Join leading names in the autism therapy industry at Autism Investor Summit East in Washington, D.C., Nov. 9–10. Featured speakers will include Alisha Simpson-Watt, founder of Collaborative ABA Services, and Elizabeth Broomfield, managing partner of Aquitaine Capital, who are quoted below. Connect with other providers, investors, payers and policymakers who are navigating heightened scrutiny, reimbursement pressure and industry growth. Don’t miss your chance to connect with industry leaders. Register here.
Historically high scrutiny will likely be the norm going forward for the autism therapy industry.
This new, constant pressure will have both a refining and weathering effect on the industry that requires all providers — regardless of size, age or development — be ready to face scrutiny of their work, especially in care documentation and billing practices. Organizations that rise to meet the moment need to be ready to explain their work to patient families, other providers, health plans and state officials with effective clarity to advance their organization’s goals and the goals of their industry. At the same time, they must be able to withstand even withering scrutiny.
“The strongest advocacy connects the data to the person,” Alisha Simpson-Watt, executive clinical director and founder of Collaborative ABA Services, said during a BHB-hosted webinar, speaking about payer-provider relations. “They want very objective information — they want to know where the child started, what progress they’re making, what barriers remain, why the recommended services are still needed.
“Data alone cannot communicate the full picture.”
Collaborative ABA Services is based in Middletown, Connecticut, and was founded in 2019. The company provides applied behavior analysis (ABA) therapy, occupational therapy, speech and language therapy, diagnostic evaluations, case management, social skills groups, parent and community training and translation services.
Providers should expect heightened scrutiny to also translate into financial pressure, Simpson-Watt said. As health plans look to tamp down on ABA spending by limiting approved hours, cutting rates and adding more administrative steps and reviews, Simpson-Watt added that providers need to know exactly what their payer contracts say and their financial implications. On top of that, organizations need to deeply understand the costs to deliver each contracted service and ruthlessly root out inefficiencies. Then providers need to turn to advocacy when reimbursement or authorization decisions create barriers.
“What that means is preparing for that scrutiny. But it holds us accountable and makes sure that we’re doing what we can on our end to meet those demands,” Simpson-Watt said.
The pressures of heightened scrutiny will hopefully create a “virtuous cycle,” Elizabeth Broomfield said during the webinar. Broomfield is the managing partner of the private equity firm Aquitaine Capital and the board chair of Mirabell Care, an Oklahoma-based pediatric therapy provider that serves patients with autism and other needs.
“Documentation and audits are going to produce better data. Better data proves outcomes. Proven outcomes provide leverage with payers,” Broomfield said. “It’s not easy, but this is what maturity looks like. We’ve seen this in other areas in healthcare, and now we’re seeing it in autism therapy.”
In the short term, Broomfield said organizations need to forecast what kind of financial hits they can withstand and run financial stress tests on their organizations. Those insights will help executives develop contingency plans for when challenges arise. She also advised pushing organizations toward diversifying payer mix and service types as much as possible.
Mirabelle Care, for example, offers a one-stop pediatric therapy model, providing ABA, speech therapy, occupational therapy, sensory-based feeding therapy and youth counseling. Formerly known as KidsChoice Therapy, Aquitaine Capital announced that it acquired the company at the beginning of 2026.
Building more efficient operations and contingency planning in the short term will also help providers make it through what are likely going to be dramatic, market-specific changes. For example, the Oklahoma Health Care Authority suddenly halted all Medicaid payments to Mirabelle Care on disputable grounds. The company has since secured an early legal victory in court that resumed payments while allegations of fraud by its previous ownership are addressed. Broomfield also highlighted the dramatic and sudden cuts within the Nebraska Medicaid program for ABA. In July 2025, state officials cut direct therapy by 48%.
“Scrutiny is good, and it’s going to force providers to step up their game; it’s going to hopefully weed out the bad actors from the good ones,” Broomfield said. “Increased scrutiny can sometimes pull in good providers along with bad ones, and sometimes there’s a lack of nuance.”
Broomfield said that organizations have an opportunity to have a hand in the development of the oversight paradigm in their market. The surge in scrutiny and pressure that came in 2025 and 2026 so far reflects the work-in-progress nature of industry oversight. Specifically, she said industry regulators need to establish clear and universal standards for authorizations and documentation, establish regular dialogue with the industry beyond policing and shared definitions of quality.
“Collective voices are louder, and you can do that regardless of size,” Broomfield said. “When you unite with other providers, you’re more likely to be heard.”
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