Three Families Lost Care to a System That Is Not Working
Behavior analysis accounted for 64 percent of every provider the state refused to enroll or reenroll last fiscal year. In June, the governor stood in West Palm Beach and announced that every…
Policy
The federal and state actions deciding what ABA can bill and who qualifies. Coverage of Medicaid rate cuts, federal HCBS reductions, OIG audits, the new CMS fraud initiative, and state lifetime-hour caps. For BCBAs and operators tracking compliance exposure. Run alongside business, private equity, clinical practice.
Virginia’s ABA Diagnosis Rule Outweighs Its 20-Hour Limit
The word autism appears nowhere in Virginia’s current ABA eligibility criteria, and the new weekly ceiling yields to a federal exception available to every child it touches. Lawmakers booked $58 million in…
Utah Makes Automatic ABA Medicaid Rate Increases Permanent
Gov. Spencer Cox signed a bill that lifts autism-therapy reimbursement whenever forecast state revenue growth reaches at least 2 percent.
CMS EPSDT Guide Undercuts ABA Hour Caps and Plateau Denials
The first rewrite of Medicaid’s children’s coverage playbook since 2014 tells states that flat limits may not stand in for case-by-case decisions. Indiana began counting children’s therapy against a 4,000-hour lifetime allocation…
Indiana Fixed ABA Medicaid Billing, Now Access Is at Risk
The state scrapped a formula that paid providers 40 percent of whatever they billed. The replacement, a fixed fee schedule with rate cuts, a 4,000-hour lifetime cap, and a freeze on new…
CMS Proposes Six New ABA Codes for 2027
The proposed 2027 Medicare fee schedule would recognize multiple-technician services and the clinical work that happens away from the patient. Whether payers cover and price that work is the question the rule…
Federal Autism Panel Advances ‘Profound Autism’ Designation
The newly restructured committee urged new federal Medicaid guidance for autism care, which could affect how high-need services, including applied behavior analysis, are prioritized. The panel meets again July 31.
House Committee Opens Billing Probe Into ABA Provider The Perfect Child
Chairman Tim Walberg and Rep. Rick Allen gave founder Simcha Bendet until July 20 to provide billing records going back to 2020. This move makes official a Wall Street Journal investigation into…
Nebraska’s New ABA Rules Are Punishing Ethical Providers—and Shrinking Access for Families
New Nebraska Medicaid service definitions that took effect July 1, 2026, cap therapy hours, end school-based billing for independent providers, and add supervision requirements. Themis Gomes says the local providers rooted in…
Kentucky Medicaid Cuts ABA Rates 4% Starting August 1
Licensed Behavior Analysts are one of 46 fee-for-service provider types facing this reduction. The state budget also plans a managed-care cut in 2028.
Advocate Says Oregon ABA Board Left Training Questions Unanswered
Christina Williams’ follow-up account of the July 10 meeting in Salem describes an unaddressed attestation concern, fiscal reasoning crowding out client safety, and public comments that drew no response. The regulator reconvenes…
Insurers Ask CMS to Set National ABA Credentialing Rules
The Association for Behavioral Health and Wellness, representing major insurers, wants Medicaid to require licensure checks, background screenings, federal supervision ratios, and technician enrollment rules.
Oklahoma Medicaid Freeze of ABA Payments to Mirabelle Care Puts 500 Kids’ Therapy at Risk
A fraud investigation targets the clinics’ former owner. The payment freeze lands on the new owner who bought the business in January, its 200 employees, and about 500 children in therapy.
TRICARE Cuts ABA Rates in Most Localities for 2026
The Defense Health Agency’s new schedule, effective May 1, lowers assessment pay in 100 out of 116 pricing areas. Providers in Nebraska and Michigan will see the largest cuts, with rates dropping…
Nebraska Cuts ABA Prior Authorization Threshold to 20 Hours
Independent providers can no longer bill Medicaid directly for therapy delivered at school under coverage changes effective July 1, adding to cuts the state began last August. One Omaha clinic owner says…
Draft Medi-Cal Rule Would Cut ABA Parity Protections
DHCS sent managed care plans a tracked-changes rewrite on June 22 and closed comments on July 3. It would expand utilization management for autism therapy and delete the operative order that plans…
Sensory Kits Help Niles Police Safely Reunite Autistic Man
Officer Jessica Zia had carried the new tools for just 20 days when a nonverbal 25-year-old wandered more than 6 miles from a Chicago group home. The nonprofit behind them has trained…
Alabama Medicaid Pauses New ABA Referral Rule Before July 1
Pediatricians had 16 days to request a specialty designation before autism diagnoses stopped qualifying children for therapy. Within 3 days, the agency put the requirement on hold and promised guidance it had…
North Carolina Agrees to Consent Order in ABA Rate-Cut Suit
DHHS affirms it must run Medicaid in compliance with the state’s disability rights statute and that families retain the right to refile. A judge’s signature would remove the September trial from the…
South Carolina Tightens Medicaid ABA Rules Effective July 1
Providers lose telehealth for the 97151 assessment code and face stronger documentation and medical-necessity checks, with a comment window that closed June 1 and a fee schedule the state says it will…
Illinois Keeps ABA Ownership Doctrine, Adds Key Exemptions
A push to repeal the licensed-owner CPOM doctrine stalled in committee. The state practitioner association’s SB 712 passed, exempting schools and nonprofits and expanding licensed practitioner owner types, but leaves for-profit practices…
Senators Schmitt and Gillibrand Press TRICARE to Cover ABA Permanently
A Republican father of a nonverbal autistic son and the Democrat who commissioned the Pentagon’s own study have made autism care a bipartisan cause. Now they want applied behavior analysis written into…
Five Steps to Illinois ABA Ownership & Business Structure Compliance by 2027
An ownership and business structure clause requires that every ABA company in the state be owned solely by licensed practitioners. Licensure law passed in 2022 means providers may need to restructure by…
The Optum ABA Playbook: How a Medicaid Cost Strategy Became an Ongoing Crisis for Autism Families
Eighteen months after the documents surfaced, about 1,000 Arizona children have lost their providers, and their families are in court. UnitedHealth faces that fight from a weaker position, with profits down and…
Maryland Routes Medicaid ABA Through One Vendor, Carelon
Every autism-therapy authorization and claim in Maryland’s Medicaid program clears a single carve-out contractor: the vendor brought in to replace Optum. In its first year, that contractor saw a behavioral-health claims backlog…
EVV Hard Edits Become a 2026 Billing Risk for ABA Providers
Electronic visit verification (EVV) was never part of the federal Medicaid mandate for applied behavior analysis. As a wave of states drops the warning period and switches on automatic claim denials through…
Georgia Lawmakers Confront CareSource on 20% Therapy Rate Cut. CareSource Executives Absent
The remaining incumbent, CareSource slashed rates 20% in 2026. Providers told a General Assembly hearing that families have nowhere else to go, and will lose access to care.
Most ABA Falls Outside the Medicaid 80/20 Rule
The pass-through targets homemaker, home health aide, and personal care work, not the clinical benefit most autism therapy is billed under. The piece of the rule ABA providers will actually feel arrives…
North Carolina’s Medicaid Autism-Therapy Spending Is Headed Past $1 Billion
North Carolina’s Medicaid spending on autism behavioral therapy reached $544 million in fiscal 2025 and is projected to top $1.1 billion by 2027. A Medicaid rules overhaul has followed.
Arkansas Weighs Who Can Diagnose Autism, a Critical Step to Qualify for ABA
A state task force is studying whether to widen the pool of clinicians who can issue a qualifying autism diagnosis, the gatekeeping step that decides when a child can start ABA. The…