Once-Fast-Growing Stepping Stones Behavioral Solutions Shutters
Impact on your practice
This high-profile provider collapse, despite commanding premium Medicaid rates, demonstrates that even generous reimbursement cannot offset systemic pressures: workforce shortages, regulatory burden, and operational complexity. Therapists should view this as a warning about sector sustainability and evaluate their own practice's financial resilience.
Key facts
Stepping Stones Behavioral Solutions (Indianapolis autism therapy provider) abruptly shuttered June 11-12, 2025 with minimal notice
Company was 3rd fastest-growing on Inc. 5000 (133% revenue growth); accumulated $45.5M in Medicaid revenue 2019-2024
Received highest average per-claim supervision payments ($566.96) and 2nd-highest direct therapy payments ($838.56)
CEO cited system failure and unsustainable operating environment; company downward spiral began November 2024
Therapy Companion analysis
The collapse of Stepping Stones Behavioral Solutions—despite earning $45.5 million in Medicaid revenue over six years and commanding the highest supervision reimbursement rates ($566.96 per claim) in the nation—signals that generous fee schedules alone cannot sustain therapy practices in the current regulatory environment. Your financial resilience depends less on what Medicaid pays per claim and more on operational stability across multiple payers and your ability to absorb sudden payment freezes, network exclusions, and compliance costs. If you operate an autism therapy practice or rely heavily on Medicaid (as Stepping Stones did with 80% of revenue), you face acute vulnerability: Indiana's fraud review froze the company's payments for months, Anthem—which controls 51% of Indiana Medicaid enrollment—dropped the provider from its network in April 2025, and Indiana Medicaid's transition to a fee schedule in January 2024 eliminated the margin that had funded above-market wages. Your practice should assume that managed care network exclusions can happen with minimal notice and that a single payer freeze can become existential within months. The CEO exhausted personal savings and took out loans before closing; this was not mismanagement but rather the math of a system where compliance, workforce, and contracted payer access create simultaneous pressure. Even solo practitioners and small group practices should stress-test their cash flow against a 90-day payment freeze from their largest payer and a sudden network termination from a dominant MCO. Stepping Stones' experience suggests that credential delays, new provider contracting backlogs, and required accreditations (Indiana now mandates CASP accreditation for autism providers) are becoming structural barriers that no single organization can overcome alone. Your practice's survival increasingly depends on diversifying payer mix, maintaining 6+ months of operating reserves, and building relationships with multiple managed care networks before a crisis forces rapid contraction.
Background
Stepping Stones' failure occurred within a broader tightening of autism therapy reimbursement nationwide. Before January 2024, Indiana Medicaid paid 40% of submitted charges, allowing providers to set rates; the shift to a fixed fee schedule eliminated this flexibility and forced immediate wage reductions for RBTs and BCBAs. Simultaneously, federal scrutiny of autism therapy reimbursement has intensified: the HHS Office of the Inspector General found $76.7 million in potentially improper Indiana Medicaid payments for autism therapy (2019–2020), and the state is now under pressure to implement fraud-fighting measures including provider reverification campaigns, hourly treatment caps, treatment-supervision ratios, and new provider moratoriums. Indiana's six-month moratorium on new ABA providers (effective June 6, 2025) and prohibition on providers with ownership changes further constrain the sector. Other states—Minnesota and New York among them—are conducting similar reverification efforts that have resulted in hundreds of provider exclusions and layoffs. This is not isolated to Indiana; providers across multiple states (Centria Autism, ABA Centers of America, Ample Joy ABA, UNIFI Autism Care) have announced significant layoffs or shutdowns. The common thread is that regulatory compliance costs, network contracting delays, and payment freezes during fraud reviews have become non-negotiable operational burdens that outpace revenue stability, particularly for Medicaid-dependent organizations.
What you should do
Conduct an immediate financial stress test: model cash flow impact of a 90-day payment freeze from your largest payer and simultaneous network termination from your second-largest MCO. If you cannot maintain payroll and essential operations for 90 days without external revenue, begin building cash reserves immediately and diversifying payer mix.
Review your Medicaid enrollment status and managed care network participation across all plans in your state. Document the specific contract renewal dates, any pending credentialing delays, and the percentage of your revenue from each MCO. If any single payer represents >40% of revenue, develop a written plan to reduce that concentration within 12 months.
If you provide autism therapy services or behavioral health in Indiana (or any state with active fraud reviews or new provider moratoriums), confirm that your organization meets all new accreditation, supervision ratio, and hourly cap requirements immediately. Noncompliance with these mandates can result in payment holds and network exclusions without appeal opportunity.
Review your employment contracts and compensation structure: if you have locked in wages above what current fee schedules support, model when that commitment becomes unsustainable. Negotiate flexible incentive structures with staff rather than base wage increases that cannot be reduced if payer reimbursement contracts.
Establish written communication protocols with all managed care networks regarding contract status, credentialing timelines, and network participation terms. Do not assume a standing contract is secure; request written confirmation of renewal status at least 120 days before expiration and begin diversification outreach immediately if renewal is contingent or uncertain.
Notable excerpts
"The system failed this company, but it never failed because of you... This field asks more than it gives back, and I gave everything I had." — CEO Veronica Napier, in closure letter to employees. This acknowledges that even best-paid providers cannot sustain operations under current regulatory and contracting pressures.
"To keep the doors open through all of this, I exhausted every option available to me. I took out loans. I liquidated my personal savings... It was not enough." — CEO Veronica Napier. Demonstrates that personal financial sacrifice and operational flexibility cannot overcome systemic payment freezes and network exclusions.
A 2024 HHS Office of the Inspector General review found Indiana Medicaid made $76.7 million in potentially improper autism therapy payments (2019–2020); the state is now implementing fraud-fighting measures including provider moratoriums, reverification campaigns, and mandatory accreditation requirements.
States affected
Policy changes drive denial patterns
Therapy Companion tracks both: the policy shifts on this page and the denial patterns hitting your claims.