The federal government announced in 2014 that Medicaid programs nationwide were required to cover medically necessary diagnostic and treatment services for children with autism.
This requirement led to millions of people having access to insurance coverage for applied behavior analysis (ABA) and other autism therapy modalities.
Massachusetts’ Medicaid program, MassHealth, has now gone a step further and will require Medicaid managed care entities (MCEs) to contract only with accredited ABA providers as part of a policy change set to go into effect on Jan. 1, 2025.
Third-party accreditation bodies are independent organizations that assess ABA providers and provide a stamp of approval if the provider meets certain criteria.
Moving forward, MassHealth-credentialed, center-based ABA providers must be accredited by a nationally recognized accreditation body specializing in ABA by Jan. 1, 2027, according to an Oct. 1 press release from the Autism Commission on Quality (ACQ)
All other ABA providers are required to be accredited by Jan. 1, 2028.
MassHealth also updated its policy to simplify requirements for autism diagnoses and clarifies expectations regarding indiviudalized treatment, training caregivers, documenting treatment plans and performance specifications.
The demand for ABA services has steadily increased in recent years, according to CentralReach data, growing by 40% from 2022 to 2024.
However, autistic people often face long waitlists when seeking services. One report found that children spent a median time of more than five months on at least one waitlist.
Accreditation bodies jumped on MassHealth’s decision to advertise their services.
“Creating financial incentives will help promote wide-scale adoption of accreditation,” Andi Waks, chair of the ACQ Accreditation Committee, said in a statement.
Louisville, Kentucky-based ACQ was founded in 2022 by the Council of Autism Service Providers (CASP).
Jade Health, formerly the Behavioral Health Center of Excellence (BHCOE), took to social media to encourage MassHealth ABA providers to apply for its accreditation.
“We help providers meet accreditation standards and thrive in a changing landscape,” the post read.
Los Angeles-based Jade Health was founded in 2015 and, along with its accreditation services, maintains an ABA data registry, offers consultation services and operates an online learning hub.