Judge Voids New York’s Early Intervention Telehealth Rate Cuts, Citing Unsupported Calculations

ALBANY, NEW YORK – A state judge has thrown out the telehealth rates New York’s Health Department issued in July 2025 for Early Intervention, the state’s program for infants and toddlers with disabilities or developmental delays. The department provided no evidence showing how it calculated the rates, he ruled.

The cuts reduced telehealth rates for basic and extended home and community visits by 22% in the New York City, Westchester, Poughkeepsie, and Long Island rate regions and by 10% elsewhere. The approved Medicaid state plan lists a Jan. 1, 2025, effective date for the reductions. Applied behavior analysis (ABA) services are billed under those visit categories. The program serves about 70,000 children in most years, according to the New York State Association of Counties. Families have no out-of-pocket costs for EI services, which state-approved agencies and individual providers deliver.

Justice William T. Little of the state Supreme Court in Albany County, a trial court, ruled Oct. 14. He annulled the July 2025 rates and sent the matter back to the department without setting replacement rates. Agencies for Children’s Therapy Services (ACTS) sued in October 2025 with Access Therapy Group and Big Minds Tiny Hands. ACTS says its 43 member agencies serve more than half the program’s children.

What the Judge Found

ACTS argued that the cuts violated the department’s own regulation. The rule requires the health commissioner to determine Early Intervention rates annually, subject to the budget director’s approval, and says they must provide “full reimbursement” for specified provider costs, including clinicians’ time, office space, and overhead. Courts give rate-setting “a high degree of judicial deference,” Little noted, quoting an appeals court. But the rates still needed a rational basis, meaning reasoned support in the record, and he found none.

The department has tied its rate changes to a push toward in-person care. In an April 2025 statement to Spectrum News, it said the 2024-25 state budget included a provider rate increase and “administrative changes to reimbursement to refocus the program to more personal, direct care.” Little acknowledged that goal but found the department’s explanation “wholly devoid of any rationale” for its calculations or how the rates met the regulation’s reimbursement requirement.

“[T]he current rates are devoid of support, save from general budgetary considerations applicable to all New York State agencies.” – Justice William T. Little, New York State Supreme Court, Albany County (2026)

At oral argument, the state told the court the original rates were calculated in 1994 and that it “think[s] there were studies that were done.” It confirmed cost-of-living increases in 1997 and 2002 and a 5% across-the-board cut in 2011, but it produced no data or calculations behind the July 2025 cuts, even when given another chance during the argument.

Where ABA Fits In

The department is also changing how ABA is authorized in a child’s individualized family service plan. Its former data system listed ABA as “special instruction,” with ABA noted as the method. June 18, 2026, guidance describes a separate “ABA services” category for New York-licensed behavior analysts and New York-certified behavior analyst assistants working under their direction. Special instruction requires one of the teaching certifications specified in the guidance. Other qualified professionals may use ABA techniques under their own service types, within their scope of practice, training, and competence.

Registered behavior technician (RBT) certification alone does not qualify someone to deliver EI services, although an RBT may serve as a one-to-one aide in group developmental services. Licensed behavior analysts and agencies that employ them may apply as ABA providers. Since Sept. 1, 2026, new initial service plans must assign special instruction to appropriately certified teachers. Corrections to existing plans were to start by that date at regular reviews, retaining the current therapist under the matching service type. All corrections are due by March 31, 2027. The department warns of billing “challenges” for inaccurately authorized services from April 1, 2027, but does not specify the consequences.

The ruling does not change New York Medicaid’s separate fee-for-service ABA schedule outside Early Intervention. That schedule lists technician-delivered treatment billed under code 97153 at $9.63 per 15-minute unit effective Oct. 1, 2026, the third reduction in a year, as BreakingNewsABA reported in September.

What Happens Next

Little did not decide whether the rates adequately reimburse providers. He expressly declined to define “full reimbursement” and based the ruling on the lack of a rational basis for the calculations. The order sets no deadline for replacement rates and does not specify what providers should be paid in the meantime.

In its Oct. 15 release, ACTS said revised rates must “provide full reimbursement,” a term Little did not define. “We trust that Governor Hochul, given her strong record of support for children and families, will direct NYSDOH to immediately rescind the rate reductions at issue, and issue new rates that reflect actual provider costs,” said Jana Vitale, the association’s president.

Richard Rothwell, CEO of Access Therapy Group, said in the release that “it is incredibly hard to find therapists who will provide services to meet children’s service plans” because occupational, physical, and speech therapists can earn significantly more in other systems.

ACTS’s lawyers filed notice of entry on Oct. 15. State law generally gives a party 30 days to appeal after service of the judgment with written notice of its entry; filing alone does not start that period. If a state agency serves a notice of appeal, enforcement proceedings are automatically stayed pending the appeal, subject to the appellate court’s authority to modify or vacate the stay.

AT A GLANCE

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