Telehealth Beyond the PHE: What ABA Agencies Need to Know

A New Telehealth Landscape After October 1

Telehealth rules are changing—again. On October 1, 2025, CMS will roll back several COVID-era telehealth waivers. For most healthcare services, this means tighter rules on patient location, approved sites, and technology requirements.

For ABA services, the outlook is different: ABA telehealth is still protected under CMS’s behavioral health carve-outs. Clients can continue to receive care from home and, when appropriate and allowed, through audio-only sessions.

But here’s the catch: even though Medicare does not cover ABA therapy, CMS policy changes often ripple through Medicaid telehealth coverage and private insurance telehealth policies. That means these shifts could affect the payers you rely on most.

ABA & Medicare: Clearing Up a Common Misconception

Here’s the bottom line: even though Medicare doesn't cover ABA therapy, and has consistently excluded it under Part B, CMS remains a policy bellwether for U.S. healthcare. Medicaid programs, commercial insurers, and auditors frequently mirror CMS standards in their own coverage policies and compliance audits.

CMS Telehealth Policy Updates for October 1

According to CMS guidance:

• Non-behavioral health services (PT, OT, SLP, etc.) revert to pre-COVID rules, with geographic/originating-site restrictions and stricter audio-video requirements.

• Behavioral health services—including ABA—keep flexibility. Patients will likley be able to continue to access telehealth from home, from other appropriate locations, and via audio-only when appropriate and allowed by policy.

Medicaid Spotlight: What to Watch

While these rollbacks technically apply to Medicare, state Medicaid programs often follow CMS policy direction. That’s especially important for ABA providers, since Medicaid funds such a high proportion of ABA services.

Here’s what to track in your state:

• 📌 Audio-only coverage: States may limit audio-only ABA sessions.

• 📌 Home-based telehealth: At-home flexibility could be narrowed in 2026 benefit updates.

• 📌 State-by-state rules: Each Medicaid program is unique—what’s allowed in one state may not be in another. So if you're operating across multipel states, be sure to track any changes in each state you serve clients in.

👉 Action step: Begin tracking your Medicaid provider bulletins and payer communications now. Don’t wait until claims deny.

How Commercial Payers May React

Expect ripple effects beyond Medicaid including possible:

• Selective alignment – ABA telehealth likely remains, but other therapies may lose coverage.

• Documentation scrutiny – Insurers may tighten audit standards for telehealth notes.

• Modality limits – Video-only requirements or periodic in-person visit requirements may emerge.

Compliance Checkpoints for Your Agency

To prepare for October 1, ABA leaders should:

• Confirm ABA services are coded as behavioral health.
  • Why it matters: CMS has created special telehealth flexibilities for behavioral and mental health services. If your claims, internal policies, or provider enrollment documents don’t clearly designate ABA as behavioral health, payers could misclassify services under categories (like “rehabilitation” or “developmental therapy”) that are subject to stricter telehealth rules. That misalignment could lead to denials, retractions, or audit findings.
• Audit telehealth documentation for time-stamps, modality, and clinical justification.

  • Why it matters: Telehealth claims are being watched closely across all payers. Auditors look for:

    • Time-stamps → to validate session length matches billing.

    • Modality (audio vs. video) → because some payers still limit audio-only, or require modifiers to distinguish.

    • Clinical justification → to prove telehealth was appropriate and clinically effective for that client.

    Missing any of these details creates risk: denied claims, clawbacks, or allegations of improper billing. A proactive documentation audit helps agencies spot and fix gaps before payers do.

• Track payer updates through portals, newsletters, and bulletins.
  • Why it matters: Even if CMS rules protect ABA, private insurers and state Medicaid programs may interpret those flexibilities differently. Many changes roll out in payer-specific policy updates, not press releases. If your agency isn’t monitoring provider portals and payer newsletters, you might miss critical changes in allowed telehealth codes, modifiers, or coverage criteria—only realizing it when denials start hitting.
• Update internal policies and training for staff.
  • Why it matters: Compliance isn’t just about leadership being aware—it’s about consistency at the ground level. If your clinical team doesn’t know how to properly document telehealth visits, or if billing staff isn’t trained on the latest modifiers, your written policies won’t protect you in an audit. Updating internal policies and training creates a defensible record that you educated your team and enforced compliance standards.
• Monitor state Medicaid updates closely—these could shift in 2026.
  • Why it matters: Medicaid is the single largest payer for ABA. State Medicaid programs often wait to see what CMS does, then adjust their coverage rules during the next plan year. With CMS’s October 1 telehealth changes, it’s very possible states will reevaluate their own telehealth flexibilities in 2026. Agencies that watch state bulletins and policy transmittals will have time to adapt before coverage restrictions or documentation requirements shift.

In Summary

Even though Medicare doesn’t cover ABA, CMS telehealth policy changes still matter. They set the tone for Medicaid and commercial insurers, which means your agency could feel the effects in the months ahead.

By monitoring payer updates and preparing staff now, you’ll protect your agency’s revenue, reduce audit risk, and reassure families that ABA telehealth services will continue without disruption.

In this article, we’ll explain:

• What CMS telehealth changes mean for ABA providers

• Why Medicaid clients could see the biggest downstream effects

• How commercial insurers may respond

• Compliance checkpoints every ABA agency should implement now

The biggest risk with telehealth policy changes isn’t whether ABA is currently allowed—it’s how quickly payer expectations can shift underneath you.

What’s acceptable today may require different documentation, modifiers, or justification tomorrow. And if your team isn’t tracking those changes in real time, the first sign of a problem is often denied claims or audit findings.

That’s not a documentation issue. It’s a systems issue.

The ABA Compliance Collective was built to help ABA organizations stay ahead of exactly this kind of risk. Members get access to tools, templates, and ongoing guidance to monitor payer changes, update internal processes, and maintain compliance as requirements evolve.

If you’re ready to take a more proactive approach to telehealth compliance, you can explore the Collective here:
https://www.abacompliance.com/collective

Not quite ready to join the community? No problem. We’ve shared one of our Telehealth Compliance Checklists from inside the ABA Compliance Collective community to help you prepare your agency for October 1.