New York Requires Two Face-to-Face Supervisions a Month. Phone and Text Don't Count.

New York's ABA rate cut got the attention. The supervision rule that arrived with it did not, and it is the one that decides whether the hours you already delivered are payable.

Effective October 1, 2025, authorized by the NYS Enacted Budget for FY 2025-26, fee-for-service Medicaid requires Licensed Behavior Analysts to supervise unlicensed individuals and technicians for a minimum of five percent of the hours that technician spends providing behavior analysis services each calendar month.

The Department adds one line that doubles its reach: “This supervision standard also applies to Medicaid Managed Care (MMC) providers in NYS.” It is not a fee-for-service rule.

Two contacts a month, and what does not count as one

“Supervision must include at least two face-to-face, real-time contacts per month (i.e., supervision may not occur telephonically, via email or text messaging).”

The parenthetical is the operative part. A phone check-in is not supervision here. Neither is a text thread or an email review, however substantive.

Beyond that:

• The LBA must observe the technician actually providing services in at least one of the two monthly meetings. A meeting about the work does not substitute for watching the work.
• On-site is preferred but not required. Supervision may be conducted “via a synchronous interactive audio and video telecommunication system,” consistent with NYS Medicaid FFS telehealth policy. Audio alone does not qualify.
• One of the two may be a small-group meeting — defined as an interactive session with multiple technicians “who share similar roles and experiences,” plus their supervising LBA. If other professionals attend, their involvement “must be limited to ensure that the primary focus remains on supporting the active participation and interaction of the unlicensed individuals/technicians.” One of the two, not both.

The 97155 trap

This is the sentence to read twice before you build the 5% out of billed time:

“The five percent minimum supervision requirement may include the use of Current Procedural Terminology (CPT) code ‘97155’ only when the LBA joins the patient and the unlicensed individual/technician during a treatment session to direct the unlicensed individual/technician in implementing a new or modified treatment protocol.”

So 97155 counts toward the requirement in one configuration only: LBA, technician and patient together, and the purpose is directing implementation of a new or modified protocol. 97155 billed for protocol modification without the technician present does not count toward the 5%. Neither does 97155 delivered to direct a protocol that has not changed.

Record retention is longer than you think

Supervision “should be recorded in the patient file of the NYS Medicaid member,” and the retention periods are not the usual ones:

• Six years minimum for ABA professionals generally;
• for minors, until the patient turns 22 — which for a child starting at three is a nineteen-year file;
• ten years for all MMC providers.

Given that OIG's four completed state ABA audits each found supervision and documentation defects in all 100 sampled enrollee-months, a retention schedule this long is not an administrative footnote.

The limits

This has been in force since October 2025 — it is a standing requirement, not a change arriving. The Department frames the 5% as aligning NYS Medicaid policy with BACB guidance, and encourages direct observation “to the fullest extent” based on ability level, clinical experience and setting, which is guidance rather than a second threshold. Managed care plans may impose their own supervision terms on top of this floor; the state sets a minimum, not a ceiling. And the retention rules quoted are those stated in the Medicaid Update — a provider's own contracts, licensure obligations and any pending litigation hold may require longer.

What you must know or do

• Count your supervision as a percentage of technician hours, per calendar month, per technician. Not per case, not per quarter. If a technician delivered 80 hours in a month, that is four hours of supervision, and a month that closes short cannot be repaired in the next one.
• Audit how your two monthly contacts happened, not that they happened. Any month where both were phone calls, or where neither included the LBA observing delivery, does not meet the standard as written — even if the total hours clear 5%.
• Re-check every 97155 unit you have counted toward the 5%. The qualifying configuration is narrow: LBA plus technician plus patient, directing a new or modified protocol. If your tracking counts all 97155 as supervision, the number you are reporting is too high.
• Managed care providers: your retention is ten years, not six. Confirm your record system actually holds ABA files that long, including supervision notes, and that it survives an EHR migration.
• If you operate in New York and elsewhere: the 5% floor matches what North Carolina requires at 10% observation and what Oklahoma requires at 5% monthly. The percentages differ, the unit differs, and the evidence each state accepts differs. A single national supervision policy will fail at least one of them.