The short version
- CASP's practice guidelines describe focused ABA at about 10 to 25 hours of direct treatment per week and comprehensive ABA at about 30 to 40 hours of one-to-one treatment.
- Colorado's draft Medicaid rule would use age-based review guidelines of 25 hours a week for ages 18 months to 5, 16 for ages 6 to 12 and 10 for ages 13 to 20. The draft says these are not caps.
- HCPF's target effective date for the rule is March 2, 2027. The Medical Services Board has not yet adopted it.
- Medicaid does not cover 40 clinic hours a week for a child who has access to school hours, unless the district shows the child cannot be served in a classroom.
- Research on whether more hours produce better outcomes is mixed. Hours should follow your child's goals and response to treatment.
How many hours of ABA per week does a child need? There is no single right number. Two reference points exist for Aurora families, a national practice guideline and Colorado’s proposed Medicaid guidelines, and neither is a prescription for your child.
What do the CASP practice guidelines say about ABA hours?
The Council of Autism Service Providers (CASP) publishes the most-cited ABA practice guidelines. Its second edition splits treatment into two bands:
| Band | Direct treatment per week | What it is |
|---|---|---|
| Focused ABA | About 10 to 25 hours, plus supervision and caregiver training | Targets specific skills or behaviors |
| Comprehensive ABA | Often 30 to 40 hours of one-to-one treatment, not counting caregiver training and supervision | Targets many developmental areas at once |
The guidelines add three details that matter to parents. Very young children may start with a few hours a day and build up as they can tolerate it. Hours go up or down depending on how the child responds. And hours usually drop when a child has met most goals and is moving toward discharge. CASP released a third edition in April 2024. The ranges above come from the second edition PDF that CASP hosts.
What are Colorado’s proposed Medicaid hour guidelines?
HCPF is writing a permanent rule for pediatric behavioral therapy. The draft update shared at the September 29, 2026 stakeholder meeting includes age-based service hour guidelines:
| Age | Guideline hours per week |
|---|---|
| 18 months through 5 years | 25 |
| 6 through 12 years | 16 |
| 13 through 20 years | 10 |
The draft is explicit that these are utilization-review guidelines, “not absolute service limits, hard caps, or presumptive maximums.” A request cannot be denied or reduced solely because it goes above the guideline. A request above it has to name the therapeutic purpose of the extra hours, explain why the child’s needs cannot be met within the guideline and show how the schedule accounts for school, sleep and family time. HCPF’s FAQ says the guidelines are meant to prompt closer review and documentation, not to cut off medically necessary care.
Timing matters. The rulemaking page says HCPF plans an initial reading before the Medical Services Board on December 11, 2026. The FAQ gives March 2, 2027 as the expected effective date, if the board adopts the rule. Already approved services that run past that date stay authorized for their authorization period. HCPF says it does not plan to make providers revise existing approvals, and the guidelines come into play at the next renewal on or after March 2, 2027.
For the approval process itself, see our Health First Colorado ABA guide.
Do more hours lead to better results?
Not in any way research can promise. A 2025 review in the Journal of Autism and Developmental Disorders describes the evidence on dosage as mixed. Some studies report that more hours help. Others, including a 2024 meta-analysis of 144 studies of children under 8, found no evidence linking more hours per week to better developmental gains. The review also notes that ABA intensity is often described as ranging from 10 to 40 hours.
That is a reason to ask your provider why they recommend a number, and what result would tell them to raise or lower it.
How do I fit ABA around preschool or school?
The hours your clinic proposes have to share a week with school, sleep, meals and play. Three sources address that directly.
Medicaid and school hours. HCPF’s PM 25-005 says Health First Colorado covers medically necessary therapy at school. It no longer covers 40 hours a week of clinic services for a child who can access school hours, unless the school district shows the child cannot be served in a classroom. Requests need school information, such as an IEP, showing the total therapy hours at school.
The draft rule on school. For school-age children, reviewers will weigh the school schedule, educational participation, other necessary services, sleep and daily living, and chances to practice skills outside treatment. The draft also says a provider “shall not require or recommend” that a child withdraw from school, reduce required attendance or switch to home instruction only to fit the provider’s preferred schedule. If services are proposed during school hours, the provider has to document why and show it was coordinated with the school. HCPF’s FAQ says a detailed daily schedule is not required on the request, but one can help the reviewer.
Preschool. For children who are not yet school-aged, the draft says reviewers weigh other necessary services, sleep, meals, play time and family participation. Cherry Creek’s special education page says its preschool programming reflects research on intensity at that age, and that school staff and parents combine efforts to deliver more hours of service. Ask your district what hours the IEP provides before you plan clinic hours around them.
An example of the arithmetic
This is an illustration, not a recommendation. Twenty-five hours a week is five hours a day, five days a week. For a child in a half-day preschool, it might mean a few hours of therapy after school plus some weekend time, with the rest of the week left for play and rest. For a school-age child with a guideline of 16 hours, it might mean a couple of hours after school on weekdays and a longer weekend session. Your BCBA should show you how the hours fit a real week before you agree.
What should I ask my provider about hours?
- What number of direct hours do you recommend, and what in the assessment led you there?
- How do those hours fit around school and rest? Can the schedule change as school changes?
- What does supervision look like, and how many caregiver training hours are included?
- What would make you reduce hours? What are the criteria for moving toward discharge?
- Do you require a minimum number of hours to start? If so, why?
The last one is a red flag if the answer is a flat number for every child. Our guide to choosing an ABA provider in Aurora goes through that and other warning signs. For school coordination, see Aurora Public Schools and Cherry Creek.
Our in-clinic, in-home and school-based programs can each be scheduled around your child’s school day. We accept all major insurance, including Medicaid, have no waitlist and start families within two weeks of approval. Contact us to talk about a schedule.
Sources
- CASP, Applied Behavior Analysis Treatment of Autism Spectrum Disorder: Practice Guidelines (2nd edition)
- CASP, ABA Practice Guidelines page (3rd edition released April 29, 2024)
- HCPF, Complete Rules: Pediatric Behavioral Therapy (PBT) Meeting
- HCPF, Pediatric Behavioral Therapy draft rule update (Section 8.281), September 2026
- HCPF, Pediatric Behavioral Therapy FAQ document draft, fall 2026
- HCPF Policy Memo PM 25-005, Pediatric Behavioral Therapy Policy Clarification
- HCPF, Pediatric Behavioral Therapies (member page)
- Journal of Autism and Developmental Disorders, Dosage in Applied Behavior Analysis (2025)
- Cherry Creek Schools, Special Education (autism programming)