MassHealth Proposes Holding ABA Rates at 2024 Levels From December 1

EOHHS reviewed 101 CMR 358.00 and proposed keeping every ABA rate where it has been since October 2024 — $16.37 a unit for 97153 — for dates of service from December 1, 2026. Its own estimate is that MassHealth spending won't change.

Massachusetts' Executive Office of Health and Human Services has proposed re-adopting 101 CMR 358.00, Rates for Applied Behavior Analysis, for dates of service on or after December 1, 2026 — with no rate changes. The hearing notice says it plainly: “EOHHS reviewed the rates in 101 CMR 358.00 and proposes to maintain the current rates.”

The turn: a review that ends where it started

Chapter 118E requires EOHHS to periodically review these rates, and this was that review. The result is the 2024 schedule carried into 2027. EOHHS estimates that “annual aggregate MassHealth expenditures will not change as a result of the proposed amendments,” and its small business impact statement counts 197 providers governed by the regulation.

The rates that carry over

All per 15-minute unit, as published in 101 CMR 358.03 since the 2024 amendment:

  • 97151 assessment: $30.73
  • 97153 treatment by protocol, technician: $16.37
  • 97154 group treatment by protocol: $13.91
  • 97155 protocol modification: $30.73
  • 97156 family guidance: $30.73
  • 97157 multiple-family group guidance: $26.12
  • H0031-U2 assessment and case planning: $30.73

The notice describes the covered population as MassHealth members younger than 21 with a diagnosis of autism spectrum disorder or Down syndrome.

The limits

This is a proposal. The remote hearing was held June 17, and written testimony closed at 5:00 p.m. that day. We have not found the final adoption in the Massachusetts Register, and the notice says EOHHS “may adopt a revised version” after comments. The amendments are also “subject to federal approval.” Rates paid by MassHealth managed care entities are set by contract, not by this regulation, unless your contract ties them to it.

What you must know or do

  • Owners billing MassHealth: budget 2027 wages and supervision against the rates above, not an increase. 97153 at $16.37 has been the rate since the 2024 amendment.
  • Owners in MCE networks: pull each contract and check whether its ABA rates are stated as a percentage of the MassHealth fee schedule. If they are, a flat 101 CMR 358.00 means a flat contract rate too.
  • Before December 1: check the Massachusetts Register for the final adoption of 101 CMR 358.00. If EOHHS adopts a revised version, the rates can differ from this proposal.