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\nFee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children  \nOIG.HHS.GOV  \nFebruary 2026 | A-09-24-02004  \nColorado Made at Least $77.8 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children  \nWhy OIG Did This Audit  \n• Applied Behavior Analysis (ABA) is a therapeutic approach for managing the symptoms of autism and other developmental disabilities, usually centered on improving social and communication skills.  \n• In the past several years, Federal and State agencies have identified questionable billing patterns by some ABA providers and payments to providers for unallowable ABA services.  \n• Colorado’s fee-for-service (FFS) Medicaid payments for ABA in 2019 were $60.1 million, and by 2023 these payments had increased to $163.5 million.  \n• This audit examined whether Colorado’s FFS Medicaid payments for ABA for 2022 and 2023 complied with Federal and State requirements.  \nWhat OIG Found  \nColorado’s payments for ABA did not fully comply with Federal and State requirements. All 100 sampled enrollee-months included payments for 1 or more claim lines that were improper or potentially improper.  \nWhat OIG Recommends  \nWe made five recommendations, including that Colorado refund $42.6 million to the Federal Government, provide additional guidance to ABA facilities for documenting and billing ABA, and periodically perform a statewide postpayment review of Medicaid ABA payments to educate providers on requirements. The full recommendations are in the report.  \nColorado disagreed with one recommendation. Colorado agreed with three recommendations, partially agreed with one recommendation, and detailed steps it has taken and plans to take in response to our recommendations.  \nOIG.HHS.GOV  \nTABLE OF CONTENTS  \nINTRODUCTION ............................................................................................................................... 1  \nWhy We Did This Audit ....................................................................................................... 1  \nObjective ............................................................................................................................. 2  \nBackground ......................................................................................................................... 2  \nMedicaid Program................................................................................................... 2  \nColorado’s Medicaid Program ................................................................................ 2  \nApplied Behavior Analysis ....................................................................................... 3  \nColorado’s Medicaid Coverage of Applied Behavior Analysis ................................ 3  \nProviders’ Use of Procedure Codes for Billing Applied Behavior Analysis ............. 5  \nHow We Conducted This Audit ........................................................................................... 7  \nFINDINGS......................................................................................................................................... 8  \nThe State Agency Made Improper Payments for Applied Behavior Analysis................... 11  \nFederal and State Requirements .......................................................................... 12  \nSession Notes or Electronic Visit Verification Records Did Not Meet  \nDocumentation Requirements........................................................................... 13  \nApplied Behavior Analysis Was Provided by Staff Who Did Not Have Appropriate Credentials ..................................................................................... 17  \nApplied Behavior Analysis Was Provided to Children Without Documentation of the Required Diagnostic Evaluations or Treatment Referrals ....................... 17  \nThe State Agency Made","cbCaivXuzF6cii8k","https://ap.wps.com/l/cbCaivXuzF6cii8k","pdf",3614787,52,"English","# INTRODUCTION\n## Why We Did This Audit\n## What OIG Found\n## What OIG Recommends\n## FINDINGS\n## CONCLUSION\n## RECOMMENDATIONS\n## STATE AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL RESPONSE","[{\"question\":\"What was the audit objective regarding ABA Medicaid payments in Colorado?\",\"answer\":\"The audit examined whether Colorado’s fee-for-service Medicaid payments for ABA for 2022 and 2023 complied with Federal and State requirements.\"},{\"question\":\"What did OIG find about Colorado’s ABA payments?\",\"answer\":\"OIG found Colorado’s payments did not fully comply with Federal and State requirements, and all 100 sampled enrollee-months included improper or potentially improper claim lines.\"},{\"question\":\"What recommendations did OIG make in response to the audit findings?\",\"answer\":\"OIG made five recommendations, including refunding $42.6 million to the Federal Government, providing additional guidance for documenting and billing ABA, and conducting periodic statewide postpayment reviews.\"}]","Colorado Made at Least $77.8 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children - February 2026 | PDF",1789916794,131]