Utah’s SB160 makes its Medicaid ABA rate-increase mechanism permanent. See current 97153 and 97155 rates, the fee-for-service carve-out, and regional comparisons.
Key Takeaways
- A permanent rate-increase mechanism. Utah families and ABA providers have spent years uncertain whether Medicaid autism rates would keep pace with rising costs. SB160, enacted in the 2026 session, makes permanent the budgeting mechanism that lets Utah raise ABA reimbursement, ending the sunset dates earlier laws kept having to extend.
- Current rates sit comfortably in the region. Direct treatment by a technician (97153) pays $19.32 per 15-minute unit and professional treatment (97155) pays $36.84, both effective July 1, 2025. Those figures put Utah’s technician rate in the middle of its neighbor group and its professional rate at the top of it.
- A fee-for-service carve-out, not managed care. Unlike most of Utah Medicaid, ASD-related ABA is carved out and paid directly through fee-for-service, not through an accountable care organization or prepaid mental health plan. That structure shapes enrollment, billing, and where providers send claims.
- Coverage reaches adults, with layered credentialing. Utah extended ABA to adults in 2023 on the same medical-necessity criteria used for children. Providers must clear Division of Professional Licensing requirements, Registered Behavior Technician standards, and day-treatment licensure before billing.
Utah has spent the better part of four years building a budget tool to push its Medicaid reimbursement for applied behavior analysis (ABA) higher, and in the 2026 General Session it made that tool permanent. Senate Bill 160, sponsored by Senator Todd Weiler with Representative Stephanie Gricius carrying it in the House, amends the section of Utah code governing base budget appropriations for Medicaid behavioral health and ASD services to remove the expiration on the rate-increase appropriation that lawmakers have been extending, session by session, since 2022.
That mechanism did not appear out of nowhere. It traces to the 2022 session, when lawmakers funded an “Equal Medicaid Reimbursement Rate for Autism” line, appropriated $3 million for fiscal year 2023, and directed the Department of Health and Human Services to spend it raising ABA rates. The 2023 session widened the benefit itself, extending ABA coverage to adults on the same medical-necessity criteria used for children. A 2025 bill carried the rate-increase appropriation through the 2026 and 2027 base budgets, and SB160 has now removed the expiration entirely. For operators weighing where to deploy capital, that trajectory can matter as much as any single number, because it signals a state that has chosen to protect ABA rates rather than treat them as a recurring budget target.
What Utah Medicaid Pays for ABA in 2026
Utah’s current ABA fee schedule took effect July 1, 2025, the start of the state fiscal year. Direct treatment delivered by a technician (CPT 97153) pays $19.32 per 15-minute unit, roughly $77 per hour of technician time. Treatment delivered by a professional (97155), behavior identification assessment by a professional (97151), and family adaptive behavior treatment guidance (97156) each pay $36.84 per unit, roughly $147 per hour. Group treatment by a technician (97154) pays $13.66, and two professional group codes, 97157 and 97158, sit at zero on the schedule, meaning they are not separately reimbursed. Treatment codes carry prior-authorization requirements.
One coding detail stands out. Behavior identification assessment by a technician (97152), a code many states reimburse, is not separately reimbursed in Utah; assessment runs through the professional code, 97151. Supervision is handled with similar specificity: the schedule instructs providers to bill 97155 for direct case supervision and HCPCS code H0032 for indirect supervision, each with a credential modifier (HP for a psychologist or BCBA-D, HO for a BCBA, and HN for a behavior analyst in training or a BCaBA). For providers building authorization requests and claims, those rules determine whether a given session is payable.
The schedule’s design carries its own logic. Utah pays the same $36.84 unit rate whether a professional is conducting an initial assessment (97151), delivering treatment (97155), or coaching a family (97156), a flat professional rate that simplifies billing but gives providers little financial reason to prefer one professional activity over another. The split between direct and indirect supervision matters operationally: a behavior analyst overseeing a session in real time bills 97155, while planning and case management performed away from the member runs through H0032, and both must carry the credential modifier identifying who did the work. Getting that pairing wrong is a common source of denied claims.
How Utah’s ABA Rates Compare Across the Region
Set against its immediate neighbors, Utah occupies a comfortable position. On the technician treatment code that drives the bulk of direct service hours, Utah’s $19.32 lands in the middle of the regional pack, above Colorado and Arizona but below Nevada ($30.10) and Wyoming. On the professional treatment code, Utah’s $36.84 is the highest figure in the comparison group, ahead of Colorado, Arizona, and Wyoming. The two charts below, drawn from MediRate’s state Medicaid ABA database, show those comparisons for 97153 and 97155.
Adaptive behavior treatment by technician (97153), per 15-minute unit. Source: MediRate.
Adaptive behavior treatment by professional (97155), per 15-minute unit. Source: MediRate.
The regional picture also reflects a national environment that has turned volatile, with some states raising rates while others pull them back. Arizona overhauled its tiered AHCCCS fee schedule in late 2025, Indiana adopted a two-phase rate phasedown that will drop its key treatment codes toward the bottom of the national range, and in Georgia, CareSource moved to cut ABA reimbursement to 80 percent of the state fee schedule. Against that backdrop, Utah’s decision to lock in an upward mechanism is an outlier worth noting for anyone tracking the largest national ABA providers and the 2026 deal pipeline, where state Medicaid economics increasingly drive valuation.
Nationally, Medicaid ABA rates for these codes run from roughly $12.50 at the low end to above $40 in the highest-paying states. Utah’s professional rate sits in the upper portion of that span and its technician rate near the middle, a combination that, paired with the new permanence, positions the state as relatively stable territory for providers at a moment when stability is scarce.
Coverage Rules, Credentialing, and the Delivery Pathway
Utah administers ASD-related ABA as a fee-for-service carve-out. The state’s provider manual is explicit that these services are not available through an accountable care organization or a prepaid mental health plan; providers bill Utah Medicaid directly. Eligibility runs through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit for members under 21 and, since the 2023 expansion, through equivalent criteria for adults. A valid ASD diagnosis is required before services begin, and only a psychologist or a behavior analyst, or someone working under their direction, may render treatment.
The benefit’s design reflects a deliberate policy goal. The funding line that started the rate effort in 2022 was named for an “Equal Medicaid Reimbursement Rate for Autism,” language that framed the increases as an effort to narrow the distance between what Medicaid paid and what commercial plans paid for the same work. On the clinical side, a valid ASD diagnosis must precede services, ideally through an interdisciplinary evaluation weighing developmental, behavioral, and social history; once authorized, ABA may be delivered across naturally occurring settings in the home and community, including more than one setting on the same day. For a family in a rural county, that flexibility can be the difference between a workable plan and none at all.
Credentialing is layered. Utah has licensed behavior analysts through its Division of Professional Licensing since enacting the Behavior Analyst Licensing Act in 2015, recognizing Licensed Behavior Analyst and Licensed Assistant Behavior Analyst roles; a 2024 amendment (SB26) added separate Behavioral Health Technician and Behavioral Health Coach credentials, still being defined through rulemaking. Technicians delivering treatment must be at least 18 and meet Registered Behavior Technician credentialing requirements, and clear the required criminal background checks. ABA companies must also hold day-treatment licensure through the Department of Health and Human Services before serving members. For families, the practical effect is a benefit that is real, now reaches adults, and depends on a credentialed workforce the state is still working to grow, the same workforce constraint that the ABA Coding Coalition has cited as billing rules tighten nationally.
What SB160 changes is less the rate than the certainty around it. By removing the sunset, Utah has signaled to providers and investors that the appropriation behind ABA increases is now a standing feature of the budget rather than a question reopened every session. That does not guarantee a higher number next year, since the mechanism permits increases rather than mandating them, but it removes a recurring cliff that complicated hiring and expansion decisions. In a national market where several states are moving the other direction, durability itself has value.
