Last month, Massachusetts became the first state to require applied behavioral analysis (ABA) providers to become accredited, marking a significant step toward regulating the autism therapy industry. The Massachusetts Executive Office of Health and Human Services implemented this new rule in October following growing concerns from the state’s attorney general and inspector general about the lack of consistent quality control at ABA clinics over the past year.
ABA providers who treat patients diagnosed with autism spectrum disorder (ASD) have largely supported the new accreditation requirement, expressing eagerness for additional regulations that would ensure a more equitable playing field in the industry. Providers are optimistic that the move will help establish a higher standard for care and accountability.
“Accreditation doesn’t guarantee business success,” Cathy Lopez, chief operating officer at Cortica, told Autism Business News. “But it does show existing and new teammates, our patients, and their families that Cortica takes its clinical quality and administrative processes seriously and can withstand the scrutiny of an external audit.”
As part of the accreditation process, providers have two accreditation bodies to choose from: the Autism Commission on Quality (ACQ) and the Behavioral Health Center of Excellence (BHCOE), both of which are part of larger organizations. The state of Massachusetts has expressed no preference for either accrediting body, leaving the decision up to the individual providers.
The introduction of these two accreditation organizations, neither of which existed a decade ago, demonstrates just how rapidly ABA therapy has expanded. It also underscores the growing challenge providers, payers, and regulators face in standardizing an industry that has yet to fully mature. This shift is part of the broader conversation on autism therapy regulation, with many professionals hoping for clearer guidelines across the nation.
The Massachusetts Mandate
The push for accreditation was catalyzed last year when Massachusetts Attorney General Andrea Joy Campbell announced a settlement of over $2.5 million with two ABA providers accused of fraudulent overbilling MassHealth, the state’s Medicaid program. In her statement about the settlement, Campbell emphasized the need for more rigorous standards, particularly after the federal government clarified a decade earlier that providers treating children with autism could bill Medicaid.
“The defendants involved in these two settlements not only failed to comply with the necessary standards for providing critical services to a vulnerable population with autism spectrum disorder, but also fraudulently exploited public funds,” Campbell said at the time.
Earlier this year, Massachusetts Inspector General Jeffrey Shapiro released a report which found that managed care entities contracted with MassHealth had failed to ensure that children on MassHealth received properly supervised treatment. In response to these findings, Massachusetts Health and Human Services set a new requirement: by the start of 2027, all ABA providers who bill MassHealth must be accredited by an external organization. By 2028, the state mandates that all ABA providers across the state be accredited, marking a firm stance on autism therapy regulation.
“Requiring accreditation by a nationally recognized accreditation body specializing in ABA provides an additional level of accountability and oversight to help ensure MassHealth members receive high-quality care,” a MassHealth spokesperson told Autism Business News.
This mandate represents a significant shift from previous regulations for ABA care in Massachusetts, which did not have such stringent accreditation requirements.
“State agencies do not usually have a large standard set for ABA care,” said Jenna Kokoski, vice president of clinical strategies at Jade Health, the parent company of the Behavioral Health Center of Excellence. “It is often comprised of clinician qualifications and clinical documentation standards.”
Kokoski added that states typically require individual clinicians to be certified behavioral analysts, a designation managed by the Behavior Analyst Certification Board, a nonprofit based in Littleton, Colorado. Aside from this, most states only require compliance with broader healthcare laws, such as the Health Insurance Portability and Accountability Act (HIPAA), Kokoski noted. This situation has long led to the industry’s push for stronger autism therapy regulation.
The Rigor of Accreditation
Jade Health, which oversees the Behavioral Health Center of Excellence (BHCOE), is an example of an organization that has been actively involved in ensuring quality in ABA care through accreditation. BHCOE, founded in 2015 in Los Angeles, is dedicated to accrediting ABA providers and ensuring they meet high standards for patient care, billing, and overall business practices.
Kokoski explained that the process of accreditation through BHCOE is intensive, with providers needing to go through a “documentation phase that shows all the right policies and procedures are in place, including for billing.” BHCOE’s rigorous accreditation process includes requirements such as the creation of diversity statements and clear protocols for reporting misconduct.
As a part of the accreditation process, each clinic must reapply for accreditation every two years, ensuring that standards are continually met and updated. BHCOE itself is accredited by the American National Standards Institute (ANSI), an important body that recognizes accreditors in various industries.
The Autism Commission on Quality (ACQ), established in 2022 in Louisville, Kentucky, by the Council of Autism Service Providers, is another key player in this evolving landscape. ACQ’s standards, which span 75 pages, cover a wide range of topics, from ethical marketing practices to patient safety.
“Alignment with ACQ’s standards implies a focus on clinical outcomes, patient safety, and compliance with applicable regulations,” said Erick Dubuque, director of ACQ.
Both BHCOE and ACQ are playing pivotal roles in raising the bar for autism therapy regulation, a shift that is expected to continue as the industry matures.
Accreditation’s Future
Despite Massachusetts’ progressive stance, the question remains: will other states follow suit? While a handful of states in the Northeast and West Coast are considering stronger standards for ABA providers, no other state has announced plans to require universal accreditation yet. As it stands, outside of Massachusetts, accreditation remains voluntary.
However, many ABA providers view accreditation as a crucial step in establishing legitimacy, both with health insurance companies and with patients. It also helps ensure that the services they provide meet high standards of quality and accountability, which can lead to long-term success.
“It allows a family to begin building a list of providers,” said Krista Boe, chief clinical officer at Acorn Health, a national autism therapy provider headquartered in Coral Gables, Florida. Boe noted that sectors from hospital systems to restaurants use accreditations as a sign of quality and maturity. Acorn Health’s clinics are accredited by BHCOE and are in the process of receiving ACQ accreditation as well.
For providers like Cortica, accreditation is seen as a baseline for ensuring clinical excellence. Lopez, Cortica’s COO, stressed that the accreditation process was a collaborative effort that required coordination across different departments to align with the framework set by BHCOE.
“We had all the key components in place for accreditation,” Lopez said. “Our challenge was to organize them in the framework BHCOE provided.”
Boe, who expressed concerns about the under-regulated nature of the industry, also sees the role of independent accreditors as an essential safeguard in the absence of formal state regulations.
“I don’t think I’m alone in believing we’re under-regulated,” Boe said. “But I don’t have a strong opinion on whether rules should come from states or an independent accrediting body.”
As more providers seek accreditation and autism therapy regulation continues to evolve, it is clear that these efforts are a crucial part of shaping a future where ABA services are delivered with the highest standards of quality and accountability.
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