MedicaidPrior AuthMedium impact
26-197 Updated ABA Medical Necessity Criteria for Medi-Cal, Effective April 20, 2026
Health Net·CA · Psychiatry, Pediatrics·Prior Authorization
Effective date
Apr 20, 2026
We identified it
Jun 20, 2026
Summary
Effective April 20, 2026, Medi-Cal will adopt new medical necessity criteria for Applied Behavior Analysis (ABA) services for patients under age 21, replacing the previous Council of Autism Service Providers criteria. This change promotes more individualized, needs-based ABA care and affects prior authorization requirements for Medi-Cal patients in Imperial County.
Action Required
Before April 20, 2026: Billing team must review and implement new ABA medical necessity criteria (CA.CP.BH.104) for all Medi-Cal patients under age 21 requiring ABA services. Update prior authorization processes to align with new clinical policy requirements. Contact Community Health Plan of Imperial Valley at 833-236-4141 for questions or Behavioral Health providers at 844-966-0298. Review complete ABA policies and documentation requirements (CA.CP.BH.105) to ensure compliance with new individualized care standards.