In recent years, the landscape of autism therapy reimbursement has seen notable improvements. The positive trend in reimbursement rates for services rendered by Registered Behavior Technicians (RBTs) and Board-Certified Behavior Analysts (BCBAs) offers a glimmer of hope for the sector. However, this progress, while promising, does not come without its hurdles. One of the most significant challenges providers face is the burden of complex and often cumbersome regulations, which can stymie growth and prevent providers from fully capitalizing on the upward trend in autism therapy reimbursement rates. To navigate this complex environment and ensure continued progress, it is crucial that all stakeholders in the autism therapy industry, including private equity firms, actively engage in advocacy efforts.
This was a central theme discussed at the recent Behavioral Health Business Autism & Addiction Treatment Forum, where industry experts underscored the importance of collective advocacy in securing better Medicaid rates and pushing for regulatory changes that support growth in the sector. As Darren Patz, partner of government affairs and public policy at DLA Piper, put it, “No margin, no mission.” In other words, securing adequate autism therapy reimbursement rates is a foundational element for providers to succeed. Once these rates are established, everything else—from attracting talent to expanding services—becomes easier.
The Road to Improved Medicaid Reimbursement
Medicaid reimbursement for autism therapy services, particularly those provided by RBTs and BCBAs, is still in the process of being fine-tuned across various states. As Patz explained, the reimbursement structure for these services is relatively new, and states are still determining appropriate rates. While this process is ongoing, the trends are promising.
LEARN Behavioral, a leading provider of Applied Behavior Analysis (ABA) therapy, has seen positive trends in autism therapy reimbursement. According to Rob Haupt, the company’s executive vice president of autism services, a significant portion of the states in which LEARN operates have increased rates for RBTs, with several states also raising rates for BCBAs. This upward trend in autism therapy reimbursement rates is a welcome development for the industry, as it allows providers to offer better compensation to staff, which in turn improves the quality of care delivered to patients.
However, Haupt emphasized that the primary motivation for advocating for increased rates is not about increasing profits for the organizations themselves. Instead, it’s about ensuring that providers can attract and retain highly qualified professionals, offer more robust training programs, and ultimately provide better care for individuals with autism. “It’s becoming a lot easier of a conversation with these states,” Haupt said, explaining that these rate increases are aimed at improving the overall quality of services provided to individuals with autism, not just the bottom line of the companies delivering them.
Similarly, Acorn Health, another prominent provider of ABA therapy, has experienced Medicaid rate increases in roughly half of the states where it operates. Acorn Health, which runs over 70 clinics in states such as Florida, Illinois, and Pennsylvania, is focused on providing high-quality services in both center-based and home-based settings. Krista Boe, Acorn Health’s chief clinical and compliance officer, noted that these rate increases are crucial in addressing the industry’s ongoing struggle to recruit and retain qualified clinicians. For many providers, offering competitive salaries and benefits is essential for maintaining a skilled workforce and reducing turnover.
The Challenges of Navigating Increased Regulations
While the trend in Medicaid reimbursement rates is positive, providers must also contend with the accompanying rise in regulations. As rates increase, new rules and compliance requirements often follow. While regulations are typically put in place to improve safety, compliance, and the overall quality of care, they can sometimes be overwhelming, complex, and even counterproductive to growth.
Haupt pointed out that while these regulations are intended to ensure safety and compliance, they can also feel “cumbersome and almost penalizing” to providers already working within a challenging financial and operational environment. The additional administrative burden can be particularly difficult for smaller providers or those operating in multiple states, where the regulatory landscape can vary significantly.
Boe also acknowledged that achieving Medicaid rate increases is no easy feat. Working with payers to negotiate annual rate increases requires significant effort and a rigorous, data-driven approach. The negotiation process can be time-consuming, and providers must be prepared to engage in lengthy discussions with government agencies and insurers to secure rate increases that align with the true cost of delivering high-quality care.
Yet, experts believe that the autism therapy community can and should play an active role in advocating for effective, efficient regulations that allow for growth while maintaining safety and compliance standards. Providers need to work alongside government agencies to craft regulations that are not only beneficial for patients but also practical and sustainable for providers.
The Power of Collective Advocacy
One of the central takeaways from the forum was the importance of collective advocacy. Industry insiders emphasized that no one organization can navigate the regulatory and reimbursement landscape alone. Instead, autism therapy providers must unite to advocate for common goals and push for changes that will benefit the entire sector. The power of collaboration and collective action should not be underestimated.
Boe highlighted the success that Acorn Health and other providers have experienced through collaboration, particularly in consortiums of organizations. These groups of stakeholders—ranging from providers to professional societies to academic institutions—can bring a much-needed strength in numbers when advocating for policy changes. By working together, they can amplify their voice and increase their chances of achieving meaningful results.
Private equity-backed ABA providers, which have become increasingly influential in autism therapy, also play a critical role in these advocacy efforts. Patz stressed that private equity firms should not shy away from these conversations but rather be vocal about the positive impact they are having on the industry. Private equity investments have led to improvements in compliance, training, and infrastructure, all of which contribute to better patient outcomes. Yet, the perception of private equity in the autism industry remains mixed. Some myths and misconceptions persist about private equity’s role, which is why it’s essential for these firms to participate in advocacy efforts to dispel any negative stereotypes and demonstrate their commitment to the long-term success of the sector.
Boe echoed Patz’s sentiment, noting that the involvement of private equity in the autism space has led to a positive evolution of the industry over the past decade. The influx of capital has allowed providers to ask harder questions, demand better proof of outcomes, and push for more measurable, long-term improvements in the lives of individuals with autism.
Preparing for the Future: Opportunities and Challenges
Despite the progress made in securing Medicaid rate increases, the autism therapy industry faces an uncertain future. Patz noted that the upward trend in autism therapy reimbursement rates has been buoyed by a strong economy, but the economic landscape could shift, which might affect the availability of funds for Medicaid programs. In the event of an economic downturn, providers will need to be prepared to adjust their strategies and continue advocating for sustainable rates.
As the industry continues to evolve, there are also opportunities to improve the status quo beyond just increasing rates. For example, maintaining telemedicine regulations, improving enrollment efficiency, and enabling remote BCBA monitoring could all help streamline services and increase access to care. These policy changes could benefit both providers and patients, ensuring that services remain accessible and of high quality.
Conclusion: A Collaborative Path Forward
The future of autism therapy lies in collaboration, advocacy, and a collective effort to overcome the challenges that the industry faces. The trend toward higher Medicaid autism therapy reimbursement rates is encouraging, but providers must continue to work together to ensure that regulations are not a hindrance to growth and innovation. By advocating for better reimbursement rates, streamlined regulations, and improved policies, the autism therapy industry can continue to expand and provide essential services to more individuals with autism.
For stakeholders across the spectrum—providers, private equity firms, government agencies, and advocates—it’s clear that the key to success lies in working together. Through unified advocacy efforts and a shared commitment to improving the quality of care, the autism therapy industry can continue to grow and thrive, ensuring that individuals with autism receive the care they need and deserve.
