Strengthening Access to Services Through Program Integrity

Autism Acceptance Month

What is Autism?

April marks Autism Acceptance Month, a time to acknowledge and support individuals on the autism spectrum and the families who rely on critical services every day. The National Institute of Mental Health (NIMH) defines autism spectrum disorder (ASD) this way:

“Autism spectrum disorder is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms generally appear in the first two years of life.

The NIMH goes on to say that the array of symptoms can vary widely, ranging from differences in social behaviors and communication styles, to intellectual disabilities to physical and mental health conditions. According to the same report, NIMH says:

“People with autism also have a wide range of health care and service needs. Research shows that access to needed services and supports early in life can promote people’s health and well-being over the long term.”

As awareness continues to grow of the social, medical, familial, and financial impacts related to ASD, so does the need for effective, evidence-based care such as Applied Behavior Analysis (ABA) therapy. Alongside this growth comes important responsibilities: ensuring these services remain accessible, sustainable, and delivered with full regulatory compliance and program integrity.

The Growing Importance of ABA and the Essential Need for Oversight

ABA therapy is a research- and evidence-based intervention predicated on the science of learning and behavior and underpinned by principles established by Harvard psychologist B.F. Skinner. The objective is to use various modifications on certain environmental stimuli to understand, and incrementally change certain behaviors, including social, communication, daily living, and learning capabilities. As Autism Care Partners puts it, ABA is a “…therapeutic approach that uses the ABC contingency model, focusing on antecedents, behaviors, and consequences, to analyze and understand behaviors,” which then becomes the basis for the therapist to set goals for the individual and their families.

As Medicaid coverage for ABA has expanded nationwide, it has opened the door for more families to access care that can be life-changing. Indeed, the American Psychological Association reports that ABA is “…very effective in improving intellectual abilities…and moderately to very effective in improving communication skills …in both expressive-language skills and receptive- language skills.”

Rapid growth in spending on ABA – from $660 million in 2019 to $2.2 billion in 2023 by state Medicaid programs – has also brought increased compliance and fraud issues. Recent audits and oversight efforts have highlighted documentation gaps, billing inconsistencies, and operational challenges across some programs. In fact, federal reviews have identified significant volumes of improper or potentially improper payments tied to ABA services.

How Myers and Stauffer Can Help

Program Integrity: A Pathway to Access and Compliance

Program integrity protects access to these programs, while ensuring appropriate, consistent, and sustainable service delivery that maintains trust and provides proper stewardship of the taxpayer dollars that funds Medicaid programs. Without proper oversight, the consequences can lead to funding instability, increased scrutiny, and even policy changes that may limit services. As we highlighted in our recent insights on Medicaid program integrity, effective oversight helps ensure that:

Services are medically necessary.
Providers meet required qualifications and contractual obligations.
Payments are accurate and supported by documentation.

Well-managed programs create a stable foundation that allows essential services such as ABA therapy to continue and even expand.

The Role of Auditing in Strengthening ABA Programs

Targeted auditing and proactive program integrity strategies can help state agencies identify risks early and address them before they escalate. Key focus areas include:

Documentation reviews to ensure services are fully supported and compliant.
Provider qualification validation to confirm appropriate credentials and supervision.
Utilization monitoring to align services with clinical necessity.
Data-driven insights to detect patterns and improve decision-making.

With increased regulatory scrutiny on ABA services nationwide, organizations that invest in these areas are better positioned to adapt, remain compliant, and continue delivering high-quality care.

Supporting Families by Strengthening Systems

At its core, Autism Acceptance Month is about people…children, adults, and families navigating complex systems to access the care they need. Program integrity may operate behind the scenes, but its impact is deeply felt. When programs function effectively, families experience fewer disruptions in care, providers can focus on delivering meaningful outcomes, and states can confidently sustain and expand services. By strengthening oversight and improving program integrity within ABA therapy, we help ensure these essential services remain available, not just today, but for the future.

Moving Forward

As the landscape continues to evolve, aligning contract and regulatory compliance, clinical quality, and operational efficiency will be key to supporting long-term success in ABA programs. At Myers and Stauffer, we partner with state agencies and healthcare organizations to enhance program integrity, strengthen oversight, support the delivery of critical services like ABA therapy, and effect transformational change in critical programs. Contact a member of our team today.