CMS Unveils ABA Toolkit Amid Growing Autism Therapy Scrutiny
CMS issued a toolkit for behavioral health services amid congressional autism therapy probes.
Why it matters: Heightened scrutiny of autism therapy billing practices signals increased enforcement risks. Healthcare legal teams must adapt to regulatory changes impacting Medicaid and CHIP autism services.
- February 2026: CMS released the 'State Medicaid & CHIP Toolkit' for children's behavioral health services.
- March 2026: HHS OIG reported $285.2M in improper Medicaid payments for ABA in Colorado (2022-2023).
- July 2026: House Committee launched investigation into Brooklyn-based autism provider, The Perfect Child LLC, over billing allegations.
In February 2026, the Centers for Medicare & Medicaid Services (CMS) issued its updated 'State Medicaid & CHIP Toolkit for Childrens Behavioral Health Services and the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Requirements.' This toolkit offers strategies to help states improve access to behavioral health services, including applied behavior analysis (ABA), for children enrolled in Medicaid and CHIP.
The toolkit’s release comes amid increasing scrutiny of compliance and billing in autism therapy services. A March 2026 audit by the Department of Health and Human Services' Office of Inspector General found $285.2 million in improper or potentially improper Medicaid payments for ABA services rendered in Colorado during 2022 and 2023. This audit highlights significant vulnerabilities in payment oversight within Medicaid programs.
Further intensifying regulatory focus, the House Committee on Education and the Workforce initiated an investigation in July 2026 into The Perfect Child LLC, a Brooklyn-based autism therapy provider, following allegations of excessive billing practices. The Committee emphasized the fiduciary responsibility of plan managers, stating: "Plan fiduciaries have a responsibility to ensure that plan assets are managed prudently and exclusively for the benefit of plan participants and beneficiaries."
These developments underscore the evolving risk landscape for healthcare legal and compliance teams involved in managing autism therapy services. Providers and state programs administering Medicaid and CHIP must navigate updated CMS guidance while addressing growing congressional attention on enforcement and proper billing practices.
By the numbers:
- $285.2 million — improper Medicaid payments for ABA services identified by HHS in Colorado (2022-2023)
- February 2026 — CMS released the children's behavioral health services toolkit
- July 2026 — House investigation launched into Brooklyn autism therapy provider
What's next: The impact of CMS's behavioral health toolkit on state Medicaid and CHIP policies will unfold as states implement new strategies. Further congressional findings on The Perfect Child LLC’s investigation are anticipated.