No Hearing, No Weekly Cap: Arizona’s Proposed ABA Rule Projects $46.5 Million in Savings

PHOENIX – Arizona’s Medicaid agency has proposed ABA rules that it estimates would save about $46.5 million a year in state and federal money. The rules would set no ceiling on weekly therapy hours.

The Arizona Health Care Cost Containment System (AHCCCS) posted the proposal Sept. 17, took written comments through Oct. 17, and held no public hearing. ABA, which AHCCCS already covers under its medical policy manual, would become a named service in state rules, with terms every health plan would apply: authorizations of no more than 6 months, written justification for more than 25 hours of therapy a week, a 12-hour limit on assessments, and 2027 deadlines for technician credentials and diagnostic evaluations.

AHCCCS attributes about $28.7 million of the projected savings to members with developmental disabilities in its long-term care program and $17.8 million to its main managed-care program and two children’s plans, KidsCare (Arizona’s Children’s Health Insurance Program) and the Children’s Health Plan. The notice does not say which provisions produce the savings or how AHCCCS estimated them, and it offers no figure for what the rules would cost providers.

Spending on ABA has climbed fast. The therapy cost AHCCCS more than $371 million in fiscal 2025, up from over $260 million in fiscal 2024, Phoenix public radio station KJZZ reported in February. In a statement to KJZZ at the time, AHCCCS said ABA use “has increased significantly in recent years” and that coming reforms would “safeguard access to medically necessary care while ensuring the long-term sustainability of the Medicaid program.”

What Providers Would Have to Do

Any request for more than 25 hours of direct ABA a week, or more than 15 hours outside school for a full-time student, would have to describe the specific symptoms that make the added hours medically necessary, the goals a member must reach to step down to less intensive care, and plans for caregiver training and supervision. The rule does not bar approvals above those levels; it requires more documentation to get them.

If a child who turned 5 before Jan. 1 of the school year is kept out of school for ABA, a request above 25 hours a week would also have to identify the barriers to school, explain how ABA will address them, and set milestones for returning. A parent or caregiver would have to sign an informed consent covering those points.

“No hard limitations on service hours are being proposed. All medically necessary services will be authorized.” – Division of Developmental Disabilities, Arizona Department of Economic Security, on AHCCCS’s draft ABA policy (May 2026)

Health plans would approve ABA for no more than 6 months at a time. Each request would need an assessment and treatment plan dated within 30 days of the request, and services would have to start within 30 days of approval. Plans would pay only for time when the interventions in a member’s approved plan are actively being delivered. A provider seeking reauthorization after delivering less than 80% of the approved hours would have to document what got in the way and its efforts to address those barriers.

Assessments would be limited to 12 hours unless documentation shows more time is medically necessary, and members would be reassessed at least every 6 months.

A licensed behavior analyst would have to provide at least 1 hour of case supervision for every 10 hours of therapy that technicians and other supervisees deliver to a member. Hands-on oversight and behind-the-scenes work, such as reviewing session data and revising treatment plans, both count. That floor sits at the bottom of the roughly 10% to 20% range that clinical practice guidelines recommend, according to the ABA toolkit CMS issued for states in August. It is twice the Behavior Analyst Certification Board’s 5% monthly minimum for supervising registered behavior technicians, a figure CMS calls “a minimum credentialing requirement rather than a recommended supervision level for all cases.”

Treatment plans would also have to include at least two hours of caregiver training a month, unless a documented clinical reason supports less or documented barriers prevent participation despite reasonable efforts to engage the caregiver.

Staff Credentials and Diagnosis Deadlines

Technicians would need an active certification from a nationally recognized technician-certification organization within 180 days of hire or by April 30, 2027, whichever is later. Exceptions would cover technicians who will work in their primary language when the exam is not offered in it, and technicians whose disability the testing body cannot accommodate. Uncertified new hires would have to start the certification process before providing any services.

Technicians and other supervisees would also need a nationwide criminal background check at hire and every 3 years after, plus abuse and neglect registry checks at hire and every year. Organizations that have not finished screening current staff by Nov. 1, 2026, would have 180 days to finish, a window that closes April 30, 2027, the same day technicians already on staff must be certified.

Families face their own deadline. A member already in ABA without a comprehensive diagnostic evaluation would need one by Nov. 1, 2027, or within 12 months of enrolling in AHCCCS, whichever is later. The evaluation must come from a psychiatrist, neurologist, psychologist, developmental pediatrician, or pediatrician with state-approved autism diagnosis training.

Services could not be denied, reduced, or ended solely because the evaluation is pending if the member has an appointment or is on a waiting list. An existing evaluation by one of those clinicians would not have to be redone solely because it lacks elements the rule now spells out.

To be eligible, a member would need a diagnosis of a qualifying neurodevelopmental disorder, such as autism, and documented impairment in at least two of these areas: communication, social interaction, harmful or disruptive behavior, or restrictive or repetitive behavior. Coverage would apply “regardless of age,” and a health plan could not deny reauthorization solely because a member no longer meets autism criteria if another qualifying diagnosis applies.

How It Got Here

AHCCCS proposed the same hour thresholds this spring in a draft update to the ABA section of its medical policy manual. It held webinars on the draft April 15 and 16, and comments ran through June 2, according to the state’s Division of Developmental Disabilities, which told families in May that it was not proposing hard limits on service hours. AHCCCS has not adopted that update: as of Oct. 20, the manual section on its website still carried 2019 and 2020 effective dates, and the agency’s Sept. 3 list of manual revisions did not include it.

In July, responding to a state audit of a separate program that pays parents as caregivers, AHCCCS listed ABA among the growing service lines behind supplemental appropriations the audit cited and said it would implement ABA reforms in the coming months. It said members, providers, and health plans praised the coming changes “as some of the most thoughtful in the nation.”

The rule is moving outside Arizona’s usual rulemaking process. In this year’s health budget law, lawmakers exempted AHCCCS from that process for rules “related to service frequency or hour limitations” adopted in the budget year ending June 30, 2027, requiring only notice and at least 30 days for public comment. AHCCCS is using the exemption for the full ABA package, including the credential, background-check, and diagnosis requirements. Under it, the agency held no public hearing, and the rule skipped review by the Governor’s Regulatory Review Council, which vets most new state rules.

Comments closed Oct. 17. As of Oct. 20, AHCCCS had not posted a final rule on its final-rules page, and the notice gives no effective date. The proposal’s first date is Nov. 1, 2026, when the 180-day screening grace period for current staff would begin.

AT A GLANCE

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