Indiana FSSA Medicaid · October 24, 2026 · Primary source
BT202562: IHCP issues updated guidance for FFS and managed care ABA therapy prior authorizations
Summary
The IHCP issued Bulletin BT202562 (May 15, 2025) updating prior authorization guidance for ABA therapy services in both fee-for-service and managed care delivery systems. The bulletin clarifies that weekly and lifetime service limitations will take effect 30 days after CMS approves a pending State Plan Amendment, and specifies which provider credentials are recognized to perform the comprehensive diagnostic evaluation required for initial PA requests. It also establishes that a CDE more than one year old requires a supplemental updated statement of need, and that continuation-of-service requests do not require a new CDE but do require an updated behavior assessment and treatment plan. A provider webinar is scheduled for June 4, 2025.
What this may mean
ABA therapy providers in Indiana must now ensure that initial PA requests include a CDE performed by one of the enumerated credential holders (doctoral-level licensed clinical psychologist endorsed as HSPP, licensed physician, APRN, or physician assistant) and that CDEs older than one year are accompanied by an updated statement of need. Both FFS and managed care providers are subject to these documentation requirements, and non-compliance with the PA documentation standards would risk denial of authorization and downstream claim denials. Weekly and lifetime service caps will become operative upon CMS approval of the SPA, triggering a further compliance obligation.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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