What the department says
The Virginia Department of Medical Assistance Services published a page titled Applied Behavior Analysis (ABA) Policy Changes, last updated July 31, 2026. It says the 2026 Appropriation Act directs the department to limit ABA services to 20 hours per week per recipient, counted cumulatively. The limit can be exceeded when medical necessity is documented under the EPSDT program, which is the exception pathway.
Diagnosis and audit requirements
The page says ABA services will require a diagnosis of autism spectrum disorder before authorization. Children age 5 and younger may instead receive a provisional diagnosis that lasts one year and must follow a protocol the department designates. The department must also work with its managed care organizations on periodic reviews of ABA payments before and after payment, and require reporting that can be compared across plans, regions, providers and the state. These audit requirements do not apply to behavior therapy that local education agencies provide and bill through the fee for service school based Medicaid program.
Status and timing
The department says it is seeking approval from the Centers for Medicare and Medicaid Services and that approval has not been granted. Current authorization processes will not change until CMS approves and the department updates its Mental Health Services Manual. The Appropriation Act refers to July 1, 2026, but the page also says the change takes effect on federal approval, and the department will announce an effective date in a later notice.
What we have not verified
We read the department's page. We have not seen the text of the Appropriation Act, the submission to CMS, or any later notice that sets an effective date.
Why it matters to an operator
Analysis: A weekly cap with a documented medical necessity exception moves the work from authorization volume to documentation quality. A Virginia practice should identify which clients are above 20 hours now, confirm that each file would support an EPSDT exception, and confirm each client's diagnosis record would meet the new requirement, so the practice is not rebuilding files after the effective date is announced.
If your Virginia caseload runs above 20 hours a week, the payer and Medicaid advisory maps your authorizations, documentation and billing against the new rules before they take effect, alongside your counsel.
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.