Policy

Insurers Ask CMS to Set National ABA Credentialing Rules

July 17, 2026 · 3:30 PM

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.

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Oklahoma Medicaid Freeze of ABA Payments to Mirabelle Care Puts 500 Kids’ Therapy at Risk

July 16, 2026 · 1:15 PM

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.

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TRICARE Cuts ABA Rates in Most Localities for 2026

July 14, 2026 · 2:00 PM

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…

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Nebraska Cuts ABA Prior Authorization Threshold to 20 Hours

July 14, 2026 · 8:00 AM

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…

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Draft Medi-Cal Rule Would Cut ABA Parity Protections

July 13, 2026 · 12:30 PM

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…

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Sensory Kits Help Niles Police Safely Reunite Autistic Man

July 12, 2026 · 9:00 AM

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…

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Alabama Medicaid Pauses New ABA Referral Rule Before July 1

July 10, 2026 · 12:30 PM

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…

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North Carolina Agrees to Consent Order in ABA Rate-Cut Suit

July 9, 2026 · 1:00 PM

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…

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South Carolina Tightens Medicaid ABA Rules Effective July 1

July 9, 2026 · 8:00 AM

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…

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Illinois Keeps ABA Ownership Doctrine, Adds Key Exemptions

July 6, 2026 · 8:00 AM

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…

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Senators Schmitt and Gillibrand Press TRICARE to Cover ABA Permanently

July 3, 2026 · 3:00 PM

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…

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Five Steps to Illinois ABA Ownership & Business Structure Compliance by 2027

July 1, 2026 · 11:40 AM

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…

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The Optum ABA Playbook: How a Medicaid Cost Strategy Became an Ongoing Crisis for Autism Families

June 30, 2026 · 1:15 PM

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…

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Maryland Routes Medicaid ABA Through One Vendor, Carelon

June 28, 2026 · 2:30 PM

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…

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EVV Hard Edits Become a 2026 Billing Risk for ABA Providers

June 26, 2026 · 8:00 AM

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…

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Georgia Lawmakers Confront CareSource on 20% Therapy Rate Cut. CareSource Executives Absent

June 25, 2026 · 8:00 AM

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.

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Most ABA Falls Outside the Medicaid 80/20 Rule

June 24, 2026 · 12:40 PM

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…

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North Carolina’s Medicaid Autism-Therapy Spending Is Headed Past $1 Billion

June 22, 2026 · 8:00 AM

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.

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Arkansas Weighs Who Can Diagnose Autism, a Critical Step to Qualify for ABA

June 18, 2026 · 5:00 PM

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…

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Massachusetts Claws Back ABA Payments Over Supervision Ratio

June 17, 2026 · 4:00 PM

The state ordered its Medicaid insurers to take back a full year of money from autism providers it says billed too little licensed oversight. Providers and at least one major health plan…

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North Carolina Opens Medicaid Probe Into Compleat Kidz

June 17, 2026 · 12:01 PM

A Times investigation documenting a seven-minute nap cap and 12 child-abuse reports at the chain pushed the state from months of budget debate into active enforcement. Its Medicaid director says suspending or…

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How ERISA Lets Self-Funded Employer Plans Exclude ABA

June 15, 2026 · 2:30 PM

All 50 states require insurers to cover autism treatment. Two-thirds of covered workers are enrolled in health coverage those mandates cannot touch, and a federal parity statute is the only backstop.

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Indiana Will Require Accreditation for Medicaid ABA Agencies

June 15, 2026 · 11:59 AM

Every enrolled agency has until Aug. 1 to prove it has started. The two bodies the state recognizes are now owned by the same trade group.

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Six States Restrict AI Claim Denials as ABA Audits Tighten

June 12, 2026 · 12:15 PM

MACPAC is asking Congress to put a qualified human behind every Medicaid medical-necessity decision. A White House preemption framework could undo the new rules before most take effect.

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Minnesota Medicaid Revalidation Cuts Off Autism Providers

June 11, 2026 · 8:00 AM

Facing a $2 billion federal threat, the state compressed years of fraud screening into 4 months. When the deadline passed, it cut payments to most of the roughly 5,600 high-risk agencies, many…

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Florida’s ABA Medicaid Shift Frays ABA Provider Networks in Miami

June 8, 2026 · 2:00 PM

Online posts describe a sudden purge of clinics. The documented reality is a managed care transition whose credentialing failures are cutting children off from therapists, and the bill meant to fix it…

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National Academies Urges Permanent TRICARE ABA Coverage

June 6, 2026 · 4:00 PM

The congressionally mandated study found ABA meets the Defense Department’s own evidence standards. For clinics that lean on military families, a permanent benefit would end a decade of demonstration-driven uncertainty.

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Medicaid Overhaul Squeezes ABA Clinics’ Billing Pipelines

June 6, 2026 · 12:01 PM

The new work rules and six-month eligibility checks fall on expansion adults, not autistic children. For the clinics that treat those children, the quieter threat is coverage churn, tighter paperwork, and leaner…

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Indiana Imposes Six-Month Enrollment Freeze for New ABA Providers, Seeks to Control Costs

June 3, 2026 · 4:06 PM

CMS approved the six-month moratorium under the same federal authority it used three weeks earlier to halt home health agency sign-ups nationwide. Indiana’s Medicaid ABA spending grew from $21 million in 2017…

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In 2026, Nevada Families Seeking ABA Therapy Pay More and Get Less. Poorest Families Most Impacted

June 2, 2026 · 6:00 PM

The Health Plan of Nevada tightened autism-therapy benefits just as enhanced federal insurance subsidies lapsed, and Nevada families say they are now paying thousands out of pocket, with some cutting medically necessary…

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