Governor Mike Braun has signed an executive order regarding Applied Behavior Analysis (ABA) that establishes a working group that should include legislators, stakeholders, and impacted families; involve a cross-section of subject matter experts from the Office of Medicaid Policy and Planning, the Department of Education, First Steps, and the Department of Child Services; and include input from parents, physicians, and ABA therapy providers. The working group will be tasked with evaluating the following solutions to address ABA costs while maintaining quality services, and presenting Governor Braun with three actionable recommendations:
- the best clinical care models to provide the right therapy at the right ages, in the right setting, to best serve children and families;
- recommendations for a better-coordinated experience for children who need ABA therapy services, but in a financially sustainable manner;
- proper transitions for children as they grow in their educational, family, and social settings;
- quality metrics for ABA therapy services;
- potential caps on hours of therapy services provided per week;
- potential caps on the number of months a child can receive therapy services;
- creating an appeals process for extenuating circumstances and
- establishing new provider enrollment and billing requirements for ABA providers to address issues identified in the federal audit.
The working group will conclude with a written report to the Governor by November 30, 2025.
Governor Braun signs executive order. Marya Sherron, a parent of a child with autism and a member of
The Arc of Indiana board; Brandi Wetherald, also a parent of a child with autism; and Caidon Wetherald, who received ABA therapy, were in attendance.
FSSA State ABA Plan Amendment
Governor Braun’s executive order follows FSSA’s announcement the week of February 10th that proposed across-the-board limits of 30 hours per week for all individuals receiving ABA would NOT move forward. While the updated State Plan Amendment still includes a three-year limitation, it will not be applied retroactively.
FSSA’s updated its State Plan Amendment for ABA services is set to take effect April 1st, pending CMS approval.
Weekly Limitation on Services
- For individuals diagnosed with ASD Level 1 – Not more than 30 hours per week
- For individuals diagnosed with ASD Level 2 – Not more than 32 hours per week OR the number of hours prescribed by the recipient’s health care provider
- For individuals diagnosed with ASD Level 3 – Not more than 38 hours per week OR the number of hours prescribed by the recipient’s health care provider
- For individuals not diagnosed with ASD, but have a documented disability for which ABA therapy is deemed medically necessary – Not more than 38 hours per week OR the number of hours prescribed by the recipient’s health care provider
Lifetime Limitation on Services
- For all individuals – Not more than 36 months of comprehensive ABA therapy
- For purposes of calculating the length of time in treatment, the time starts on the effective date of the State Plan Amendment (i.e., regardless of the number of months that an individual has already received ABA therapy, the individual will be able to continue services at least until 4/1/2028)
- Following the 3-year limitation, individuals may still qualify for limited-hour, behavior-specific, focused ABA based on medical necessity.
Additionally, FSSA will continue to require prior authorization for services, with peer review potentially required for individuals who require services for two or more years.
The Arc of Indiana remains strongly committed to eliminating the lifetime cap, as it does not reflect the needs of individuals who may require continued therapy to make progress.
Kim Dodson, The Arc of Indiana CEO, said, “While we know that more conversations need to take place, specifically on the lifetime cap, this is a major victory. We thank Representative Robb Greene for his tireless advocacy on this issue, as well as Representative Becky Cash who also worked with FSSA. Most importantly, we thank the families and advocates who took the time and effort to educate their legislators and the Governor on the importance of ABA therapy. Their efforts truly made a difference. We also appreciate Governor Braun’s creation of a task force to continue to study this important issue and make recommendations for further reforms to Governor Braun.