MedicaidPrior AuthMedium impact
Behavioral Health Treatment (BHT) – Applied Behavioral Analysis (ABA) Authorization Request Form
L.A. Care Health Plan·CA · Psychiatry, Pediatrics·Prior Authorization
We identified it
Jun 20, 2026
Summary
L.A. Care has updated their Behavioral Health Treatment (BHT) Applied Behavioral Analysis (ABA) authorization request form for members under 21. The form requires prior authorization for ABA services including diagnostic evaluations, functional behavioral assessments, and continuity of care services, with specific eligibility criteria and documentation requirements.
Action Required
Immediately: Use the updated L.A. Care BHT-ABA authorization request form (LA5480 03/24) for all behavioral health services. Submit completed forms with documentation via fax to (213) 438-5054. Ensure all 4 eligibility criteria are met before requesting FBA services: member under 21, physician recommendation with documentation, medical stability documentation, and no need for 24-hour medical monitoring. Do not schedule services until authorization is obtained as claims will be denied without proper authorization.