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Autism therapy providers approach contracting negotiations with payers lacking a key element of these discussions: leverage.

The new and highly fragmented autism therapy industry sits across the table from highly consolidated payers in both the public and private sectors. Across all payer types, 66% of metropolises see one payer holding 50% of the market. With narrow exceptions, this requires that providers take a different track with payer negotiations.

“You have to try to understand before being understood,” Michael Quinn, CEO and president of Independence, Missouri-based Autism Support Now, told Behavioral Health Business. “Try to understand from the payer’s perspective what the pain points are. Then, that opens the door to broader conversation.”

Autism Support Now employs 177 people and operates 10 clinics in Missouri and a location in Kansas. It currently offers only applied behavior analysis (ABA) services. In 2026, the company will add diagnostics services. It will also add several clinics to its footprint as soon as the first quarter of 2026, Quinn said.

Getting the conversation going with payers requires finding the right door first and then getting it to open, both of which are challenges for autism therapy providers. And for that, there are no real secrets or pricey solutions. It simply takes dogged perseverance to find the right person to ask the right questions to.

But once you’ve gotten to the right person, there is a vital tactic to employ that has worked for Autism Support Now in the past.

“If you have data reflecting the efficacy for beneficiaries, that sparks a conversation and promotes ongoing conversations,” Quinn said. “That’s where we are going in this industry … It doesn’t matter how fancy your clinics are or how much you pay your employees. That’s where the rubber meets the road.”

The combination of persistence, data and asking the right questions composes a vital formula that Quinn says Autism Support Now applies in several aspects of their conversations with payers.

For example, credentialing new providers with payers can be a major challenge for autism therapy providers. Autism Support Now has approached payers with long turnaround times, highlighted the challenge with data, asked what it can do to shorten times and done whatever is needed to keep that door open.

But when the light touch reaches its end without the necessary outcome, and after all reasonable attempts, then executives need to seriously consider the mandate each provider has to do whatever it takes for the benefit of their patients.

“I don’t want to give off the impression that I go in like a bull in a china shop; that’s the last resort,” Quinn said. “But I’ve deployed that with two commercial payers. We basically put them on a 60-day notice that their beneficiaries’ services will be discontinued. That resulted in a 51% increase in the 97153 code [reimbursement] with one of the largest commercial payers in the country. Now they don’t really like me. It’s fine. We’re not going to be on each other’s Christmas lists. That’s fine. But I’m not doing this for popularity.

“I believe I’m here to be a voice for those who don’t have a voice. So when I’m fighting for these children and families, I feel like I’m doing it for the greater good.”

Autism Support Now was founded in 2013. Quinn joined the organization in April 2022.

The following Q&A has been edited for length, clarity and style.

BHB: When you look back at 2025, what have been the most defining moments for the organization? 

Quinn: There have been a number of defining moments. But I want to focus on three areas.

The first one will be the quality of care. I think we have enhanced the quality of care among our clinicians significantly. We have allocated a lot of resources to onboarding, training and continuous professional development. The overwhelming response is very, very positive. We’re seeing progress in the development data of children.. We really lean into quality of care.

We’re now, I believe, regarded in the autism community as a very reputable entity because of what we’ve done with quality care and expanding access to care for underserved communities. That would be second — we’ve continued to expand ABA provisions for underserved communities, particularly Medicaid. We opened another location near St. Louis.

The last one I would say is our ability to articulate eloquently and effectively to payers, “Here’s what we do, here’s how we do it and this is why we want a rate increase.’ And we’ve been very successful in that. We’ve gone and provided a very compelling case around the clinical data that justifies the conversation.

How have your conversations with payers changed in 2025 compared to 2024 or other past years?

I’ve been pretty consistent in how I engage with the various state and commercial payers. I think like any relationship, there has to be some kind of commonality, and the provider-payer relationship is no different. They want to ensure that what they’re getting for their beneficiaries reflects clinical efficacy. One of the ways you do that is by showcasing data, and that’s what we have done consistently in our conversations. We’ve shown them case studies that show that, when children receive ABA with fidelity and routinely, the developmental outcomes are very, very promising.

The conversations have been very consistent with the sharing of data, clinical data. It’s also been very consistent with sharing economic data showing what it costs to provide just one hour of ABA and how that compares to what they are paying.

Also, additional documentation has helped inform the conversation. Without naming payers, one of them was not very committed to getting us to a rate where we needed to be economically. So, I got a copy of their financial report and amplified their net profit from the prior fiscal year in ABA. That changed everything.

A key here has been perseverance. So perseverance and a little bit of data has been our formula.

Payers and providers can find alignment by serving underserved communities. But those communities are likely underserved because of barriers to care. Has Autism Support Now been able to partner with a payer to get care to those in need of access? Briefly, what did that look like?

Seventy percent of our clients are Medicaid beneficiaries. Medicaid is our biggest payer. They’ve been an amazing partner. I never thought I would say that about a state entity. I think in any relationship, if it’s transactional, it’s not going to be long-term. I think this relationship has been very fruitful, because we’ve kind of tried to understand before being understood, and we’ve tried to get a sense of what their pain points are. And it opens the door. It’s like when you go dating. What are you interested in? What are you not interested in? That kind of thing. You can get a sense of that person and what they represent. Then you build on that. If it’s just transactional all the time, that leads to a short-term gain. But it’s not going to last long-term, in my experience.