CareSource Indiana ABA coverage (Hoosier Healthwise / HIP).

Follows the Indiana Medicaid rule: ABA is covered for members 20 years of age and younger. Effective April 1, 2026 coverage runs exclusively through EPSDT, and for dates of service on or after October 1, 2026 IHCP will not authorize or reimburse ABA for members 21 and older — a state policy that binds every MCE.^[4][3][5]

Follows the Indiana Medicaid rule: a CDE more than one year old requires an updated statement of need, which must include a referral from an appropriate referring practitioner and an up-to-date behavior assessment completed by the ABA provider. Members continuing current services need no new CDE but do need an updated behavior assessment and treatment plan. A behavior assessment completed within the previous six months should be obtained from the original provider rather than repeated. IHCP states these documentation requirements apply to managed care as well as fee-for-service.^[5][4]

Follows the Indiana Medicaid rule — which is also CareSource's stated position, since it archived its own ABA policy (MM-0900) at the end of 2022 and reserves the right to follow CMS and state guidelines without a formal documented policy. The CDE must be performed by a doctoral-level licensed clinical psychologist endorsed as an HSPP, a licensed physician, a licensed APRN, or a licensed physician assistant with specialized training in the current DSM autism criteria. The archived policy's looser formulation — “licensed physician, HSPP, or qualified specialist” — is no longer the operative document.^[5][1][2]

Follows the Indiana Medicaid rule: the behavior assessment must include the Vineland Comprehensive Parent Interview Form with the Maladaptive Behavior domain, the BASC Parenting Relationship Questionnaire and an age-appropriate objective direct skills assessment, signed by the lead analyst and parent or guardian, with the complete scoring report including outcome scores and graphs submitted with the PA. Only BASC-4 satisfies the requirement after October 1, 2026. There is no CareSource-specific ABA form — submissions use the Indiana Medicaid universal PA request form — so the state's package is the package.^[4][6][1]

Follows the Indiana Medicaid rule: a physician must make a treatment referral recommending ABA therapy, and the CDE’s own required components include a physician’s referral for autism-specific services. Prior authorization is required on top of the referral for every ABA service, through this plan rather than through Acentra Health.^[4][5]

Follows the Indiana Medicaid rule: effective April 1, 2026, codes 97151, 97152, 97153, 97154 and 0373T can no longer be billed with telehealth modifier 95 and require in-person delivery. The plan publishes no ABA telehealth policy of its own.^[3]

CareSource publishes the Indiana statutory clock, marked “Updated July 1st, 2025”: standard pre-service “Forty-eight (48) business hours” and urgent pre-service “Twenty-four (24) business hours,” both excluding weekends and holidays and each extendable 14 calendar days; urgent concurrent 48 hours with no extension; post-service (retro) 30 calendar days. That is IC 27-1-37.5-23, which applies to Medicaid risk-based managed care and deems the service authorized if a deadline is missed; the federal floor (42 CFR 438.210(d): 7 calendar days, 72 hours expedited) is looser. No ABA-specific reauthorization submission lead time is published.^{[9][10][11][12]}

CareSource is secondary to any other coverage (IHCP is payer of last resort), and it publishes its own PA-when-secondary rule, which is narrower than the IHCP module's general statement: when CareSource requires PA and another payer is primary, the “Provider must follow the primary insurers requirements and obtain prior authorization,” and must “obtain prior authorization from CareSource when primary payer’s authorization was denied partially or in full” — attaching “the primary payer's authorization denial and/or the primary payers EOP denial.” Practically: get the commercial plan's ABA authorization first; if it is cut or denied, request CareSource PA with that denial. Bill the primary first and submit its EOB/EOP with the CareSource claim. TRICARE is not a problem here: 32 CFR 199.8 excludes Medicaid from the “double coverage plans” TRICARE pays after, so for a child with both, TRICARE pays before Medicaid.^[9][13][14]

Follows the Indiana Medicaid rule: ABA performed by a BCaBA or credentialed RBT must be under the direct supervision of a BCBA, BCBA-D or HSPP, and since April 1, 2026 at least 1 hour of BCBA (or IHCP-approved qualifying clinician) supervision is required per 8 hours of technician-delivered therapy. Behavior assessments may only be performed by a psychologist, BCBA-D or master's-level BCBA. IHCP states that its ABA documentation requirements apply to both fee-for-service and managed care, and this plan publishes no supervision standard of its own.^[4][3][5]

Follows the Indiana Medicaid limits: up to 40 hours per week may be requested with anything beyond that needing an additional PA; each prior authorization is capped at six months; and since April 1, 2026 comprehensive ABA (16+ hours/week, modifier UA) draws from a 4,000-hour (16,000-unit) lifetime allocation per member, with 97155 and 97156 excluded and targeted ABA (≤15 hours/week) exempt. No per-day MUE ceiling is published at either level.^[4][3]

Follows the Indiana Medicaid rule: the treatment plan must be built around the member's school attendance (including homeschooling) and other daily activities, while services focusing solely on recreational or educational outcomes are not covered, and neither are services duplicative of an IEP that address the same goals using the same techniques as the treatment plan.^[4]

Follows the Indiana Medicaid rule: ABA rendered by a BCaBA or RBT must be billed under the NPI of an IHCP-enrolled ABA therapist or school corporation, on a professional claim. Since July 1, 2025 the rendering practitioner must be enrolled under ABA specialty 615, 624 or 625, and since April 1, 2025 the rendering NPI must align with the credential-level modifier (U1 RBT / U2 BCaBA / U3 BCBA-HSPP). Plan-level claim formatting may still differ — MCEs publish their own billing requirements.^[4][3]

Not published by Indiana Medicaid or by this plan. IHCP is explicit that within managed care “individual managed care entities (MCEs) establish and publish their own billing and reimbursement requirements,” so unlike the clinical criteria, code-pair rules are not inherited from the state by default.^[5]

Ask the plan: The MCE directly — ask whether 97155 pays alongside 97153 for the same clock time, and request the plan's billing and reimbursement requirements in writing.

Neither Indiana Medicaid nor this plan publishes a session-note signature rule. The state's published signature requirements attach to the plan documents — the behavior assessment and the treatment plan must each be signed by the lead analyst and the parent or guardian — and BT202562, the bulletin titled for ABA documentation requirements, does not reach the individual session note. IHCP states its documentation requirements apply to managed care as well as fee-for-service, but also that MCEs establish and publish their own billing and reimbursement requirements, so the gap is not automatically filled at the state level.^[4][5]

Ask the plan: The MCE directly — ask for its ABA documentation and session-note standard in writing. BT202562 also promises a future bulletin clarifying documentation requirements under the updated ABA State Plan Amendment; check for it before relying on this.