← Back to list
Applied Behavior Analysis - MEDICAID - LOUISIANA (Revised)
Act
by Oct 7, 2026
Effective date
Oct 7, 2026
Identified
Oct 3, 2026
Summary
Humana Louisiana Medicaid revised its Applied Behavior Analysis (ABA) coverage policy effective 10/07/2026, establishing a two-step prior authorization process requiring a comprehensive diagnostic evaluation (CDE) by a qualified health care professional before ABA services can be authorized. The policy clarifies QHCP qualifications, CDE requirements, behavior treatment plan documentation, and coordination with IEPs and waiver services for members under 21 with diagnosed behavioral/developmental conditions.
Get alerts when payers change rules like this one
We check Humana and other payers every day and email you when a change matches your specialty and state.
Get Humana alertsPolicy Monitoring is free. No card required.
What to do
by Oct 7, 2026 · 10 steps
01Billing and clinical teams must implement the two-step prior authorization workflow for all ABA service requests.
02First authorization for functional assessment and behavior treatment plan development (using 'Mental Health Services Plan Development by Non-Physician' authorization code).
03Second authorization for ABA-derived therapy services.
04Billing team must update software to require submission of CDE documentation with initial prior auth requests only (per member per provider).
05Ensure ABA providers submit complete documentation including: CDE, behavior treatment plan, IEP (or written explanation if unavailable), and for waiver-enrolled members, the waiver plan profile table and schedule.
06Front desk staff and providers must screen for member age (under 21), behavioral deficits/excesses interfering with activities, DSM-5 diagnosis, and QHCP prescription.
07If IEP is required for school-based services, do not approve until IEP is provided.
08Coordinate with Waiver Support Coordinators for members in waiver programs to confirm enrollment and service overlap.
09Failure to obtain prior authorization before service delivery will result in claim denials.
10Update encounter forms and provider notification letters to reflect new QHCP qualifications (pediatricians using MCHAT-R/F, developmental specialists, psychologists, psychiatrists, and qualified licensed professionals meeting specific experience/supervision requirements).
Original notice
Applied Behavior Analysis - MEDICAID - LOUISIANA (Revised)
mcp.humana.com · Always check the source before changing claims.