I respectfully urge to reconsider the proposed provisions that would restrict Applied Behavior Analysis (ABA) services to individuals diagnosed with Autism Spectrum Disorder (ASD) and impose a 20-hour-per-week limit.As discussed in the peer-reviewed article The Evidence-Based Practice of Applied Behavior Analysis, ABA has applications across multiple fields and populations. Access to medically necessary, function-based behavioral intervention should therefore be determined by an individual’s clinical needs and documented benefit, rather than being categorically restricted by diagnosis. Similarly, a 20-hour weekly limit may be insufficient for children with significant behavioral and developmental needs, including severe self-injury, physical aggression, elopement, and other safety risks. Service intensity should be established through individualized assessment, objective data, treatment response, and clinical judgment, with appropriate utilization review to ensure services remain medically necessary—not through a rigid cap that may interrupt meaningful progress or compromise safety.

I also urge the Board to reconsider requirements mandating in-person evaluations without exceptions. Although in-person assessments may be appropriate and beneficial in many circumstances, an inflexible requirement could create unnecessary barriers for children and families in rural or underserved communities where qualified providers are limited or travel is difficult. Appropriate exceptions should permit clinically suitable telehealth evaluations or other validated assessment arrangements when necessary, while maintaining standards for assessment quality and patient safety. Additionally, family participation should be encouraged, supported, and incorporated into treatment planning whenever feasible; however, a lack of parent or caregiver participation should not automatically result in termination of a child’s medically necessary services. Families may face employment obligations, transportation barriers, caregiving responsibilities, health concerns, or other circumstances that limit their availability. Providers should make reasonable efforts to facilitate participation and document those efforts while continuing to prioritize the child’s needs. Care coordination requirements should likewise recognize that ABA providers cannot compel participation by outside professionals or control their availability. A provider’s inability to secure cooperation from another service provider should not, by itself, jeopardize a child’s access to medically necessary treatment.

I support appropriate clinical oversight, accountability, documentation, and periodic review to ensure ABA services are effective, ethical, and medically necessary. However, these safeguards should not become barriers that disproportionately affect children with complex needs, limited access to providers, or families experiencing significant logistical challenges. I respectfully request that the Board revise the proposed provisions to preserve access to ABA based on individualized clinical need, allow clinically justified exceptions to in-person evaluation requirements, and avoid automatic service termination based solely on caregiver participation or external care coordination limitations. I further urge the Department of Medical Assistance Services (DMAS) to ensure that any resulting policies and implementation procedures preserve access to medically necessary services, including appropriate exceptions to weekly service limits when supported by clinical documentation and applicable requirements under EPSDT. The ultimate priority must be the health, safety, development, and well-being of the children receiving care—not arbitrary restrictions that may prevent them from receiving the level and type of treatment they need.