Who Really Sets the Hours? Ask Before You Sign.

Before the tea: This is a recap of a Wall Street Journal story (Oct 21, 2026). It is not legal, billing, or insurance advice.

Picture this: You're a BCBA at a new clinic. You complete an assessment and recommend the number of therapy hours you believe a client needs. But then leadership pushes back, suggesting the client should receive more hours than you recommended.

Sounds like a red flag? That's the concern raised in a recent Wall Street Journal investigation. The Journal examined Medicaid billing data from five of the largest private-equity-backed ABA providers. In 2024, those companies billed an average of 29% more therapy hours per week than their competitors.

Former employees told the Journal they felt pressured to recommend more intensive therapy schedules. The companies pushed back on those claims, saying treatment hours are based on each child's individual needs and that BCBAs have the authority to make their own clinical decisions.

So, who's right? We're not here to make that call.

Who sets the hours?

A BCBA assesses the child, considers the family's goals and priorities, and recommends the number of therapy hours that are clinically appropriate for that individual client.

Recent federal Medicaid guidance reinforces that approach. The guidance also cautions against treating 40 hours per week as the default or best practice for young children.

Ask it in your interview.

Who sets a client's hours?

What happens when you recommend fewer?

Watch for quiet signs too.

Does every kid seem to land in the same full-day or half-day slot?

Is your caseload small enough to actually reassess, and lower hours when a kid is ready?

Pair's Take

A Green Flag clinic answers these questions straight. Our matchmakers ask clinics this stuff before you ever sit down with them.

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