unemployment through the state (CA), what happens to their medical benefits?

You would need to refer to your employee handbook or speak to a member of the leadership team to advise on the organization’s current practices. Additional information regarding California state law can be found here: Coronavirus Disease (COVID-19) – FAQs on laws enforced by the California Labor Commissioner’s Office. In addition, check with your state’s unemployment insurance program regarding the rules in your state.

Do you have any information in regards to VA Premier or Optima following these other companies to allow Telehealth during this time?

The payor spreadsheet is updated daily with the most recent information collected. Current information for VA Premier and Optima is included.

For providers moving to telehealth, does liability insurance need to be modified or are the telehealth sessions covered by existing liability policies?

Some liability insurance policies include telehealth as a covered service, while others may require providers to pay for a supplemental telehealth insurance policy.

I am an RBT providing in-home services. Is there something that we can carry on us to show that our job is considered essential and that's why we're out?

Yes, it is recommended that you carry proof that you are an essential service provider. This should be provided by your organization. You can also find a template in our file share section.

If a parent cancels for an extended period of time and their child needs treatment and precautionary safety measures are in place; how much grace time should they be given to return for services?

Each organization defines cancellation policies independently. You can also refer to the payor for guidance on how to best collaborate about these issues.

Is there a form I can use for a liability waiver for staff and for parents? A form that is not just for COVID-19 but waives liability for performing ABA (staff) and for in-home?

Sample forms can be found on the BHCOE website under “COVID-19 Resources for Members” under “Policies and Procedures.”

Can we ask families and direct service providers to take their temperature before initiating services in the home?

You can ask employees to take their temperature. See On the Coronavirus Front Line: Legal Issues for Healthcare Providers. As an alternative, employers may also ask employees to report their temperature and confirm absence of symptoms to occupational health before each shift.

I am worried about contracting an acute form of COVID-19. If I stay home, I am at risk of losing my job and also the financial burden of not working. What can I do?

Complete Question: I work for a behavior services company that provides services that are deemed “medically necessary.” I have documented asthma and am concerned by the fact that I am required to come into work during this pandemic and work closely with clients who have weakened immune systems and poor hygiene. Given my health condition, I am worried about contracting an acute form of covid-19. If I stay home, I am at risk of losing my job and also the financial burden of not working. What can I do?

Employers should be implementing health and safety guidelines and are required to provide a safe workplace Employer Responsibilities | Occupational Safety and Health Administration. Under the Occupation Safety and Health Act (OSH Act), employees are only entitled to refuse to work if they believe they are in imminent danger. In cases where the worker is immune-compromised, they should be eligible to refuse work. See the following guidance:

We are being told we need to confirm that every client has telehealth benefits before billing telehealth…

Complete Question: When we call authorization departments to see if our ABA auths will cover telehealth services, we are being told we need to confirm that every client has telehealth benefits before billing telehealth. Do you have any recommendations on how to do this more efficiently?

Many organizations identify all patient benefits prior to the intake process. For situations similar to COVID-19 it is suggested you speak with your Network Administrator for guidance.

How do I become an individual member of BHCOE?

Go to https://bhcoe.org/join-as-an-individual-member

For those who cannot afford membership at this time, you can click the 14-day free trial option.

What should companies do to minimize employee risk of contracting the virus while delivering direct client services?

Check the OSHA guidelines to determine necessary equipment required. You can find their general suggestions here. The recommendaiton for Personal Protective Equipment (PPE) is only suggested if you are sick or interacting with someone sick.

Which is safer in-home or in-clinic?

There are risks associated with each location. Many center-based clinics have closed or revised the clinic setting to ensure there are no more than 10 people in a room at the same time. They have also moved to in-home therapy or telehealth to ensure social-distancing.

If a client's family member has been exposed to the virus and is self-quarantining in the home…

Q: If a client’s family member has been exposed to the virus (a coworker at the family member’s office tested positive) and is self-quarantining in the home, should staff continue providing session in that location?

A: No, if someone is self-quarantining, they should not be in contact with anyone else.

Reference was made to a list of funding sources which accept telehealth. Is this list available to the public?

Q: Reference was made to a list of funding sources which accept telehealth. Is this list available to the public or must one be a member to access it?

A: The list is a ‘live document” currently available to BHCOE members. It can be found here.

What should we do under "shelter-in-place" orders?

Q: What is recommended if one’s company, clients and providers all reside and/or are located in a region and state where shelter in place order has been proclaimed?

A: State specific information regarding “shelter in place” order can be found here: What’s a ‘Shelter in Place’ Order, and Who’s Affected?

If my employee's hours are reduced because of cancellations…

Q: If my employee’s hours are reduced because of cancellations, and they apply for partial unemployment through the state (CA), what happens to their medical benefits?

A: It is recommended that you refer to your employee handbook or speak to a member of the leadership team to advise on the organization’s current practices. Additional information regarding California state law can be found here: Coronavirus Disease (COVID-19) – FAQs on laws enforced by the California Labor Commissioner’s Office.

And Check with your state’s unemployment insurance program regarding the rules in your state.

For providers moving to telehealth, does liability insurance need to be modified…?

Q: For providers moving to telehealth, does liability insurance need to be modified or are the telehealth sessions covered by existing liability policies?

A: Some liability insurance policies include telehealth as a covered service, while others may require providers to pay for a supplemental telehealth insurance policy. Check your plan to confirm your coverage.

Ask Your Questions

Do you have a question about COVID-19 that we should add to this list? Share your questions (and answers!) with us here.

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