---
title: "HAP ABA coverage in Michigan: the intake guide."
url: "https://carelu.com/payers/hap-michigan"
markdown_url: "https://carelu.com/payers/hap-michigan.md"
state: MI (Michigan)
payer: "Health Alliance Plan (HAP) — Michigan"
kind: Commercial insurance
description: "How Health Alliance Plan (HAP) covers ABA in Michigan: ABA treatment on HAP’s prior-authorization list, InterQual criteria behind login, the SB 247 7-day/72-hour clock, Michigan’s mandate caps and exemptions, and what intake must confirm with HAP."
last_reviewed: September 2026
---

# HAP ABA coverage in Michigan: the intake guide.

_Payer Guide · HAP · Michigan · Last updated September 2026 · 14 primary sources_

> Henry Ford Health’s plan: ABA treatment on HAP’s PA list; criteria behind login; SB 247 7-day/72-hour clock.

Health Alliance Plan (HAP), a Michigan-based nonprofit plan of Henry Ford Health, publishes the basics of its ABA coverage. Its public materials confirm that ABA treatment requires prior authorization and that HAP follows Michigan’s prior-authorization law, but its ABA clinical rules sit behind provider login, so more of this guide is "ask HAP" than for Blue Cross or Priority Health. HAP’s Medicaid product is HAP CareSource; for Medicaid members ABA runs through the county PIHP (see our Michigan Medicaid guide).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org). [1]
- **Prior auth for treatment**: Required — "Applied Behavioral Analysis (ABA) Treatment" is on HAP’s Prior Authorization List Summary (reviewed 07/10/2026). [1]
- **Autism diagnosis required?** _(licensed criteria)_: HAP’s ABA diagnostic criteria are not public (InterQual / CBHM list behind login); the Michigan mandate covers ASD diagnosed by a licensed physician or psychologist on fully insured plans. [1][4]
  - In licensed criteria: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org).

## At a glance

- **Covers ABA?:** Yes — ABA treatment is a covered, prior-authorized service (subject to the member’s plan documents)
- **State mandate:** MCL 500.3406s (insurers; 2012 PA 100, amended 2016) and MCL 550.1416e (health care corporation certificates)
- **Mandate age:** Treatment coverage may be limited to members through age 18
- **Mandate caps:** Annual maximums allowed: $50,000 through age 6, $40,000 ages 7–12, $30,000 ages 13–18; no visit limits
- **Exempt from mandate:** Self-funded ERISA plans; exchange QHPs beyond essential health benefits; short-term policies of 6 months or less
- **Licensure:** Behavior analysts licensed by LARA (Public Health Code Part 182A, law since 2016; BACB certification required); technicians unlicensed
- **Prior auth:** ABA treatment on HAP’s prior-authorization list (reviewed 07/10/2026); details in the CBHM outpatient list
- **Criteria:** InterQual (portal access by request)

## What HAP publishes about ABA

HAP’s Prior Authorization List Summary (reviewed July 10, 2026) lists "Applied Behavioral Analysis (ABA) Treatment" among services requiring prior authorization and refers providers to the "Coordinator Behavioral Health Management-Outpatient Authorization list for detailed information," which, like HAP’s InterQual criteria, requires a provider login. HAP’s Coordinated Behavioral Health Management (CBHM) team, (800) 444-5755, is the behavioral health contact for members. Coverage is "based on the member’s subscriber documents," so the schedule of benefits decides limits. [1][2][3]

On timing, HAP states its compliance with Michigan’s prior-authorization reform (Senate Bill 247): non-urgent requests are approved if no action is taken within 7 calendar days of submission, urgent requests within 72 hours, and new or changed prior-authorization requirements are posted 60 days ahead for non-drug benefits. [1][2][3]

## The Michigan autism mandate: what it guarantees, and its age and dollar limits

Michigan’s autism mandate has two parallel statutes: MCL 500.3406s for insurers (added by 2012 PA 100, amended by 2016 PA 276, applying to policies delivered, issued or renewed beginning 180 days after its April 18, 2012 enactment) and MCL 550.1416e for health care corporation group and nongroup certificates. Both require coverage "for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders," including behavioral health treatment such as applied behavior analysis, and bar the carrier from limiting the number of visits, from denying coverage because treatment "is educational or habilitative in nature," and from applying dollar limits, copays, deductibles or coinsurance that do not apply to physical illness generally. [4][5]

Unlike newer mandates, Michigan’s still carries age and dollar ceilings the carrier may choose to apply: coverage for treatment may be limited "through 18 years of age" and to a maximum annual benefit of $50,000 through age 6, $40,000 from 7 through 12, and $30,000 from 13 through 18. Treatment must be "prescribed or ordered" by a licensed physician or licensed psychologist who finds it medically necessary, behavioral health treatment must be "provided or supervised by a board certified behavior analyst or a licensed psychologist," and the diagnosis means assessments "including the autism diagnostic observation schedule, performed by a licensed physician or a licensed psychologist." While a member is in treatment the carrier may require a treatment plan and treatment review, request the ADOS results, request that the ADOS be repeated no more than once every three years, and request an annual development evaluation. Utilization review, medical-necessity review, network requirements and coordination of benefits still apply. Exempt: self-funded ERISA employer plans (outside state insurance law), exchange qualified health plans to the extent the coverage exceeds essential health benefits, and, under 500.3406s, short-term policies of six months or less. [4][5]

## Licensure and rates

Michigan licenses behavior analysts through LARA’s Board of Behavior Analysts under Part 182A of the Public Health Code (Michigan’s licensure law dates from 2016). A license requires current BACB certification in good standing sent directly from the BACB, a criminal background check, human-trafficking and implicit-bias training, and renews every four years; assistant behavior analysts have their own LARA license and supervision verification. Technicians are not licensed by the state. HAP does not publish ABA rates; they are contract terms. [6][7][8]

## Intake gates

The questions that decide whether a family can start with Health Alliance Plan (HAP) — Michigan, and what they have to bring.

- **Age limit** _(plan-dependent)_: HAP publishes no ABA age rule on its public site. Michigan’s mandate lets a fully insured carrier limit autism treatment coverage to members "through 18 years of age" and cap it at $50,000 a year through age 6, $40,000 for ages 7–12 and $30,000 for ages 13–18; whether a given plan uses those limits is in its certificate. Self-funded ERISA plans set their own terms. [1][4][5]
  - Ask the plan: HAP member benefits (certificate / schedule of benefits) at verification: fully insured vs. self-funded, and any mandate age-18 or annual-dollar limits.
- **Referral required?** _(plan-dependent)_: HAP’s public materials state no ABA referral rule beyond prior authorization. For a fully insured Michigan policy the mandate adds an order requirement: covered treatment is care "prescribed or ordered for an individual diagnosed with 1 of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary," and the treatment plan is developed "when the treatment of an autism spectrum disorder is first prescribed or ordered." Self-funded ERISA plans sit outside the statute. [4][1]
  - Ask the plan: HAP member benefits (HMO referral rules) and CBHM, (800) 444-5755.
- **Prior-auth decision time** _(plan-dependent)_: HAP publishes its compliance with Michigan’s prior-authorization law (Senate Bill 247, MCL 500.2212e): non-urgent requests "Will be approved in 7 calendar days if no action was taken from the date of the original submission," and urgent requests "Will be approved if no action was taken within 72 hours." Contracted providers submit through the HAP portal and non-contracted providers through the non-contracted provider link. The statute does not reach private self-funded employer plans, which follow ERISA (15 days, one 15-day extension; 72 hours urgent). [2][9][10]
  - Ask the plan: At verification confirm fully insured vs. self-funded and the HAP authorization turnaround with CBHM, (800) 444-5755.
- **Other insurance (who pays first)** _(plan-dependent)_: Which plan pays first is set by Michigan’s Coordination of Benefits Act for state-regulated plans: for a dependent child whose parents are married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan covering the parent longer); for divorced or separated parents a court order assigning health coverage controls, then the order in MCL 550.253. The autism mandate adds that a member with two policies covering autism gets benefits "subject to the limits of this section when coordinating benefits." If the child also has Michigan Medicaid, HAP pays first: Medicaid is payer of last resort and "is not liable for payment of services denied because coverage rules of the primary health insurance were not followed," so get HAP’s authorization even when Medicaid (the PIHP) will pay secondary. TRICARE pays after other coverage except Medicaid (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [11][4][12][13][14]
  - Ask the plan: Ask HAP at benefits verification for the member’s coordination-of-benefits order (HAP Coordinated Behavioral Health Management, (800) 444-5755, or the HAP provider portal); self-funded plans set their own COB terms in the plan document. Record every other coverage the child has.
- **Telehealth** _(ask the plan)_: HAP publishes no ABA telehealth rule on its public site. [1]
  - Ask the plan: HAP provider portal telehealth policy or CBHM, (800) 444-5755 — ask which ABA codes may be delivered by telehealth.

## Delivery and billing rules

Coverage decides whether Health Alliance Plan (HAP) — Michigan pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org). [1][3]
- **Daily limits / MUEs** _(licensed criteria)_: HAP publishes no ABA hour or unit limit on its public site; authorized hours come from the behavioral health review. [1][3]
  - In licensed criteria: InterQual Behavioral Health criteria via HAP’s InterQual portal (request access at InterQualReq@HAP.org), or the authorization determination.

## What intake should collect for Health Alliance Plan (HAP) — Michigan

- **HAP product and funding type:** Commercial HMO/PPO vs. HAP CareSource (Medicaid, routes to the PIHP); fully insured vs. self-funded.
- **Diagnostic evaluation with ADOS results:** The mandate lets a fully insured plan request the ADOS used in the diagnosis.
- **Physician or psychologist order:** Required for covered treatment on fully insured Michigan plans.
- **Assessment and treatment plan:** Submitted with the ABA prior-authorization request through the HAP portal.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does HAP require prior authorization for ABA?

Yes. ABA treatment is on HAP’s prior-authorization list; the detailed behavioral health list and criteria are in the provider portal.

### How fast must HAP decide?

HAP says non-urgent requests are approved if it takes no action within 7 calendar days and urgent requests within 72 hours, per Michigan’s prior-authorization law. Self-funded employer plans follow federal ERISA timelines.

### My child has HAP CareSource. Who approves ABA?

HAP CareSource is a Medicaid plan; Michigan Medicaid assigns ABA to the PIHP for the child’s county, not the health plan.

## Primary sources

1. [HAP — Prior Authorization List Summary (reviewed 07/10/2026)](https://edge.sitecorecloud.io/henryfordhe8435-hap1bde-prodac6d-83ac/media/project/hap/hap/files/hap/providers/prior-authorization-requirements.pdf)
2. [HAP — Prior Authorization Reform: What You Need to Know from Senate Bill 247](https://edge.sitecorecloud.io/henryfordhe8435-hap1bde-prodac6d-83ac/media/project/hap/hap/files/hap/providers/prior-authorization-reform.pdf)
3. [HAP — InterQual criteria access (provider login)](https://www.hap.org/providers/interqual-criteria)
4. [MCL 500.3406s — autism coverage (Insurance Code), Michigan Legislature](https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-500-3406s)
5. [MCL 550.1416e — autism coverage (Nonprofit Health Care Corporation Reform Act), Michigan Legislature](https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-550-1416e)
6. [LARA — Michigan Board of Behavior Analysts (Public Health Code Part 182A; R 338.1801–338.1835)](https://www.michigan.gov/lara/bureau-list/bpl/health/hp-lic-health-prof/behavior-analysts)
7. [LARA — Michigan Behavior Analyst Licensing Guide (rev. 1/26/2026)](https://www.michigan.gov/lara/-/media/Project/Websites/lara/bpl/Behavior-Analysts/Licensing-Info-and-Forms/Behavior-Analyst-Licensing-Guide-FAQ-12626.pdf)
8. [BACB — U.S. Licensure of Behavior Analysts](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
9. [MCL 500.2212e — prior authorization process and timelines, Michigan Legislature](https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-500-2212e)
10. [29 CFR 2560.503-1 — ERISA claims procedure](https://www.ecfr.gov/current/title-29/section-2560.503-1)
11. [MCL 550.253 — Coordination of Benefits Act, order of benefit determination](https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-550-253)
12. [Michigan Medicaid Provider Manual (July 1, 2026) — Coordination of Benefits chapter](https://www.mdch.state.mi.us/dch-medicaid/manuals/MedicaidProviderManual.pdf)
13. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
14. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.