November 2025 delivered a stark message to ABA practice owners: "Volume is no longer enough." While demand is historically high, the unit economics of pure-play ABA are being squeezed by aggressive state austerity and rising compliance costs. This briefing condenses the month's critical developments into actionable insights for strategic planning.
Things to Know
The Market: Growth vs. The Squeeze
New benchmarking data from CentralReach reveals a paradox defining late 2025.
The Good News: Service hours and claims volume are up 20% year-over-year, proving demand is recession-proof.
The Bad News: Reimbursement isn't keeping pace with inflation. The growth in multidisciplinary care (ABA + Speech + OT) is outpacing ABA-only models, growing at a 30% CAGR.
Strategic Takeaway: The era of the single-specialty ABA clinic is ending. Integrated care models are not just clinically superior; they are financial hedges. If ABA rates stagnate, Speech and OT lines can protect margins.
M&A Strategy: The "Flight to Quality"
The acquisition market is active but highly selective.
JoyBridge Kids + Pediatric Advanced Therapy: This November acquisition wasn't about adding ABA capacity; it was about adding capabilities. JoyBridge acquired a Speech/OT/PT provider to build a "continuum of care".
Soar Autism Centers Raises $17M: Investors backed Soar's Early Start Denver Model (ESDM), betting on naturalistic, play-based intervention over traditional DTT.
The Lesson: Valuation is now driven by clinical diversification and specialized care models, not just geographic footprint.
Regulatory Red Flags: Colorado & Idaho
Two state-level crises in November serve as bellwethers for national trends.
Colorado's "Existential" Threat: Facing a budget deficit, Colorado Medicaid proposed deep rate cuts. Crucially, regulators explicitly blamed "profit-driven business models" and Private Equity involvement as justification for the cuts.
Idaho's Structural Shift: Effective December 1, 2025, Idaho is unbundling rates (eliminating daily HART rates) and cutting provider pay by 4-15%.
Action Item: Audit payer mix. If heavily leveraged in a single state Medicaid program, exposure is significant. Diversify into commercial payers or adjacent service lines.
Operations: Preparing for 2026 RBT Changes
The BACB released data confirming that inadequate pay and unpredictable scheduling are the top drivers of RBT turnover.
The Clock is Ticking: Massive certification changes take effect January 1, 2026.
New Supervision Rules: The Non-certified RBT Supervisor role is being eliminated. Only BCBAs/BCaBAs can supervise RBTs starting 2026.
Recertification: Shifts to a 2-year cycle with a new 12-hour Professional Development requirement.
Owner's Move: Budget for higher BCBA supervision hours next year. Start adjusting org chart now to ensure adequate BCBA coverage to meet new supervision mandates without burning out clinical leadership.
Risk Management: The Hospitalization Study
A controversial study published this month linked ABA therapy to 30% higher odds of mental health hospitalization in youth.
The Fallout: While likely driven by selection bias (kids in ABA often have higher acuity), this headline gives ammunition to payers looking to deny care and critics of the industry.
Defense Strategy: Double down on Compassionate Care and Assent-Based protocols. Clinical documentation must explicitly track learner happiness and assent to refute claims that therapy is inducing stress or trauma.
Summary
The "growth-at-all-costs" playbook is obsolete. The winners of 2026 will be the Integrated Care providers who use AI to crush administrative costs and offer a diversified menu of services (ST, OT, Mental Health) to insulate themselves from single-code rate cuts.