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HD 4989

An Act increasing access to ABA services by recognizing assistant level providers

194th Legislature (2025-2026) Introduced by Sean Garballey and 5 co-sponsors

Expands MassHealth to cover ABA services by assistant-level providers under supervision, and includes AAC devices, contingent on federal matching funds.

Reported, referred to the committee on Joint Rules, reported, rules suspended and referred to the committee on Health Care Financing
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Bill Summary · HD 4989

Summary: An Act increasing access to ABA services by recognizing assistant level providers (HD 4989)

Overview

This Massachusetts bill would expand Medicaid (MassHealth) coverage for autism-related treatments to include ABA services delivered by assistant-level providers, with supervision by licensed behavior analysts, for children and youth under 21. It also clarifies coverage for augmentative and alternative communication (AAC) devices, including tablets, under the same program. The proposal relies on availability of federal financial participation (matching funds) to trigger coverage.

Purpose and Intent

  • Increase access to evidence-based ABA services for children under 21 with autism.
  • Recognize and authorize assistant-level providers (e.g., Behavior Technicians and Licensed Assistant Applied Behavior Analysts) to deliver ABA services when supervised by a licensed ABA professional.
  • Expand coverage for AAC devices, ensuring that families have access to needed communication supports, even when devices are not federally funded, provided the Commonwealth’s share of the costs remains comparable.

Key Provisions

  • Amends Section 10H of Chapter 118E (MassHealth) to introduce the following:
    • Coverage of medically necessary ABA treatments for individuals under 21 diagnosed with autism by a licensed physician or licensed psychologist.
    • Inclusion of ABA services delivered by:
    • Behavior Technicians
    • Licensed Assistant Applied Behavior Analysts
    • Licensed Applied Behavior Analysts
    • All services must be supervised by a licensed applied behavior analyst.
    • Coverage of dedicated and non-dedicated AAC devices, including medically necessary tablets.
    • If federal funds are available, these ABA services and AAC devices must be covered, with a broader “including, but not limited to” scope for ABA providers.
    • For AAC devices not eligible for federal funds, the division must provide coverage if the Commonwealth’s share of the non-federal device is not greater than the Commonwealth’s share for a comparable federally funded device.

Who Is Affected

  • Children and young adults under 21 with autism who are enrolled in MassHealth.
  • ABA service providers, including assistants (Behavior Technicians, Licensed Assistant ABA, and Licensed ABA Analysts) operating under appropriate supervision.
  • Families and caregivers relying on ABA and AAC devices for communication and behavioral supports.

Financial and Implementation Considerations

  • Eligibility for coverage is contingent on federal financial participation (federal matching funds).
  • The bill creates a framework for reimbursement of services by assistant-level providers, potentially expanding the MassHealth provider network.
  • AAC device coverage is tied to federal eligibility, but with a safeguard allowing non-federal devices if cost is not greater than the Commonwealth’s share for a comparable device.
  • Implementation would require administrative alignment within MassHealth and any necessary supervisory protocols for assistant-level providers.

Procedural and Timeline Aspects

  • Introduced: August 11, 2025.
  • Status: Reported, referred to the Joint Rules Committee; rules suspended and referred to the Committee on Health Care Financing.
  • Legislative actions:
    • 2025-08-11: Referred to House Rules.
    • 2025-10-08: Reported, referred to Joint Rules, then to Health Care Financing.
  • No specific effective date is provided; implementation would follow final passage and any regulatory enrollment timelines, subject to federal funding availability.

Notes

  • Title emphasizes “recognizing assistant level providers”; the text explicitly names Behavior Technicians and Licensed Assistant Applied Behavior Analysts alongside Licensed Applied Behavior Analysts.
  • The bill reflects ongoing efforts to align autism treatment coverage with workforce innovation and assistive technology needs.

Compiled from official sources — confirm details with the bill’s official record.

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