CurrentCareSourcePolicy N/A

Applied Behavior Analysis (ABA) reimbursement for Autism Spectrum Disorder - Arkansas PASSE

Defines reimbursement, provider, supervision, documentation, and service delivery rules for ABA services for Arkansas PASSE members; affects Arkansas Medicaid-enrolled ABA providers, BCBAs, BCaBAs, RBTs, and affiliated group providers.

Policy Summary

PayerCareSource

PolicyApplied Behavior Analysis (ABA) reimbursement for Autism Spectrum Disorder - Arkansas PASSE

Policy CodePolicy N/A

Change TypeNew policysupervision and observation clarifications

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionObtain medical necessity review prior to providing any ABA service and ensure supervising BCBA reviews and approves data/notes before claim submission.

SourceLink

POLICY UPDATE CHANGES

New standalone reimbursement policy for ABA services for Arkansas PASSE effective 09/01/2025.

RBT supervision and BCBA/BCaBA supervision requirements and observation thresholds clarified (including 5% observation and 1 hour per 30 days).

5%minimum in-person observation threshold per supervisee

1 hr/30dminimum in-person observation frequency per BCaBA/RBT

12maximum combined supervisees per BCBA

25supervision caseload limit (hrs/week)

50max billable ABA hours per clinician/week

Coverage Criteria for ABA Services

Coverage criteria for ABA services

Covered ABA services are reimbursable when delivered in accordance with the member's Individual Treatment Plan (ITP) and meeting provider, supervision, and documentation requirements.

Services must be delivered in accordance with the member's Individual Treatment Plan (ITP).

Service definitions

Behavior Identification Assessment: Performed by a BCBA; units include face-to-face BCBA evaluation time and BCBA non-face-to-face time preparing the comprehensive evaluation report and initial ITP.
ABA Therapy Treatment Services: One-on-one delivery by a BCBA, a BCaBA supervised by a BCBA, or an RBT supervised by a BCBA; group ABA therapy is prohibited; weekly billed units cannot exceed authorized units; unused authorized units in a week do not carry forward; a single clinician cannot perform more than 50 billable ABA therapy treatment service hours per week.

Policy Summary

PayerCareSource

PolicyApplied Behavior Analysis (ABA) reimbursement for Autism Spectrum Disorder - Arkansas PASSE

Policy CodePolicy N/A

Change TypeNew policysupervision and observation clarifications

Effective DateSep 1, 2025

Next Review DateN/A

Key ActionObtain medical necessity review prior to providing any ABA service and ensure supervising BCBA reviews and approves data/notes before claim submission.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

BCBA supervision requirements

Supervising BCBA must be an enrolled Arkansas Medicaid provider.
Minimum in-person observation thresholds for each BCaBA or RBT: 5% of the supervisee's total ABA treatment hours and at least 1 hour of ABA delivery every 30 days.
When not directly observing a session, the supervising BCBA must be on-call and immediately available to advise and assist for the entirety of any supervised session; telecommunication availability is sufficient.
Supervising BCBA must review and approve data collection and progress notes completed by BCaBA or RBT prior to submitting a claim for any ABA therapy treatment services delivered.
Supervision caseload limit (lesser of)
- A maximum combined total of 12 BCaBAs and RBTs at any given time.
- A caseload requiring no more than 25 hours per week of billable adaptive behavior treatment with protocol modification services.

Units, Fee Schedule, and Billing Rules

Units and fee schedule rulesmixedCovered

Fee schedule methodology	Reimbursement at the lower of billed charge or Arkansas Medicaid maximum allowable; same maximum for all ABA providers.
Unit definition	A full unit of service must be rendered to bill a unit; partial units may not be rounded up and are not reimbursable.
Aggregation rule	Non-consecutive periods of service delivery over the course of a single day may be aggregated when computing a unit of service.
Concurrent billing	Unless otherwise specifically stated in the ABA Provider Manual, concurrent billing is not allowed.
Non-billable time - preparation/breaks	Time spent preparing a member for services, cleaning or prepping an area before or after services, and/or rest, toileting, or other break times between service activities is not billable.
Non-billable time - documentation	Time spent on documentation alone is not billable as a service unless otherwise specifically permitted in the ABA Provider Manual.

Unit billing rules

Unit granularityFull units only; partial units may not be rounded up and are not reimbursable.

Aggregation of non-consecutive timeNon-consecutive periods of service delivery over the course of a single day may be aggregated when computing a unit of service.

Unit calculations by service typeBehavior Identification Assessment units include BCBA face-to-face evaluation time and BCBA non-face-to-face time for report/initial ITP; ABA Therapy and Adaptive Behavior Treatment units include only direct one-on-one service time or in-person supervision/observation time as specified.

Weekly limits and carryforwardPrescribed/authorized weekly units not performed do not carry forward and cannot be made up in other weeks; a week is Monday through Sunday.

Clinician maximum hoursA single clinician cannot perform more than 50 billable hours of ABA therapy treatment services per week.

Prior Authorization and Provider Responsibilities

Prior Authorization

Obtain medical necessity review and be prepared for documentation requests

A medical necessity review is required prior to the provision of any ABA service. Coverage is subject to the member’s benefits and eligibility, and CareSource may request therapy or supervision documentation. Compliance may be monitored through post-payment data analysis, audits, recoveries, and prepayment review; when other insurance exists, Medicaid is payer of last resort and primary payer determinations must be provided.

Medical necessity review required prior to any ABA service provision.
CareSource may request therapy or supervision documentation and conduct pre- or post-payment review and audits.
When member has other insurance, Medicaid is payer of last resort and primary payer evidence must be provided.
Coverage and reimbursement are subject to member benefits, eligibility, and applicable fee schedule limits.

OpenPayer

Applied Behavior Analysis (ABA) reimbursement for Autism Spectrum Disorder - Arkansas PASSE

Coverage Criteria for ABA Services

Units, Fee Schedule, and Billing Rules

Prior Authorization and Provider Responsibilities

Key Definitions and Billing Concepts