How Long Does It Take to Start ABA Therapy? The Washington Timeline, Step by Step

How long does it take to start ABA therapy? Most parents picture one waitlist, but in Washington it is nine steps: a diagnosis, an order for ABA, intake, a benefits check, an assessment, a treatment plan, insurance approval, staffing, and the first session. A few of those steps have legal deadlines measured in days. The rest have none, and that is where the months go.

We could not find published Washington data on ABA wait times. The best peer-reviewed numbers come from Michigan. In a survey of Michigan caregivers run in early 2021 and published in Behavior Analysis in Practice, 35 of the 48 caregivers who had pursued ABA (72.9%) had been on a waitlist. The average time on a waitlist was 5.66 months. Children who had already started services had waited 4.84 months on average. Children still waiting had been on a list for 8.57 months. That is a small sample from another state, so treat it as a rough guide, not a forecast for your family.

The ABA start timeline in Washington, step by step

Step	Who does it	Typical time	What can speed it up
1. Diagnostic evaluation (Center of Excellence for Apple Health, age 20 and under)	Diagnostic clinic, psychologist, or developmental pediatrician	Often the longest wait before ABA, commonly months	Join more than one diagnostic waitlist and ask for the cancellation list
2. Written report and ABA order	The diagnosing clinician	Varies by clinic	Ask at the appointment when the report and order will be ready, and ask for your own copy
3. Intake call and benefits check	ABA provider’s intake team	Can start the same week if documents are ready	Send the report, order, and both sides of your insurance card on the first call
4. Assessment authorization, if your plan requires one	Provider requests, insurer decides	Not required for Apple Health home and community assessments; state-regulated plans have 3 to 5 calendar days for a standard request	Ask your plan whether the assessment needs approval
5. Assessment (CPT 97151)	BCBA	Apple Health allows up to 7 hours per assessment, often split over two or more visits	Offer flexible times and send records ahead
6. Treatment plan	BCBA writes it, you review and sign	For Apple Health, the request must reach HCA within 60 days of the assessment	Review and sign promptly, and ask when it will be submitted
7. Treatment authorization	Your insurer	1 to 5 calendar days for state-regulated plans and Apple Health managed care; 15 days for Apple Health fee-for-service and self-funded plans	A complete request sent electronically
8. Staffing and schedule	ABA provider	No deadline; the most variable step	Daytime availability, flexibility on setting, and more than one provider
9. First session	Therapist and your child	The first weeks focus on building trust	Share what your child loves before day one

Where the waitlist sits depends on the provider. Some put families on a list before intake. Others do the assessment and authorization first, then wait for a therapist. Ask each provider where its wait happens, so you know which part of this chart you are actually waiting on.

Steps 1 and 2: the diagnosis and the ABA order

Insurance-funded ABA starts with a written autism diagnosis. For Apple Health, HCA requires an evaluation from an approved Center of Excellence (COE) and an order for ABA for clients 20 and younger. A diagnosis from another clinician will not unlock Apple Health coverage. Our post on why a diagnosis is needed for ABA covers what the report has to include, and our guide to autism testing on the Eastside lists where to go and how to shorten diagnostic waits.

The HCA billing guide says the COE sends the evaluation and ABA prescription to the ABA provider you choose, or gives them to you to forward. Ask for your own copy either way. If a provider calls you back and the paperwork has gone missing, you can send it in minutes. If the diagnosis is brand new, our new autism diagnosis guide covers the first months.

Steps 3 to 6: intake, the assessment, and the treatment plan

At intake, the provider checks your benefits: whether ABA is covered, what you will owe, and what the plan needs before the first session. Then a BCBA does the assessment, billed as CPT 97151. Our post on the ABA assessment explains what happens in the room.

Two Apple Health rules from the billing guide shape the timing:

• The assessment does not need prior authorization in home and community settings. HCA limits it to 28 units, or seven hours, per assessment, and two assessments per calendar year.
• The treatment request has a deadline. The prior authorization request, with the assessment and treatment plan, must reach HCA within 60 days of the assessment. For fee-for-service clients, providers must submit it at least 15 days before they expect services to begin.

The BCBA must share the plan with you and get your signed approval. A plan that sits unsigned for a week adds a week. Commercial plans set their own rules. Some cover the assessment with no approval. Others want approval before the BCBA bills a single unit.

How long does insurance have to approve ABA in Washington?

Not long, if the request is complete. This is the part of the timeline most parents do not know has a legal clock.

State-regulated plans. Washington’s prior authorization law, RCW 48.43.830, passed in 2023 as E2SHB 1357, applies to health plans issued or renewed on or after January 1, 2024. The Insurance Commissioner’s rule, WAC 284-43-2050, took effect January 27, 2025, according to the OIC’s rulemaking page. The insurer must decide and notify the provider within:

• 3 calendar days for a standard request sent electronically, excluding holidays
• 1 calendar day for an expedited electronic request
• 5 calendar days for a standard request sent by fax or another non-electronic method
• 2 calendar days for an expedited non-electronic request

The clock runs from when the insurer has the information it needs. If something is missing, the insurer has to ask for it (within one calendar day for electronic requests), and the deadline applies once it arrives.

Apple Health managed care. HCA’s report to the Legislature on prior authorization says the managed care contracts use the same 3 and 5 calendar day standards, and 1 and 2 days for expedited requests, effective January 1, 2024. If a plan asks the provider for more information, the provider gets 4 days to respond on a standard request.

Apple Health fee-for-service. Under WAC 182-501-0165, HCA reviews a request within 15 days and approves it, denies it, or asks for more information.

Self-funded employer plans. The OIC does not regulate these plans, which are common at very large employers, so the state deadlines do not apply. Federal rules under 29 CFR 2560.503-1 give the plan up to 15 days for a pre-service decision, with one 15-day extension if it tells you why before the first 15 days are up. Urgent requests get 72 hours.

If approval is taking weeks, ask your provider four things: when the request was submitted, whether it went electronically, whether the plan asked for anything else, and the reference number.

Step 8: staffing, the step with no deadline

Once the authorization comes back, the provider needs a therapist whose hours match your child’s schedule. No law requires an ABA provider to have an opening, and this is where most families wait the longest.

After-school slots are the ones nearly every school-age family asks for, so they go fast. If your child is not getting much from the school day right now, read our post on evening waitlists and daytime sessions before you rule out daytime hours.

If no in-network provider can serve your child, your plan may have to arrange care elsewhere. For state-regulated plans, WAC 284-170-200 requires access to a nonurgent specialist appointment within 15 business days of a referral. Our guide to single case agreements explains how to use that rule to get an out-of-network provider covered at in-network cost.

What you can do this week to shorten the wait

1. Get on more than one list. For Apple Health families, this is HCA’s own advice. Our Apple Health ABA guide covers what HCA says about waitlists.
2. Check the network before you call. Confirm each provider is in network for your exact plan. Apple Health managed care members should call the plan for its in-network list.
3. Have the report and order ready to send. Keep PDFs of the diagnostic report, the ABA order, and your insurance card on your phone.
4. Ask about daytime slots and setting. A center-based morning slot or an in-home slot may open sooner than a 4 p.m. clinic slot.
5. Ask whether the assessment can happen first. Some providers will assess while you wait for staffing. Ask how they time the authorization so its months are not used up before a therapist is assigned.
6. Ask whether your plan needs approval for the assessment. If it does, the provider can request it at intake.

What to do while you wait

Ask about parent training. Apple Health’s billing guide has a path for caregiver training only, before direct ABA starts. The BCBA does an assessment and writes caregiver goals. Managed care families should check with the plan about preauthorization. Our parent training page explains what those sessions cover.

Ask about speech and occupational therapy. Seattle Children’s waiting handout notes that health insurance may cover speech and OT for communication, social, motor, and sensory needs. Ask your plan which providers are covered.

Under 3: call ESIT. Washington’s Early Support for Infants and Toddlers serves children from birth to 3, and the same Seattle Children’s handout says no medical diagnosis is needed to ask for an evaluation. Federal rules at 34 CFR 303.310 require the evaluation, assessments, and first IFSP meeting within 45 days of the referral. Call Help Me Grow Washington at 1-800-322-2588.

3 and up: request a school evaluation in writing. The Seattle Children’s handout notes that an autism diagnosis is not required for school services. Under WAC 392-172A-03005, the district has 25 school days to decide whether to evaluate, then 35 school days after you consent to finish the evaluation and decide eligibility.

If your start date lands near January 1, 2027

New ABA billing codes take effect on January 1, 2027. Insurers have to decide how to handle authorizations that cross that date, and some may ask for a new request. If your child’s treatment request goes in during November or December, ask the provider whether it will need to be reissued. Our post on the 2027 ABA code changes lists the questions to ask.

Starting ABA with Orchid

Orchid Academy is in network with Premera, Regence, Blue Cross Blue Shield, Cigna, Aetna, Washington Apple Health, Molina, Asuris, Personify Health, and TRICARE, and private pay is available. Our care team handles authorizations, reauthorizations, appeals, and single case agreements, so you are not chasing reference numbers yourself. An autism diagnosis is required before services begin.

Our center-based academies serve children ages 2 to 15, Monday to Friday from 9:00 to 6:00: Creekside Academy and Maple Street Academy in Issaquah, and our academy in East Wenatchee. We also offer in-home ABA in Bellevue, Bothell, Kirkland, Sammamish, Covington, Federal Way, Auburn, and the East Wenatchee area, plus speech therapy, occupational therapy, and parent training.

Request a call back and tell us which step you are on. We will tell you what we need next and check your benefits. You can also see all Orchid locations.