Running an ABA practice, in plain language.
Billing and authorization changes, payer news, and practice operations, written for BCBAs, clinical directors, and the people who keep ABA practices running.
How Many RBTs Can One BCBA Supervise? The BACB Won't Give a Number, So Here's the Math.
The BACB sets no maximum number of RBTs per supervisor. What it sets is a floor per RBT: 5% of monthly service hours, two real-time contacts, one of them individual, and one observation. Ethics Code 4.03 makes the BCBA responsible for knowing their own limit and documenting it. States are filling the gap: South Carolina caps BCBAs at 12 weighted cases, and Oklahoma's Humana plan doubles case supervision to 10% starting today. Here's how to work out a ratio you can defend.
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bacbBCBA Applications Under the 2022 Rules Close December 31. Here's What Changes for Your Trainees on January 1.
The BACB's 2027 BCBA and BCaBA requirements take effect January 1, 2027. A complete application (paid, with every document received) must reach the BACB by December 31, 2026 to be reviewed under the 2022 rules. After that, BCBA pathways 3 and 4 are gone, concentrated supervision drops from 10% to 7.5%, the monthly fieldwork cap rises from 130 to 160 hours, and observations are counted in minutes. Here's what changes and what practices with fieldwork trainees should do in the next 11 weeks.
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payersAetna Calls ABA "a Cost Issue" and Launches an Autism Program in 2027. Here's What Your Authorizations Should Expect.
Aetna Mental Wellbeing is building a "holistic autism solution" with a full member launch at the start of 2027, with Cortica as a key partner and a plan to help define autism standards of care. One Aetna executive put the motive plainly: "on the ABA side, it really is a cost issue." Here's what Aetna said, what it didn't, and how ABA practices with Aetna members should prepare.
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billingThe 2027 ABA CPT Codes Are Out. 97155 Splits in Two, and BCBAs Can Finally Bill for Indirect Work.
The AMA released the 2027 CPT code set in September, and the ABA Coding Coalition published the crosswalk. Six new codes take effect January 1: 97148, +97149, 97159, +97160, 97173, and 97180. 0362T and 0373T are permanently deleted. BCBAs who treat a client alone move off 97155 to 97173, and 97180 covers non-face-to-face clinical work that was never separately billable before. Here's the code-by-code crosswalk and what to do before your next authorization request.
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practice management34% of RBTs Who Quit Cited Unpredictable Pay. How ABA Practices Cut RBT Turnover.
Median RBT turnover runs around 65% a year, and the largest ABA organizations approach or pass 100%. BACB exit data points at a fixable cause: a third of former RBTs cited unpredictable pay. Here's what the data says, what retention-first practices do differently, and the math on paying RBTs through cancellations.
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complianceIndiana Just Told ABA Providers How to Handle Naps, Referrals, and FBAs. The FBA Deadline Is October 29.
Three IHCP bulletins dated September 29 change what Indiana Medicaid expects in every ABA treatment plan. Naps go on the schedule and can't be blocked because they're nonbillable. Only a physician, HSPP, APRN, or PA can write a referral, never a BCBA. And starting October 29, any behavior targeted by a BIP needs a complete functional behavior assessment behind it.
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complianceMassHealth Wants $943,000 Back Over a 1:10 Supervision Ratio. A LEARN Behavioral Unit Just Sued.
Autism Spectrum Therapies, part of LEARN Behavioral, filed suit on September 23 to stop MassHealth and its managed care plans from recouping $943,000 for 2024 ABA services. The recoupment rests on a 1:10 supervision ratio the provider says came from 2016 guidance, never went through rulemaking, and is being measured by comparing just two CPT codes. It's the first lawsuit of its kind, and the math behind it could reach any state.
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floridaCMS Told Florida's ABA Task Force the Path to a Treatment Plan Can Take 20 Hours. Florida Pays for Six.
At the Florida ABA Task Force's second meeting, CMS's Dr. Caprice Knapp said reaching an individualized treatment plan can take up to 20 hours, and that CMCS uses soft limits, not hard ones. Florida Medicaid reimburses a maximum of 24 units (6 hours) of 97151 per behavior assessment and 18 units (4.5 hours) per reassessment. The Task Force reports December 31. Here's what the cap forces practices to cut, how to document inside it, and how to quote CMS correctly when you push back.
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medicaidNew York Is Cutting 97153 to $9.63 a Unit on October 1. Here's What $38.52 an Hour Actually Buys.
New York Medicaid will pay $9.63 per unit for CPT 97153 starting October 1, 2026: a 33% cut from $14.45, the third reduction in a year, and half of what the state paid in early 2025. That's $38.52 per billed hour, the lowest Medicaid rate in the country. We ran the fully loaded RBT cost math, and it leaves almost nothing for the rest of the practice.
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medicaidA North Carolina Medicaid Plan Just Bet on Fewer ABA Hours. Your Next Renewal Will Feel It.
Alliance Health, a North Carolina Medicaid Tailored Plan covering 464,000 people, has contracted with Cortica on a model built on the idea that treating a child's medical conditions lowers the ABA hours they need. NC Medicaid kids average about 32 ABA hours a week. Cortica's CEO describes his model bringing a 40-hour case down to 10. Independent practices in the same network should expect that comparison to show up in authorization reviews.
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