ABA News,
Translated.

What The Source Said

Senators Eric Schmitt (R-MO) and Kirsten Gillibrand (D-NY) sent a letter to the Pentagon asking that ABA therapy become a basic medical benefit under TRICARE, the military health plan. Since 2021, TRICARE has covered ABA only through a special demonstration program with extra hurdles: mandatory repeat testing, required parenting stress questionnaires, limits on where therapy can happen, and fewer approved billing codes than private insurance allows. The senators cite a newly completed independent review by the National Academies of Sciences, Engineering, and Medicine, which found that ABA meets the military's own standards for reliable medical evidence and recommended ending the redundant assessments, letting clinicians pick their own tools, approving all standard ABA billing codes, and allowing therapy in schools and community settings.

What The Source Said

The HHS Office of Inspector General released an audit (report A-09-24-02004) finding that Colorado Medicaid made at least $77.8 million in improper payments for ABA services to children in 2022 and 2023. Of 100 sampled enrollee-months, every single one contained at least one improper claim. The most common problems were missing or weak documentation, billing errors on the CPT 97155 code (which covers BCBA-delivered treatment), uncredentialed technicians delivering billed services, and gaps in prior-authorization paperwork. OIG asked Colorado to refund $42.6 million in federal share and to issue clearer guidance on what counts as billable ABA time. (Note: this report is older than our 14-day window. We're including it because it sets the documentation standard CMS is now using nationwide, and it is referenced repeatedly in the April 2026 revalidation initiative.)

What The Source Said

On April 21, 2026, CMS Administrator Dr. Mehmet Oz told all 50 states they must build new plans to re-check, or 'revalidate,' the Medicaid providers in their networks. States had 10 business days to confirm they would do it and 30 days to submit a two-year revalidation strategy. CMS named Applied Behavior Analysis (called 'Early Intensive Developmental and Behavioral Intervention' in federal language) as one of fourteen high-risk service categories. States set their own definition of 'high-risk' but were told to focus on providers without a National Provider Identifier and those not screened in the last twelve months.

What The Source Said

Starting in 2026, Texas Medicaid is enforcing authorized ABA hour limits on a per-week basis, not averaged across the authorization period. If a child is approved for 20 hours per week, providers must stay within 20 hours every week. Weeks over that limit will not be reimbursed. This changes the flexibility providers previously had to bank unused hours and use them later. Authorization reviews for Superior HealthPlan transitions also moved from Magellan Healthcare to Centene as of November 2025.