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Issue 6 |
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👋 Hey there!
California's new ABA protections stop at Medi-Cal. The rediagnosis ban in force since January and the forfeited-hours ban Newsom signed on September 27 both exclude Medi-Cal plans by name. AB 375's analysis covers commercial plans and doesn't address Medi-Cal. The one Medi-Cal bill runs the other way. SB 874 starts with background checks, then lets DHCS rewrite hours, supervision ratios and center-based billing by plan letter, with no further rulemaking. Texas Medicaid, meanwhile, requires every three years the rediagnosis California's commercial plans can no longer ask for. Which side of that line each client sits on decides which of this week's items are about you.
⭐ Featured This Week
Newsom Signed California's Ban on Forfeited ABA Hours. It Starts January 1. California Legislative Information: AB 2233 bill hisNewsom signed AB 2233 on September 27 as Chapter 591. From January 1, 2027, California commercial plans and insurers can't let weekly caps forfeit authorized ABA hours inside a six-month authorization. Medi-Cal plans are excluded. Read Full Article → 🎧 Listen
📚 Research Digest
AI Coaching Raised Parent Fidelity. Clinicians Still Edited 31% of What It Said. Akemoğlu et alIn a four-dyad multiple-baseline study, AI-scored video feedback lifted parent fidelity with Tau-U of 1.00 for every family. Human reviewers edited 31.4% of 879 AI codes. Review took 5–10 minutes a session versus 20–30 minutes to code by hand. Read more → 🎧 ListenFour Ways to Prevent Resurgence, Tested Head to Head. The Popular One Backfired. Mitteer DRAcross 24 data sets, a lean reinforcement schedule for destructive behavior in baseline cut resurgence for 6 of 6 children (Mdn 67.14%). Thinning FCR reinforcement during treatment helped one child and made it worse for two, by 96.95% and 154.57%. Read more → 🎧 ListenVR Got Two Trainees to Criterion on Functional Analysis. Both Failed the Live Test. Clay CJIn a JABA feasibility study, 2 of 6 trainees hit criterion on VR alone and skipped the feedback phase. In live role-play both fell below criterion, 14–83% correct. A peer who received brief feedback held 91–100%. VR cost $15,999 once; in-person $22,000 a year. Read more → 🎧 ListenSkill-Based Treatment Cut Problem Behavior. 80% of Its Studies Rated Below Adequate. BunyanA September 28 JADD meta-analysis of skill-based treatment found a mean Tau-BC of 0.47 across 59 computable participants. It rated 80% of studies below adequate and called SBT an “emerging” evidence-based practice. Read more → 🎧 Listen
✅ BACB Updates
BCBA Fieldwork Changes January 1: 7.5% Concentrated Supervision, 160-Hour Months BACBFrom January 1, 2027, BCBA concentrated fieldwork needs 7.5% supervision instead of 10%, the monthly cap rises from 130 to 160 hours, and observations become 60 or 90 minutes a month. Hours logged at 7.5% can't count as concentrated under 2022 rules. Read more → 🎧 Listen
⚖ Legislation Tracker
New York Cut 97153 to $9.63 on October 1. That's Half the April 2023 Rate. New York State Medicaid UpdateNew York Medicaid fee-for-service has paid $9.63 a unit for 97153 since October 1, down from $14.45, a 33.4% cut. Against the April 2023 rate of $19.26 that is exactly half. 97152, also technician-delivered, stays at $19.26. Read more → 🎧 ListenIndiana Stopped Accepting the BASC-3 PRQ on October 1. BASC-4 Dropped the PRQ. IHCP Bulletin BT2026123From October 1, Indiana Medicaid accepts only BASC-4 in ABA treatment plans. The BASC-3 Parenting Relationship Questionnaire it made mandatory in 2024 does not exist in BASC-4, so a packet filed October 2 on a BASC-3 PRQ is incomplete. Read more → 🎧 ListenArizona Stopped Paying 58.66% of Whatever You Bill for Caregiver Training Oct. 1 AHCCCSFrom October 1, Arizona's fee-for-service ABA schedule prices 97156 at $23.97 and 97157 at $7.99 per 15 minutes, ending a percent-of-charges arrangement dated January 1, 2019. It reaches three programs only: AIHP, Tribal ALTCS and DDD Tribal Health. Read more → 🎧 ListenMinnesota Put EIDBI Notes on a 72-Hour Clock. A 40-Hour Weekly Limit Comes Next. Minnesota Laws 2026Minnesota law now requires EIDBI documentation entered within 72 hours of service, enforceable by payment withholds. From July 1, 2027 or federal approval, EIDBI billing is capped at 40 intensive hours and 20 observation-and-direction hours a week. Read more → 🎧 ListenMissouri Provisional Analysts Without a Degree Can Bill Only Three ABA Codes MO HealthNet Provider Bulletin Vol. 48 No. 50Since February 1, MO HealthNet pays provisional behavior analysts who haven't finished their degree only for 97152, 97153 and 97154. Claims for 97151, 97155, 97156 or 97158 are subject to recoupment. The bulletin posted six weeks late. Read more → 🎧 ListenLabor Department Narrows Parity Enforcement to Three Areas. ABA Sits in All Three. U.S. Department of Labor EBSAEBSA's September 8 bulletin narrows federal parity enforcement for employer plans to blanket exclusions, prior authorization and review, and network adequacy including reimbursement. Its last report credits an ABA exclusion removal covering 319,000 participants. Read more → 🎧 ListenCalifornia Banned Autism Rediagnosis Demands in January. Medi-Cal Plans Are Exempt. California LegislatureSince January 1, California commercial plans and insurers can't require a rediagnosis to keep autism treatment covered, for contracts issued, amended or renewed from that date. Medi-Cal is excluded, and utilization review still applies. Read more → 🎧 ListenNew Hampshire Denies ABA Group Claims Without an Enrolled BCBA. It Started August 1. New Hampshire Division of Medicaid ServicesSince August 1, New Hampshire Medicaid denies ABA group claims that don't name an enrolled rendering provider. Every BCBA needs an NPI, state enrollment and MCO credentialing, and goes on claims for the technicians they supervise. Read more → 🎧 ListenMissouri Added a Law Exam August 30. Its Next Rule Bans Group Supervision. Missouri Code of State RegulationsSince August 30, Missouri LBA applicants must score 70% on a $75 state law exam, and provisional applicants must submit a completed graduate degree. A pending rule would ban group supervision and require supervisors at the same company, in-state. Read more → 🎧 ListenGeorgia Medicaid Gives Every ABA Request Over 30 Hours a Week an Enhanced Review Georgia Department of Community HealthGeorgia's July 1 ABA manual sends every request over 30 hours a week to enhanced review, lets prior auths go in only two months early and bars retroactive dates. The supervising BCBA is the rendering provider on RBT claims such as 97153. Read more → 🎧 ListenVirginia's Draft ABA Manual Names the Diagnosis Rules. Comments Close October 21. Virginia DMASVirginia's draft Medicaid ABA manual requires an F84.0 diagnosis or, for children 5 and under, a provisional one backed by an evaluation appointment. Twenty hours a week is the limit outside EPSDT. Comments close October 21, and DMAS plans an October 22 start. Read more → 🎧 ListenCalifornia Banned Rediagnosis Demands. Texas Medicaid Requires One Every 3 Years. Texas Medicaid Provider Procedures ManualTexas Medicaid requires the ASD diagnosis behind an ABA authorization to have been made or reconfirmed within three years, at initiation and at every recertification. Past three years, the child needs a full comprehensive re-evaluation. Read more → 🎧 ListenCalifornia Restores Commercial Coverage for Telehealth ABA by Paraprofessionals California Legislative Information: AB 375AB 375, signed September 27, makes California's qualified autism service paraprofessionals “health care providers” under the telehealth statute from January 1, 2027. The Senate analysis says commercial plans must then cover BHT they deliver by telehealth. Read more → 🎧 ListenTexas Would Make AI a Licensure Matter for Behavior Analysts. It Hasn't Adopted It. Texas RegisterTexas proposed rules would require an LBA to personally verify and document in the client's file every plan change derived from AI, and to obtain written consent before using client data for report generation or marketing. Filed June 8, still not adopted. Read more → 🎧 ListenMedi-Cal ABA Agencies Must Background-Check Patient-Facing Staff by July 1, 2027 California Legislative Information: SB 874SB 874 requires every enrolled Medi-Cal BHT provider to run state and national criminal background checks on patient-facing employees by July 1, 2027, and keep proof for audits. DHCS must also seek input on supervision ratios and hours. Read more → 🎧 Listen
💼 Industry News
Humana's Oklahoma 10% ABA Supervision Rule Starts October 12, Not May 19 Humana Healthy Horizons in OklahomaHumana Healthy Horizons in Oklahoma's notice says ABA case supervision rises from 5% to 10% of direct treatment hours on October 12, 2026. We reported May 19, the date on OHCA's list. Humana's own date governs. Read more → 🎧 ListenWashington Cut ABA Rates 2% in January, and Designed the Cut to Reach MCO Contracts Washington State Health Care AuthorityWashington's Apple Health ABA fee schedule fell 2% on January 1: 97153 went from $12.65 to $12.40. HCA said it cut fee-for-service rates so MCO payments pegged to them would fall without recontracting. H2020 followed July 1. Read more → 🎧 ListenCigna Rejects ABA Data More Than 60 Days Old, and It Checks the Dates Evernorth Coverage Policy EN0499Cigna's ABA policy EN0499 needs the assessment done within 60 days before treatment and current data no older than 60 days when a request arrives. Data must be split by setting. A break over 60 days means a new standardized assessment. Read more → 🎧 ListenAetna Sets ABA Hours by How Far Below Average a Child Scores AetnaAetna's ABA guide grants 1–4, 4–7 or 7–10 hours a week per domain at 1, 1.5 or 2 SD below the mean. Coverage ends after successive periods with under 1 SD of gain. Every continuation is a new precert, on a form mandatory since August 1. Read more → 🎧 ListenHumana's Oklahoma ABA Assessment Caps Started September 16. Six Ways Past Them. HumanaHumana's Oklahoma Medicaid ABA policy, HUM-OK-2663-000, took effect September 16: 24 units (6 hours) for an initial 97151, 16 units (4 hours) for a 97151-TS reassessment every six months. Six exception categories are now written down, each with its own documentation test. Read more → 🎧 ListenPerformCare Rejects IBHS Claims With a Primary ID Diagnosis, Back to July 1 PerformCare Provider Notice IBHS 26 102PerformCare says IBHS claims with an intellectual disability code (F70–F79) as the primary diagnosis are expected to reject for dates of service on or after July 1, 2026. Claims already denied should be corrected and resubmitted. Read more → 🎧 ListenBCBS in Texas, Illinois and Oklahoma Pays One BCBA per Day and Moved ABA to MCG Blue Cross and Blue Shield of TexasHCSC's Blue plans in Texas, Illinois, Oklahoma and New Mexico moved ABA medical necessity to MCG on January 1. Their billing policy since March 20 pays one BCBA per member per date for similar services and caps assessments at 32 units. Read more → 🎧 Listen📤 Pass it on Know someone in ABA who should be reading this? We will send them one invitation from you — and nothing else unless they subscribe. Invite a colleague →
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