Consider This Before Expanding Your ABA Services into a New State

With demand for ABA rapidly growing, moving into a new state can look like an enticing opportunity. Ensure your expansion is a long-term success with a bit of research first.

As insurance coverage continues to expand for Applied Behavior Analysis (ABA Therapy), locations with new or expanding laws may have caught your eye and have you wondering if an opportunity exists to provide services. Before jumping state lines, be sure you can answer the following questions and know how the answers will affect your business.

Has a mandate passed in the state regarding ABA coverage and what does it say?

Be sure you truly understand the state mandate that requires coverage of ABA. Read carefully so you can answer what services are covered, who is covered, who can provide services, and whether or not there are any limits or caps on the benefit. While all but four states now have mandates requiring the coverage of ABA, each law varies in scope and effectiveness. For example, Colorado still has caps being enforced on the basis of both annual dollar amount and age. On the other hand, California has no dollar or age cap. In North Carolina, BCBAs are not licensed, but the mandate reads that a licensed provider must supervise ABA cases, meaning ABA providers are forced to work with a Licensed Psychologist or other type of licensed provider to bill insurance for ABA services. Some of these variations could have a very large impact on your business model.

Is there a licensure requirement for BCBAs?

Some states have passed licensure laws for BCBAs. The move toward licensure is consistent with other medical professions, which can be a good thing. If the state you are moving into has licensure laws, do your research to find out about the process and average timeline so you know what to expect. The process to wait for both licensure with the state and credentialing with insurance companies takes time, and you will need to plan to carry the cost of a BCBA while s/he goes through the process. Also, be aware of the state mandate (see above). If the mandate requires licensed providers for ABA, make sure you can get licensed!

How long has the ABA mandate been in place and how saturated is the market with providers?

Believe it or not, the first state mandate requiring ABA coverage passed 15 years ago (Indiana in 2001)! Depending on ABA training programs, professional opportunities, the insurance landscape, and geographic location, markets may be desperate for providers and others have providers who are desperate for clients. Do your groundwork early to find out if parents are anxiously seeking providers with openings and what cities, towns, or neighborhoods seem to have the most need. Good places to reach out might include parent support groups, providers in related fields such as speech providers, community groups such as the local state Autism Society, and social media groups. Ask if providers have wait lists and if families are actively looking for more providers. Also, find out if insurance companies are still accepting new providers in the area. You can usually find this information on the insurance website or by calling the contracting department.

What insurance companies are in the area?

Granted, this one could take some time, but it is definitely worth the effort. During your research, find out which insurance companies are prominent in the area and whether or not small, local insurance companies have a critical presence. Not only could the landscape be different from your current location, the prevalence of funding sources can vary in different locations throughout a single state. Some neighborhoods may be dominated by insurance coverage, while others may have a large number of children covered by Medicaid. Some states are dominated by a single large insurance carrier, and some cities have a large population of TRICARE beneficiaries. Any plans you can make based on this information will certainly give you a boost in connecting with clients.

Is Medicaid effectively covering behavioral therapy?

I suggest to providers that Medicaid, especially in a state with which you are unfamiliar, be approached cautiously. I have seen providers already established in states that launch Medicaid coverage run into countless barriers. If a state has recently announced that Medicaid will cover behavioral therapy but has yet to navigate BCBAs through the enrollment system, you should tap into advocacy groups in order to see how things are progressing. An important note is that groups providing services such as speech, occupational therapy, and psychiatry in addition to behavioral therapy, may have become Medicaid providers before the addition of behavioral therapy as a benefit. I have seen ABA providers rush to a location or hire new staff to serve Medicaid members without being able to enroll. Everyone in the community (parents, advocates, and providers) needs to work together to get the process moving to get services to children. While you wait for the Medicaid process to settle down, be sure you have other funding sources or services that can sustain your new location!

Other Tips:

  • Look at major metropolitan areas. Large populations will help you build a client base and get your foot in the door, especially in a new state. From there, you can launch services in more rural locations if the need exists.
  • Have conservative timelines, do as much preparation as possible before opening your doors. Plan financially for a new location to be unprofitable for up to six months while you get in network with insurance, onboard staff, and grow a client base. Remember, if you are accepting insurance, it can take another 6-8 weeks from your first client session to see payment from the insurance company.
  • Do some networking—this is the fun part! To get your Continuing Education Units (CEUs), go to an ABA Therapy conference in the new state you are considering. You could attend the national APBA conference or go to the Autism Law Summit hosted by Autism Speaks each year. Both of these conferences have a lot of good information on practicing in the industry and navigating the business side of your specialty. You can talk to other providers to get the lay of the land and to understand any difficulties or barriers being experienced by BCBAs and ABA clinics in different locations. The expertise you can tap into from others who have been on the ground will be the most accurate and up to date information available. In my experience people in the field are incredibly collaborative and helpful! If we all continue to help each other, the availability of services will keep growing for families and children in need.

While demand and growth for your services can be exciting, be sure you have a solid business plan and good financial landscape before expanding. If you can plan your growth using a sustainable model, then you will be able to provide more services to children, more jobs for therapists, and more success for ABA!