The Louisiana Department of Health's draft rule for Medicaid applied behavior analysis would change 28 of the 29 areas compared here with the current provider manual. 10 of those are likely to hit providers hard.
Current: Louisiana Medicaid Services Manual, Chapter 4, issued August 22, 2025. Draft: LDH draft of LAC 50:XV Subpart 1, with edits through November 6, 2026, shared after the November 9, 2026 ABA Summit. Prepared November 15, 2026.
Figures are from LDH's November 9, 2026 summit presentation, which cites the CMS/MITRE ASD–ABA Data Book (August 2026) and the Louisiana Medicaid ABA dashboard. National 2025 data are preliminary.
LDH has asked for comments on the draft "as soon as possible" at this address:
appliedbehavioranalysis@la.gov
What LDH says happens next:
LDH said it especially wants to hear whether a proposal would delay or interrupt needed services, whether terms and exceptions are clear, how it would affect families, providers, schools and health plans, and what alternatives would meet the same goal. Specific examples and numbers from your own practice carry the most weight.
In eleven years the manual has never had an hours cap, a lifetime limit, mandated breaks, a wage rule or an accreditation requirement. The draft also reverses the telehealth and remote-supervision allowances added in 2023 and 2024.
Sources: current ABA manual (PDF) · manual revision log · the draft rule and summit slides were distributed by LDH to summit participants.
Points worth raising in comments
Beyond the policy itself, the draft has gaps and internal conflicts that LDH would need to resolve before it could be applied consistently.
No named clinical standard
The draft refers to "evidence-based standards of practice" but adopts none by name. The 4,000-hour limit, the two- and three-year windows and the progress-or-denial rule stand on their own rather than on a recognized treatment guideline.
How often breaks are required
The rule text says a 15-minute break for every 120 minutes of treatment. LDH's summit slides say after each consecutive hour. The cost to families and providers differs by nearly half.
When the lifetime clock starts
One sentence says time is counted from the rule's effective date. Another reduces services for children "in excess of the lifetime limit prior to" that date.
The missing exception
LDH's slides describe a medical-necessity exception to the 4,000-hour limit. The text offers only limited, behavior-specific ABA afterward. Federal EPSDT rules require medically necessary care for children under 21.
A garbled supervision clause
The clause barring out-of-state supervision runs directly into a leftover "2:10" ratio, so it is unclear whether the two-hours-per-ten ratio survives.
Fewer evaluators, and they must be independent
Nurse practitioners and other licensed clinicians who can diagnose today are missing from the draft's list, and evaluators can have no tie to the ABA provider. The draft does not say who is responsible for finding one, or what happens to children waiting.
Undefined terms
"Salary" in the 50% technician pass-through, "progress" in the renewal standard, and "foundational versus educational" for school services are not defined. The accrediting body is abbreviated "AQC"; the Autism Commission on Quality uses ACQ.