What was posted
The New York Office of the Medicaid Inspector General posted an audit protocol titled Applied Behavior Analysis (ABA) on June 29, 2026. The posting itself only names the protocol and points to the office's audit protocols page. The protocol document describes itself as guidance for reviewing whether ABA claims meet Medicaid requirements and says it does not create new legal obligations. It states that it covers services provided from August 1, 2021 through June 25, 2026.
What the reviewer checks
The protocol lists 18 steps. The core questions are whether the clinical record is available and documents each billed service, and whether billed units match documented units. A missing record means all related claims are disallowed, and any billed units beyond the documented units are disallowed. The reviewer also checks the referral, the licensed behavior analyst's annual status report to the referring practitioner, the individualized treatment plan, the documentation of supervision, the licensure or certification of the person who delivered the service, the correct procedure code, and whether the provider on the claim matches the record.
Record requirements the protocol names
A referral must come from an eligible New York licensed practitioner, be no more than two years old, and include the patient's age, diagnosis (autism spectrum disorder or Rett syndrome), date of diagnosis, a statement that ABA is needed, and for autism a severity level and a DSM checklist. The licensed behavior analyst must give the referring practitioner at least one status report a year. The treatment plan must be prepared by a licensed behavior analyst and updated at least every six months and after significant changes in the patient's condition. Supervision of CBAAs and other unlicensed staff must be documented in the patient file. The protocol also checks that other insurance was billed first and supporting records such as explanations of benefits were kept, that services were ordered or performed by providers enrolled in New York Medicaid and not excluded, and that managed care enrollee claims went to the responsible plan.
What we have not verified
We read the posting and the protocol document. We have not seen any audit that applied the protocol or any OMIG statement about how it will be used.
Why it matters to an operator
Analysis: The protocol is a checklist an operator can test against today. Pull a sample of New York Medicaid files and ask the protocol's questions in order: is the record complete, do units match documentation, is the referral current and complete, is the treatment plan current, and is supervision documented in the file. Gaps found now are fixable before a reviewer finds them.
If an OMIG review would find your records short, the compliance audit tests your files against the same questions before an auditor asks, alongside your counsel. If you have already received an audit notice or records request, call your counsel first.
Book a free 30 minute scoping callEngagements are business and compliance advisory, delivered alongside your counsel, who provides legal advice. Nothing here is legal advice.
This brief rests on the primary source linked above. Education only; nothing here is legal advice.
ABAWiser provides research, analysis, and compliance advisory services. We are not a law firm, we do not provide legal advice, and no engagement creates an attorney client relationship. Dossiers track developments as they occur and may be incomplete or updated as a story evolves. Confirm any statutory or regulatory point against the primary source before acting on it.