For the first time, Colorado state agencies will have the ability to regulate autism therapy centers and require their employees to get certified.<\/p>\n
House Bill 1425<\/a>, signed by Gov. Jared Polis last week, will create a board to license providers of applied behavior analysis, with unlicensed practice classified as a misdemeanor. The new law also allows the state to regulate clinics<\/a> treating at least three children.<\/p>\n Applied behavior analysis, known as ABA, involves breaking down skills step-by-step and rewarding children for desired behaviors. Parents of children with severe autism have credited it with helping them learn to communicate and perform self-care, while autistic adults sometimes describe it as damaging to their mental health.<\/p>\n The ABA sector has grown rapidly in recent years, fueling concerns about whether states have enough oversight of what their Medicaid dollars are buying. A federal audit found Colorado may have paid nearly $80 million to providers without documentation to prove they provided the services \u2014 a concern auditors also raised in other states. The new law, however, doesn\u2019t specifically address billing and documentation.<\/p>\n About 500 clinics operate in Colorado, with roughly 2,000 analysts and 8,000 technicians, according to the bill\u2019s fiscal note<\/a>. Analysts have a master\u2019s degree and develop a child\u2019s care plan, while technicians, who provide most of the hands-on therapy, didn\u2019t have to complete specific training before the bill passed.<\/p>\n In a signing statement, Polis said the bill would protect children and ensure staff safety.<\/p>\n \u201cThis bipartisan bill is an example of how we can come together, listen and collaborate to solve difficult issues. I thank the sponsors, advocates and parents for doing the hard work to find the best path forward,\u201d he said.<\/p>\n The fiscal note estimated the bill would cost between $2.3 million and $3.1 million each of the next three years, and require between 19 and 25 employees to implement.<\/p>\n Spending on ABA has shot up nationwide since the federal Centers for Medicare and Medicaid Services began requiring state Medicaid plans to cover it in 2014, with greater increases as private-equity firms began buying centers.<\/p>\n Former employees of practices bought by private equity reported pressure to spend less time developing individual plans for patients and to either see more clients or increase billable hours with each, according to a report from the nonprofit Private Equity Stakeholder Partnership<\/a>.<\/p>\n In 2024, Colorado\u2019s Medicaid program spent more on autism therapies than on all emergency room visits<\/a>, and the state\u2019s Department of Health Care Policy and Financing proposed lowering rates paid to providers<\/a> and allowing more opportunities to look for improper payments. The legislature ultimately didn\u2019t adopt those recommendations.<\/p>\n An audit by the Office of the Inspector General<\/a> found Colorado may have overpaid providers by $77.8 million, and could owe the federal government $42.6 million for its share of the Medicaid payments. The inspectors took a small sample of payments and determined most were either definitely or potentially improper, mostly due to a lack of documentation. The state disputes the auditors\u2019 methodology and said Colorado likely owes less, or perhaps nothing.<\/p>\n State-level audits in Nevada and Massachusetts had similar findings, as did one of payments through Tricare, which covers military members and their families. The U.S. Department of Justice also recently charged the owner of two clinics in Minnesota<\/a> with paying kickbacks to parents to enroll children in autism therapy they apparently didn\u2019t need.<\/p>\n The bill\u2019s sponsors said the bill would preserve access to ethical providers, while putting controls on those focused more on profit than children\u2019s well-being.<\/p>\n \u201cRight now, the ABA landscape is uneven,\u201d Rep. Kyle Brown, a Louisville Democrat and one of the sponsors, said during a legislative committee hearing in May.<\/p>\n Representatives for the Colorado Department of Human Services supported the bill, saying it would allow them to investigate complaints, which in recent years included allegations ranging from one center hiring a sex offender to serving children raw chicken and providing excessive medication.<\/p>\n Medicaid will have to pay for services by technicians still completing their licensure for up to 45 days. The Colorado Department of Health Care Policy and Financing, which runs the state\u2019s Medicaid program, asked for a shorter grace period than the 60 days initially included in the bill, while ABA providers wanted at least 90 days.<\/p>\n \u201cWe\u2019d like to give people time to move through the (certification) process at a reasonable pace,\u201d said Will Martin, a board member of the Colorado Association for Behavior Analysis<\/a>. Overall, however, the provider trade association and heads of individual facilities who spoke to the legislature said they supported the bill.<\/p>\n