and when asked what justified the pricing increases she pointed not to a single cost driver but to decisions made alongside a business partner.⁴
The answer does not sit with the company alone, because the structure that allows it does not originate there.
Autism therapy operates in a part of healthcare that lacks a universal national standard for how many hours a child should receive, leaving treatment plans to be adjusted by clinicians over time, which helps families but removes a natural ceiling on expansion. National Medicaid data show an average of about fourteen hours of therapy per week per patient in 2023, yet many providers billed far more—thirty hours or more weekly for some children, effectively turning therapy into a full-time schedule.⁵
At that level, the system begins to tilt. Providers expand capacity, clinics multiply, and a growing workforce delivers the hours that sustain the model, while oversight moves more slowly, trailing the pace set by reimbursement.
Audits in states including Maine, Wisconsin, Indiana, and Colorado found documentation problems across every sample reviewed, including claims for therapy billed while children were resting or watching videos, a pattern that did not trigger widespread fraud findings but exposed how easily a system built on time can outpace the mechanisms designed to monitor it.²
By the time rules adjust, the structure is already embedded. Indiana eventually replaced its reimbursement formula with a flat rate of roughly $68 per hour, collapsing the previous pricing model almost overnight, and for clinics built on higher reimbursement the shift was not gradual but structural, forcing immediate adaptation.³
Back in the therapy room, the session continues as the technician presents another card and the boy hesitates, then answers, and the tablet records the result while the hour advances minute by minute, each entry marking both progress and completion.
His mother checks the clock again, then looks down at her coffee, which has gone cold without her noticing.
For the family, the hour carries weight that cannot be measured in billing codes. It is an investment in language, in independence, in the possibility that the boy will move through the world with fewer barriers than he would have without it, and that belief holds even when the system surrounding it operates on a different set of incentives.
“What if he needs more?” she asks when the session ends, her voice careful, as if the question itself might increase the answer.
“We can add hours,” the technician says, not hesitating this time.