Indiana Tightens Medicaid Oversight of Autism Therapy Billing
In a commentary piece, the author argues that Indiana's reforms to its Medicaid applied behavioral analysis (ABA) program offer a model for other states combating fraud and improper billing. The piece cites state data showing ABA spending grew from $17 million to $611 million by 2023, and a federal inspector general audit finding improper or potentially improper claims in all 100 sampled enrollee-months, with at least $56 million in improper fee-for-service payments in 2019-2020. Under Gov. Mike Braun, Indiana is requiring ABA provider accreditation by October 2027, imposed a temporary moratorium on new agency enrollments, mandated clinical supervision ratios for behavior technicians, barred telehealth billing for services requiring in-person observation, and restructured fee schedules. The author points to a new CMS ABA toolkit and 421% national growth in ABA spending from 2021 to 2025 as evidence other states should adopt similar safeguards.