MedicaidPrior AuthMedium impact
BT202562: IHCP issues updated guidance for FFS and managed care ABA therapy prior authorizations
Indiana Medicaid (IHCP)·IN · Psychiatry, Pediatrics·Managed Care
We identified it
Jun 18, 2026
Summary
Indiana Medicaid has updated documentation and prior authorization requirements for ABA therapy services for members 20 years and younger with autism spectrum disorder. Key changes include clarified provider qualifications for comprehensive diagnostic evaluations, updated documentation requirements for initial and continuing services, and new weekly/lifetime service limitations coming when the State Plan Amendment is approved by CMS.
Action Required
Register for mandatory provider webinar on June 4, 2025 (10-11 AM ET) to understand new ABA therapy requirements. Update ABA therapy prior authorization workflows to ensure comprehensive diagnostic evaluations are performed by qualified providers (licensed psychologists with HSPP endorsement, physicians, APRNs, or physician assistants). For CDEs older than one year, obtain updated statement of need with referral and current behavior assessment. Prepare for additional service limitations when State Plan Amendment is CMS-approved - watch for future bulletin with specific PA process updates.