Rhode Island pays ABA through HBTS codes tiered by degree, not credential. A June enrollment moratorium and pending October raises shape the months ahead.
Key Takeaways
- No 9715x codes for children. Rhode Island bills children’s ABA through Home-Based Therapeutic Services codes, paying $16.65 per 15 minutes for direct therapy and up to $34.91 for doctoral-level supervision.
- Enrollment paused for newcomers. EOHHS imposed a six-month moratorium on newly enrolling HBTS and ABA providers starting June 16, a term that would run to mid-December.
- Raises are funded but not yet posted. The FY2027 budget includes OHIC’s recommended rate increases effective October 1, 2026, and EOHHS says they will apply retroactively once federal approval and systems work are complete.
- December is the next marker. Providers should watch the moratorium’s status and when the new fee schedule posts; OHIC’s recommendations equal a 7.4 percent increase for home- and center-based therapeutic services.
Rhode Island’s Medicaid program does not pay for children’s applied behavior analysis (ABA) under CPT codes 97153 or 97155. ABA runs through Home-Based Therapeutic Services (HBTS), a program whose certification standards treat ABA as a subset of HBTS, and it bills under HCPCS codes that pay clinical time by degree level rather than by behavior-analytic credential. The only 9715x code on the state’s January 1, 2026 fee schedule is 97151, and it is priced only under developmental disabilities programs run by the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH).
Two developments are reshaping that system. In June, Rhode Island Medicaid imposed a six-month moratorium on newly enrolling HBTS and ABA providers. And the state’s FY2027 budget funded rate increases recommended by the Office of the Health Insurance Commissioner (OHIC), effective October 1, though the updated fee schedule had not been posted as of late October 2026.
Rhode Island’s Medicaid Moratorium on New ABA Providers
The Executive Office of Health and Human Services (EOHHS) CEDARR Services page, last updated August 12, says Rhode Island Medicaid has implemented a six-month temporary moratorium on newly enrolling HBTS and ABA providers, starting June 16, 2026. The notice says it affects only newly enrolling providers, so it does not reach agencies already enrolled. It does not state a reason or a specific end date; six months from the start runs to mid-December.
Acuity could not confirm from EOHHS’s website whether the moratorium remains in effect. The agency’s main provider enrollment page, which listed the notice earlier this year, no longer carried it as of late October.
Rhode Island is not alone in pausing ABA enrollment. Indiana’s Medicaid program received CMS approval for a moratorium on new ABA provider enrollment, effective June 6, 2026, for an initial six months, according to a state bulletin. Temporary enrollment moratoria are governed by federal regulation at 42 CFR 455.470. When CMS released its state ABA toolkit on August 4, it reported that Medicaid and CHIP ABA spending rose 421 percent from 2021 to 2025, against 67 percent growth in the number of children with autism receiving services.
How Rhode Island Pays for ABA Through HBTS Codes
HBTS divides the work into direct services delivered by paraprofessional home-based workers and clinical services delivered by licensed professionals. Direct services, called Specialized Treatment and Treatment Support, bill under T1024 at $33.30 per 30-minute unit, or $16.65 per 15-minute unit with the U1 modifier. That works out to $66.60 an hour.
Clinical tiers are set by degree. Clinical supervision bills under H0046 at $59.07 per 30 minutes for a master’s-level clinician and $69.81 for a doctoral-level clinician, or $29.54 and $34.91 per 15 minutes. Treatment consultation under H2014 pays the same $29.54 and $34.91 per 15 minutes. Lead therapy, an ABA-specific role, bills under H0046 without a degree modifier at $38.67 per 30 minutes, and treatment coordination under T1016 pays $21.98 per 15 minutes.
Those rates took effect October 1, 2024, after OHIC’s first review cycle. T1024 rose from $31.00 per 30 minutes, and master’s-level supervision rose from $55.00, according to OHIC’s rate review file. OHIC’s consultants have also reported that, as of October 1, 2024, Medicaid managed care organizations are contractually required to pay at least the fee-for-service rate, so the fee schedule sets a floor for plan payments as well.
Figure 1. Rhode Island HBTS/ABA rates per 15-minute unit, by role, on the Medicaid fee schedule as of January 1, 2026 (rates set October 1, 2024). This series’ standard comparison charts, built on the MediRate platform, track CPT 97153 and 97155 across neighboring states. Rhode Island does not bill either code for children’s ABA, so a cross-state chart would leave Rhode Island off entirely. Acuity instead compiled this chart directly from the state’s fee schedule, obtained through MediRate’s state document library, using the billed 15-minute rate for each code (the U1 modifier where the base unit is 30 minutes). The chart does not reflect OHIC-recommended increases effective October 1, 2026, which await federal approval. Source: Rhode Island Medicaid fee schedule (January 1, 2026), via MediRate.
Credentialing: Licensed Clinicians Supervise, Paraprofessionals Deliver
The HBTS certification standards, dated July 2016, set credentials by role. A home-based worker delivering Specialized Treatment must be at least 19 with a high school diploma and two years of supervised experience with children with special health care needs, or hold an associate’s degree in human services, be enrolled in at least six semester hours of relevant coursework or, with EOHHS approval, bring three years of experience with adults with developmental disabilities. All must pass background screenings. The listed qualifications do not include Registered Behavior Technician (RBT) certification.
Clinical supervisors must hold a Rhode Island license as an independent clinical social worker, clinical social worker, marriage and family therapist, mental health counselor or psychologist, or be a Board Certified Behavior Analyst (BCBA). Among behavior analysts, EOHHS allows only BCBAs, not Board Certified Assistant Behavior Analysts, to provide clinical supervision and treatment consultation. The standards note that Rhode Island began requiring licensure for behavior analysts in 2012.
The standards cap clinical supervision at eight hours a month and generally limit HBTS treatment to 20 hours a week, though the section on treatment intensity excludes ABA programs from that ceiling. Lead therapists, whom EOHHS classifies as administrative support, must have worked six consecutive months as home-based workers in an ABA program and report to the behavior analyst or clinical supervisor.
Paying clinical time by degree puts Rhode Island alongside Delaware, which also tiers ABA rates by education. Weekly hour ceilings have drawn scrutiny elsewhere, from Virginia’s proposed 20-hour cap to CMS guidance that hourly maximums can work only as soft limits for children. Supervision is a live issue too: in Massachusetts, a LEARN Behavioral unit has sued MassHealth over a recoupment tied to a supervision ratio.
OHIC Rate Review and the October 1 Medicaid Rate Increase
OHIC reviews social and human service program rates every two years under state law. Its 2025 cycle built independent rate models for HBTS codes; in a worked example, the model produced a T1024 comparison rate of $36.14 per 30 minutes, about 8.5 percent above the current $33.30. OHIC treated the models as one of several inputs and reported a composite difference of 4.9 percent above current rates across HBTS codes. Its final recommendations, published August 29, 2025, equal a 7.4 percent increase for home- and center-based therapeutic services, measured against a $17.3 million fee-for-service baseline.
The Governor proposed phasing in the OHIC increases over two years beginning October 1, 2026, according to EOHHS testimony on a related bill. The enacted budget instead includes the increases as OHIC recommended, effective October 1, except where a recommendation exceeds Medicare rates, in which case the Medicare rate applies, EOHHS says.
Implementation is still under way. EOHHS posted public notices on September 1 for State Plan Amendments covering children’s services, EPSDT and other categories, and says federal approval, contracting and systems work will extend beyond October 1. Its FY2027 initiatives page says the October fee schedule has not been posted and that rates will be applied retroactively to October 1 if implementation is delayed.
The commercial market adds context. OHIC’s consultants found that commercial allowed amounts for home- and center-based therapeutic services generally fall between 100 and 150 percent of the October 2024 Medicaid rate, and that the category accounted for about $229 million in total expenditures in their SFY 2024 benchmarking, the largest children’s services line in that analysis.
How Rhode Island’s ABA Rates Compare and What Comes Next
Rhode Island’s $16.65 direct-therapy rate sits between its neighbors’ 97153 rates, but the codes do not match: T1024 covers both Specialized Treatment and Treatment Support, and Rhode Island pays clinical time by degree rather than through 97155. New Hampshire pays $17.79 for 97153, Acuity has reported, and Connecticut pays $14.00, according to Acuity’s Connecticut installment. MediRate maintains the underlying rate detail for state Medicaid programs nationwide.
Two dates matter for providers. Six months from June 16 falls in mid-December, and the notice does not say whether the moratorium could be extended. And the timing of federal approval will determine when the October increases, applied retroactively, reach provider payments.
Frequently Asked Questions
What does Rhode Island Medicaid pay for ABA in 2026?
Under the January 1, 2026 fee schedule, direct HBTS and ABA therapy under T1024 pays $33.30 per 30 minutes, or $16.65 per 15 minutes with the U1 modifier. Master’s-level clinical supervision pays $59.07 per 30 minutes and doctoral-level supervision $69.81. OHIC-recommended increases effective October 1, 2026, are pending.
Does Rhode Island Medicaid use CPT codes 97153 and 97155?
Not for children’s ABA. ABA bills through HBTS codes, including T1024, H0046, H2014 and T1016. The only 9715x code on the fee schedule, 97151, is priced under BHDDH developmental disabilities programs.
Can new ABA providers enroll in Rhode Island Medicaid?
EOHHS imposed a six-month moratorium on newly enrolling HBTS and ABA providers beginning June 16, 2026, and says it affects only newly enrolling providers. Providers should confirm its current status with EOHHS.
Who can supervise HBTS and ABA services in Rhode Island?
Rhode Island-licensed independent clinical social workers, clinical social workers, marriage and family therapists, mental health counselors, psychologists or BCBAs. Rates for clinical supervision vary by master’s or doctoral degree, not by credential.
