The applied behavior analysis (ABA) industry is experiencing an influx of investment dollars thanks to changes in state laws and insurance coverage. Now the challenge is to maintain quality while growing to meet the ever-increasing demand.
State Insurance Mandates
Currently, 48 states and the District of Columbia have laws that require insurance coverage of autism services such as ABA, according to Autism Speaks. In addition, the federal Medicaid Act requires states to cover ABA services for children who need such treatment under its Early and Periodic Screening, Diagnostic, and Treatment provision.
Insurance coverage for ABA is now so common that the American Medical Association recently announced that as of January 1, 2019, the medical billing codes for ABA will go from temporary to permanent. That means the Association recognizes ABA as a medically necessary treatment.
Along with their mandates to insurance providers to cover ABA, states are also implementing greater government oversight of ABA providers. Connecticut recently became the 30th state to require therapists providing ABA services to have a license or to work under the supervision of a licensed behavior analyst.
Supply and Demand
The increase in insurance coverage, along with the nation’s high rate of autism diagnoses, means the number of families clamoring for ABA services has hit new highs. But the demand is dramatically outpacing the supply. In North Carolina, the waiting lists for ABA services can be years long because there simply are not enough Registered Behavior Technicians (RBTs) to meet the demand.
Waiting is a scary prospect for parents. There is wide-spread agreement in the child development and medical communities that the earlier a child with autism begins ABA therapy, the better.
As we all learned in Econ 101, high demand plus low supply equals a business opportunity. The need for more ABA providers has caught the attention of private equity firms. The market for ABA is so hot right now, there is even an Autism Investor Summit scheduled for 2019.
The infusion of private equity dollars could lead to a dramatic expansion of access to ABA services for children and families. For example, Indianapolis-based Hopebridge went from 17 offices in two states to 30 offices in four states after receiving an influx of cash from a private equity firm.
However, rapid expansion and a focus on profits can put quality of care at risk. Some autism experts worry that ABA providers fueled by private equity will revert to “old school” ABA and fail to use contemporary ABA approaches that incorporate naturalistic teaching strategies and developmental principles like joint attention.
If ABA providers can keep their focus on ensuring that their Registered Behavior Technicians receive quality trainings, that their Board-Certified Behavior Analysts provide close supervision, and that their services are informed by the latest science in ABA, then the increased investment in ABA provider agencies could be an answer to prayers for many parents of young children with autism.