Employing the diagnostician inside the ABA LLC converts the whole entity to all-licensed ownership. Flip: keep diagnosis in a separate licensee-owned entity connected through a management company, or use an outside referral.
Who may give the diagnosis in Pennsylvania
The medical-necessity diagnosis is made by a licensed physician or a licensed psychologist. Under the Pennsylvania Autism Insurance Act (Act 62), covered autism services must be identified in a treatment plan developed by a licensed physician or a licensed psychologist, and under Pennsylvania Medical Assistance the qualifying providers also include physician assistants, certified registered nurse practitioners, licensed clinical social workers, and certified school psychologists. A BCBA may not diagnose ASD; it is outside the behavior-analyst scope. The two diagnosticians that matter for the ownership analysis are the psychologist and the physician.
How Pennsylvania treats psychology and medicine ownership
Psychology and medicine are both restricted professional services in Pennsylvania, and every owner and manager of a restricted professional company must be a licensed person. Behavior analysis is not on the list, but under Act 170 rendering a restricted service even as one aspect converts the entire entity into a restricted professional company.
What bringing the diagnostician in-house does
Employing the diagnostician inside the ABA LLC converts the whole entity to all-licensed ownership. Flip: keep diagnosis in a separate licensee-owned entity connected through a management company, or use an outside referral.
How to structure it in Pennsylvania
Keep the ABA entity ABA-only and non-licensee owned, and put the diagnosis in a separate licensee-owned entity connected through a management company on fair-market-value, not volume-based, terms so the referral survives the federal Anti-Kickback Statute; or rely on an outside referral with no remuneration flowing for the referral. If the diagnostician is a physician and the payer is Medicaid, the federal physician self-referral rules add a layer that a psychologist does not trigger. The full three-entity structure is set out in the diagnostician question hub.
What the scaled operators actually do
The dominant Pennsylvania pattern keeps diagnosis outside the ABA entity. Families arrive with a diagnosis from a health system, an academic or nonprofit diagnostic center, an independent licensed psychologist, or the Commonwealth Autism Diagnostic Clinic program, and one large regional platform states plainly that ABA requires a diagnosis provided by an MD or PhD obtained elsewhere. Some private-equity-backed platforms do market in-house diagnostic evaluations by licensed psychologists, though the public record does not show whether those psychologists sit in the same company as the ABA therapy or in a separate licensed diagnostic entity. Given the restricted-professional-company rule, the compliant way to offer in-house diagnosis is a separate licensee-owned diagnostic entity, not the ABA LLC. The market keeping diagnosis in a separate vehicle matches what the statute pushes you toward.
The corporate-practice, professional-entity, and anti-kickback rules summarized here are amended and reinterpreted, and verbatim text is a starting point rather than a conclusion. The official Pennsylvania code, the applicable federal safe harbor, and qualified healthcare-regulatory and tax counsel are the authoritative sources.