CMS Releases Guidance on ABA Therapy Compliance Amid Rising Fraud Concerns

CMS has issued new guidance addressing compliance and payment-integrity risks in applied behavior analysis (ABA) therapy for autism, one of Medicaid's fastest-growing service categories. The guidance responds to increasing expenditures, varying clinical practices, and reported fraud schemes in ABA services. Rapid program growth, extensive use of paraprofessional staff, and complex documentation and supervision requirements have created heightened compliance risks. The guidance affects state Medicaid agencies overseeing ABA programs, managed care organizations with behavioral health responsibilities, and ABA providers navigating fraud and abuse prevention requirements.

Behavioral Health · Managed Care