Disclosure: As new regulations reshape the ABA industry, SOS Franchising is advocating for policies that strengthen oversight without creating barriers that prevent responsible providers from serving children.
New regulations are changing how ABA providers operate across the United States. While many of these measures are intended to improve accountability, protect patients and reduce fraud, they can also create challenges for providers trying to open clinics, maintain operations and expand access to care.
SOS Franchising discusses the real-world impact that new ABA regulations can have on providers, small-business owners and, most importantly, children and families seeking autism services.
The message was straightforward: strong oversight and access to care should not have to compete with each other.
ABA providers work within a healthcare delivery system where quality, safety, and accountability are important.
Federal and private health insurance companies, along with the relevant government agencies, must protect children, avoid fraud, and make sure that taxpayer money and private payer dollars are being spent properly. Accreditation, credentialing, documentation requirements, and other oversight mechanisms can help achieve those goals.
SOS Franchising supports responsible oversight.
The worry is when onerous regulatory requirements deter qualified providers from entering the market or make it financially unfeasible for already certified legacy families to continue to serve families.
Massachusetts provides a clear example.
Since January 1, 2025, Carelon of Massachusetts has not permitted new ABA providers to apply to be in-network with MassHealth, its MCOs, or BCBS if they are not already accredited. That means a new provider can’t join a payer network before it has even had an opportunity to establish its clinic and begin serving patients.
For families already facing limited access to autism services, restrictions on new providers can have consequences beyond the administrative process.
Regulatory changes can appear straightforward when viewed from a policy document.
For a small ABA provider, however, every new requirement can involve substantial time and expense.
The Massachusetts accreditation process illustrates the problem. The Autism Commission on Quality (ACQ) is the accrediting body consistently identified by Massachusetts payers for ABA providers. According to the reference experience described by SOS Franchising, ACQ indicated that the accreditation process takes an average of six to eight months.
That review period comes after the provider has already invested in establishing its business.
There is another challenge: a provider must already be treating at least one patient before ACQ can begin its accreditation process.
This creates a difficult financial cycle.
A provider may need to begin operating and treating a patient to satisfy accreditation requirements, while also facing payer restrictions that make reimbursement difficult or unavailable until accreditation is complete.
The costs do not stop during that period.
Rent still has to be paid. Employees still need salaries. Insurance, software, utilities, clinical supervision, and other operating expenses continue.
In the Worcester example discussed by SOS Franchising, the accreditation application waitlist was approximately three weeks, followed by an average accreditation process of six to eight months. After accreditation, the provider faced another approximately six months of payer contracting before it could obtain prior authorization and begin billing through the network.
That can create a potential timeline of 14 months or more between beginning the process and reaching a position where a clinic can operate with normal payer reimbursement.
For a small business, that is more than an administrative inconvenience.
It is an economic barrier to entry.
The ABA industry is not made up only of large healthcare organizations.
Independent providers and locally operated clinics are also part of the care infrastructure serving children with autism.
These businesses can create local employment opportunities, expand provider availability, and give families additional options when seeking care.
For franchise owners, entering the ABA industry can also represent a significant personal and financial commitment. SOS Franchisees invest in their communities while taking responsibility for building and operating their own centers under the SOS model.
They need to meet clinical and operational standards.
They also need a regulatory environment in which responsible businesses can realistically comply with those standards.
When regulatory systems require lengthy reviews, multiple layers of approval, or significant upfront investment before a provider can begin receiving reimbursement, the barrier to entry can become substantial.
Over time, that may favor organizations with the greatest financial resources rather than organizations best positioned to serve local families.
That is not the outcome policymakers should be seeking.
Massachusetts is not the only state where ABA providers are navigating new requirements.
Indiana Medicaid requires ABA agencies to apply for accreditation by August 1, 2026, with full accreditation required by October 1, 2027 to maintain enrollment.
North Carolina has also established accreditation reporting requirements for affected behavioral health providers, with a deadline of April 20, 2027 for providers already enrolled in the relevant services.
Pennsylvania has taken a different approach through licensing requirements. Unlicensed organizations have been barred from providing applicable services since 2020.
These examples demonstrate why regulatory implementation deserves careful attention.
The question is not whether ABA providers should meet appropriate standards.
The question is whether the systems used to evaluate providers have enough capacity to process applications within the timelines being imposed and whether responsible providers can continue serving children while those reviews are underway.
The regulatory conversation ultimately needs to return to the people these systems are designed to serve.
Children receiving ABA therapy rely on continuity.
Parents rely on providers being available when services are needed.
When a clinic cannot open, a family may remain on a waiting list.
When an existing provider is unable to meet a new requirement within a required timeframe, families may face disruptions in care.
When fewer providers are willing or able to enter a market, families have fewer choices.
These consequences demonstrate why regulatory implementation matters just as much as the regulation itself.
A policy can have a legitimate objective and still create unintended consequences.
The solution is not to eliminate accountability. It is to design accountability in a way that protects children while allowing qualified providers to continue serving them.
There is a practical middle ground between inadequate oversight and excessive barriers.
Regulators can continue requiring meaningful clinical, ethical, and operational standards while also considering whether providers have reasonable timelines and workable processes for meeting those standards.
Implementation can take into account the difference between a provider that is intentionally violating requirements and one that is actively working in good faith to comply.
Review processes should have the capacity to handle the number of providers being asked to participate.
And regulatory systems should consider the potential impact on access before requirements are implemented in ways that could cause responsible clinics to close or prevent new clinics from opening.
Strong oversight should make healthcare safer and more accountable.
It should not unintentionally make healthcare less available.
The ABA industry has taken the position that we can shoot for higher standards and also achieve access to care, according to SOS Franchising.
It will require working to root out fraud, waste, and abuse while also implementing practical pathways for qualified providers to follow to meet new requirements.
It also means paying attention to the stakeholders, the providers, clinicians, entrepreneurs, and families that feel the pain of policy decisions.
With ABA regulations ever-evolving, SOS Franchising will strive to maintain a balanced argument: children need safe and effective care, and responsible providers need a level playing field to provide it.
This increased oversight should only help solidify the quality of services in the ABA industry, not reduce the number of providers available to families.
The objective should be clear:
Protect public resources. Raise standards. Support responsible providers. And keep children’s access to care at the center of every decision.
To improve quality, patient safety, accountability, and oversight of ABA services.
Yes. Clinics may continue paying rent, payroll, insurance, and other costs while waiting for approvals or accreditation.
Not necessarily. Requirements can vary by state, payer, and accrediting organization.
They should track deadlines, understand payer requirements, maintain documentation, and begin accreditation or licensing processes early.
They can influence startup timelines, operating costs, reimbursement, and the process of opening a new center.
Nichole Daher is an American entrepreneur, book author, autism advocate, and founder of Success On The Spectrum (SOS)-the first autism treatment franchise in the United States-known for its parent viewing rooms and quality-driven ABA services. She currently serves as CEO of SOS Franchising, where she provides support, resources, and opportunities for entrepreneurs to open their own Success On The Spectrum autism centers.
