Legal Notice

Notice of Applied Behavior Analysis (ABA) Workgroup

The Department of Medical Assistance Services (DMAS) is hosting a workgroup as directed by the General Assembly, regarding the utilization of Applied Behavior Analysis (ABA) and you're invited!

In this six-meeting series, the first workgroup meeting will take place on September 22, 2026, from 1-3pm.

Agenda items include:

• Background of Virginia Medicaid's ABA benefit;

• Purpose of the workgroup;

• Statewide data on utilization trends;

• MCO data on utilization trends including by delivery method;

• High level overview of clinical best practice guidelines

Meeting Details:

Microsoft Teams meeting

Join: https://teams.microsoft.com/meet/221475508908737?p=pkjoMTLtUmYQX28mkY

Meeting ID: 221 475 508 908 737

Passcode: Mq6xD7ed

Budget Item 291 #13C:

"3. The Department of Medical Assistance Services (DMAS) shall convene an ABA benefit Utilization Workgroup for the purpose of examining Medicaid expenditures and utilization trends for this service and identifying strategies to control costs while still preserving access to care for those in need of the therapy. The workgroup shall: (i) identify utilization trends, including trends among those with different diagnosis acuity levels; (ii) examine different delivery methods of ABA services and their impact on utilization; (iii) review utilization and service authorization criteria including standard assessment tools and diagnostic criteria taking into account differing service intensity and duration requirements; (iv) evaluate utilization management tools that align with national clinic practice guidelines promulgated by independent national nonprofit organizations; (v) define medical necessity criteria taking into account behavioral factors, ability to learn, age and development, and skills development including clear criteria for eligibility, scope of services and documentation requirements; (vi) review provider qualification recommendations related to ABA practitioner certification and licensing; and current supervision requirements and standards to help ensure appropriate clinical oversight; (vii) evaluate the appropriateness of ABA services for children with diagnoses other than ASD; and (viii) review the MCO annual reporting data to identify any areas of potential improvement to the delivery of services and any needed changes in regulations or policies from DMAS. The workgroup shall include stakeholders, including ABA service providers, including center-based models and home-based models, representatives from managed care organizations serving Medicaid patients, Virginia licensed behavioral analysts, and a child or adolescent psychiatrist. The workgroup meetings shall be open to the public and offer opportunities for public input."