The treatment plan is the most important document in your child's ABA program. It decides what your child works on, how many hours insurance is asked to approve, and how everyone will know whether therapy is working. Yet many parents sign it after a quick look. This guide explains what a plan must contain under Florida law and insurer policies, what the technical terms mean, and how you can shape it.
What does Florida law require in an ABA treatment plan?
For plans covered by Florida's autism insurance law, s. 627.6686(4)(a) limits coverage to treatment "prescribed by the insured's treating physician in accordance with a treatment plan." Subsection (7) says the plan must include:
- a diagnosis;
- the proposed treatment by type;
- the frequency and duration of treatment;
- the anticipated outcomes stated as goals;
- the frequency with which the treatment plan will be updated; and
- the signature of the treating physician.
In practice, the BCBA writes the detailed behavior plan and your child's doctor provides the prescription or order the plan requires. Plans differ on the exact paperwork. Our guide on whether ABA needs a doctor's prescription explains the physician's part.
What do insurers add to those requirements?
Insurer medical policies ask for much more detail than the statute. Here is how three common payers compare.
| Plan element | Florida statute (627.6686) | Cigna (Evernorth EN0499) | UMR (form UMF0035) |
|---|---|---|---|
| Diagnosis | Yes | Confirmed autism diagnosis with diagnostician's credentials and date | Proof of autism diagnosis; school evaluations alone not accepted |
| Assessment | Not specified | Standardized instrument, caregivers involved, within 60 days before treatment | The ABA evaluation |
| Measurable goals | Goals stated as anticipated outcomes | Measurable goals in every setting, with baseline data | Individualized goals with target dates |
| Mastery criteria | Not specified | Required | Progress reported at concurrent reviews |
| Generalization | Not specified | Generalization plan required | Not listed separately |
| Parent or caregiver training | Not specified | Measurable goals and data | Parent training goals required |
| Hours and supervision | Frequency and duration | Supervision 1 to 2 hours per 10 hours of direct treatment | Units requested per 6 months |
| Transition or discharge | Update schedule | Fading/transition plan and discharge criteria | Transition/discharge plan |
| Coordination | Not specified | With schools and other providers | With other services, including school |
Florida Blue, Aetna and TRICARE have their own criteria. Aetna's guide, for example, expects progress to be evaluated every six months on standardized measures. Your plan's documents and medical policy are the final word.
What are goals, targets and mastery criteria?
These three terms appear on almost every plan.
Goals
A goal is the broad skill or change the plan is working toward, usually within the six-month authorization period. Example: "Your child will request help or a break using a picture card or words across home and school."
Targets
Targets are the specific, teachable pieces of a goal. For the goal above, targets might be: request "help" with a closed container; request "break" during a hard task; request help from a new adult. Targets are taught one or a few at a time, and new ones are added as earlier ones are learned.
Mastery criteria
Mastery criteria say exactly when a target counts as learned. A typical example: "independently, in 80% of opportunities, across three consecutive sessions, with two different staff members." Good mastery criteria include:
- Accuracy or frequency: how often or how well the skill happens.
- Independence: whether prompts or help are still needed.
- Consistency: across several sessions or days, not once.
- Generalization: with different people, materials and places.
The percentages in these examples are common in practice, not a legal standard. Your BCBA chooses them for each target.
Baseline
Baseline is where a skill or behavior stands before teaching starts, for example "requests help in 0 of 10 opportunities" or "about six instances of hitting per day." Without a baseline, nobody can show progress. Cigna's policy specifically requires baseline data.
What else should a good plan include?
- Behavior reduction plans, if needed, should explain what the behavior is, why it happens (its function), what replacement skill will be taught, and how staff will respond. The response should be the least intrusive option.
- Parent training goals, such as "parent will use the break routine during homework in 4 of 5 observed opportunities."
- Recommended hours by service type: direct sessions with an RBT, BCBA supervision, and parent training.
- Settings: home, center, school, daycare or community.
- A fading and discharge plan that explains how support will step down.
How can I give input on my child's plan?
The BACB Ethics Code says behavior analysts should involve clients and stakeholders in "selecting goals," and should describe objectives, procedures, timelines and the review schedule in writing before starting (Codes 2.09 and 2.16). In practice, you can:
- Before the assessment, write your top three concerns and the skills you most hope for.
- Ask for a meeting to review the draft before you sign it.
- Check each goal against your list. Ask, "How will this help at home?"
- Question any goal that targets a harmless trait, such as stimming or eye contact, and ask why it is included.
- Ask about your child's preferences and, for older children, their own say in goals.
- Ask how often you will see data and how the plan will change if a goal stalls.
- Keep a copy of the signed plan and each update.
Your signature is your consent to the plan. You can ask questions or request changes before signing, and you can ask for changes later. If you want an outside view, see getting a second opinion on an ABA plan.
What does one goal look like from start to finish?
Here is an example of how a single goal might be written and tracked. It is an illustration, not a template every plan follows.
- Concern from the parent: "He screams when he can't open his snack."
- Baseline: requests help in 0 of 10 opportunities; screams in most of them.
- Goal: will request help with a sign, picture or word when a task is too hard, across home, center and school.
- Targets: help with snack containers; help with zippers; help with toys that do not work; help from a new adult.
- Mastery criteria: independently in 80% of opportunities across three sessions, with two different adults.
- Parent goal: parent prompts and honors help requests at snack time each day.
- Review: data graphed weekly; goal reviewed at the six-month update.
Red flags in a treatment plan
- Goals copied from a template with no link to your child's assessment or your concerns.
- No baseline data, so progress cannot be shown.
- Goals focused on harmless autistic traits, such as stopping stimming, with no reason given.
- No parent training goals, or no plan for generalization to home and school.
- Recommended hours with no explanation of how they connect to goals.
- No discharge or fading plan.
How are progress and updates handled?
Most plans are updated at least every six months for reauthorization, with progress reports that show graphs for each goal, which targets were mastered, and new goals. Learn to read those reports in how to read an ABA progress report. The assessments behind the plan are explained on our ABA assessments page.
How Hope Center builds treatment plans
At Hope Center for Behavior Change, the initial assessment takes 2 to 4 hours in one or two sessions, at home or at the center. The BCBA then takes up to two weeks to write the plan, and our clinical director reviews every plan before it goes to insurance. You review and sign it before it is submitted. Goals are discussed with you in weekly parent training. To begin, see our new families page or call 561-337-8865.