CommercialAdministrativeHigh impact
ABA accreditation requirements and deadlines
Harvard Pilgrim Health Care·MA, RI, NH, ME, VT · Pediatrics·Provider Newsletter
We identified it
Sep 15, 2026
Summary
Point32Health is requiring all contracted ABA (applied behavioral analysis) providers to obtain accreditation from a nationally recognized accrediting body. This requirement applies to Harvard Pilgrim and Tufts Health Plan products across all states in their service area, with staggered deadlines: Massachusetts and Rhode Island providers must be accredited by January 1, 2027, and all other providers by January 1, 2028. Billing and authorization processes remain unchanged.
Action Required
By January 1, 2027 (MA/RI providers) and January 1, 2028 (all other providers): Providers in your network offering ABA services must verify accreditation status from one of Point32Health's accepted accrediting bodies (Autism Commission on Quality, Jade Health [formerly BHCOE], or Global Autism Project Accreditation). Billing team should: (1) Maintain a provider roster tracking accreditation status and deadlines by geography; (2) Flag any contracted ABA providers lacking current accreditation 90 days before their deadline; (3) Notify providers of their specific deadline based on location (2027 for MA/RI, 2028 for NH/ME/VT and all other states); (4) After January 1, 2028, verify all new ABA provider applicants have accreditation before contracting. No changes to billing codes, prior authorization procedures, or claim submission processes are required. Failure to ensure provider accreditation compliance may result in loss of contracted status or service interruptions for patients.