---
title: Inland Empire Health Plan (IEHP) ABA coverage (Medi-Cal).
url: "https://carelu.com/payers/inland-empire-health-plan-california"
markdown_url: "https://carelu.com/payers/inland-empire-health-plan-california.md"
state: CA (California)
payer: Inland Empire Health Plan (IEHP, Medi-Cal)
kind: Medicaid managed care plan (MCO)
parent_program: Medi-Cal (California Medicaid)
description: "How Inland Empire Health Plan covers Medi-Cal Behavioral Health Treatment (ABA) in Riverside and San Bernardino counties — in-house BHT through the provider portal, no autism diagnosis required, 6-month unit requests, 2-per-10 supervision, the H-code grid (H0031 = FBA here), school services with PA, and the transition at 21."
last_reviewed: September 2026
---

# Inland Empire Health Plan (IEHP) ABA coverage (Medi-Cal).

_Payer Guide · Inland Empire Health Plan · Last updated September 2026 · 9 primary sources_

> Riverside/San Bernardino LI (1.37M); BHT in-house via portal, 6-month units, 2:10 supervision, H0031 = FBA.

Inland Empire Health Plan is the local initiative for Riverside and San Bernardino counties — 1,366,393 Medi-Cal members in August 2026, the third-largest plan in the state (Molina is the other plan in both counties). "IEHP provides and covers all medically necessary Behavioral Health Treatment (BHT) services" itself: authorizations go through IEHP Behavioral Health on its Provider Portal, not the member’s IPA, under a Behavioral Health Agreement with rates in its Attachment B. IEHP’s policy text (MC_12K3) is the 2024 version; IEHP’s 2025 summary of changes lists it as unchanged and the 2026 summary as a minor wording update.

This plan administers the **Medi-Cal (California Medicaid)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Medi-Cal (California Medicaid) guide](https://carelu.com/payers/medi-cal-california-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — "All BHT services provided by the BHT Provider under this policy require prior authorization"; the FBA is H0031, requested through the IEHP Provider Portal on a physician or psychologist’s formal request [1][2][4]
- **Prior auth for treatment**: Required — through the Provider Portal "BH Referral Request," in units for a 6-month period (hours/week × 4 × 26), with IEHP’s mandatory 6-Month and Exit Progress Report template; more hours need an addendum with a fully updated treatment plan [3][4]
- **Autism diagnosis required?**: No — "IEHP provides medically necessary Behavioral Health Treatment (BHT) services for all Members that meet criteria, even without a diagnosis of autism spectrum disorder (ASD)" [1]

## At a glance

- **Plan type:** Local initiative, Two-Plan model (Riverside, San Bernardino)
- **Who runs BHT:** IEHP Behavioral Health (not the IPA)
- **Diagnosis:** Not required — physician/surgeon/psychologist recommendation
- **Assessment auth:** Yes — H0031 FBA via the Provider Portal
- **Treatment auth:** 6-month unit requests on the portal; mandatory progress-report template
- **Supervision:** Up to 2 hours per 10 hours of direct treatment (H0032)
- **First appointment:** Initial assessment offered within 10 business days of approval

## IEHP’s BHT rules

IEHP’s evaluation criteria (UM_BH 08) need an ASD diagnosis, suspected ASD, or a determination that BHT is medically necessary; medical stability; and "a formal request from a physician or psychologist requesting BHT Services that outlines the member excesses and/or deficits of behaviors that significantly interfere with home or community activities." Everything is authorized: H0031 for the FBA, H2019 for one-to-one direct service, H0032 for supervision and parent training (no modifier for a mid-tier supervisor, HO/HP for a BCBA), H2014 for social skills groups and S5111 for multi-family caregiver groups. Requests go through the portal "BH Referral Request" in 6-month units ("# of hours per week x 4 units x 26 weeks = Qty"), and units must match the treatment plan, which must use IEHP’s "ABA (BHT) 6-Month and Exit Progress Report Template" with all 11 APL 23-010 elements. School services go in the treatment plan and are allowed "if there is prior authorization from IEHP and the school agrees," including private and charter schools. [2][1][3][4][5]

Two access rules for providers: the initial assessment appointment "must be offered within ten (10) business days of authorization being approved," and "Authorizations for BHT will not extend past the Member’s 21st birthday" — within 60 days of it the provider "must initiate the transition process to an alternative funding source (e.g., Regional Center, County Services, or Department of Rehabilitation)." Revised treatment plans are faxed to IEHP BH at 909-890-5763; Provider Call Center 909-890-2054. [2][1][3][4][5]

## Intake gates

The questions that decide whether a family can start with Inland Empire Health Plan (IEHP, Medi-Cal), and what they have to bring.

- **Age limit**: Under 21: "Authorizations for BHT will not extend past the Member’s 21st birthday," and within 60 days of it the provider "must initiate the transition process to an alternative funding source (e.g., Regional Center, County Services, or Department of Rehabilitation)." No minimum age. [1]
- **Who may diagnose**: A "licensed physician, surgeon or psychologist" (MC_12K3); UM_BH 08 says "physician or psychologist." [1][2]
- **Referral required?**: The requirement is a formal request from a physician or psychologist describing the behaviors that interfere at home or in the community; PCPs, IPAs and BH providers route it through IEHP’s portal BH web forms. No separate PCP referral route is specified for BHT. [2][1]
- **Other insurance (who pays first)**: "Medi-Cal Members with Other Health Coverage (OHC) must utilize their OHC for covered services prior to accessing their Medi-Cal benefits"; IEHP does not process claims when the eligibility record shows OHC (other than codes A or N) "unless the Provider presents proof that all sources of payment have been exhausted," and payment "will not exceed the Member’s OHC cost sharing amount." IEHP does not say whether its own BHT authorization is needed while it is secondary. (Source: IEHP’s 2024 claims chapter.) [7][13]
- **Diagnosis recency** _(plan-dependent)_: IEHP publishes no age limit on the recommendation or diagnosis (checked MC_12K3, UM_BH 08 and the 2025 BHT notices), and APL 23-010 sets none; the treatment plan must be "revised and modified every six months." [2][8]
  - Ask the plan: IEHP Provider Call Center (909-890-2054) — how recent the physician or psychologist request must be.
- **Diagnostic tools required** _(plan-dependent)_: IEHP names no required instrument; the treatment plan must include assessment "dates, scores, descriptions and assessment summaries." [3]
  - Ask the plan: IEHP Behavioral Health (909-890-2054) — whether a particular adaptive or skills instrument is expected in the FBA.
- **Telehealth** _(plan-dependent)_: IEHP publishes no BHT telehealth rule (MC_12K3’s reference to "virtual school sessions" is about the school setting); the Medi-Cal telehealth rule applies, which does not settle technician-delivered direct service by video. [1][10]
  - Ask the plan: IEHP Behavioral Health (909-890-2054) — which BHT codes it will authorize by telehealth.

## Delivery and billing rules

Coverage decides whether Inland Empire Health Plan (IEHP, Medi-Cal) 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.

- **Supervision**: "H0032 and H0032-HO/HP will be approved for up to two hours of case supervision for every 10 hours of direct treatment" (20%); more needs individualized clinical justification. The ratio applies to H2019 + H2014 combined and to H0032 + H0032-HO combined. A bachelor’s-level mid-tier supervisor needs "twelve semester units in Applied Behavior Analysis (ABA) and one year of experience"; a BCaBA can bill H0032, H2019 and H2014. [4]
- **Daily limits / MUEs**: No daily or weekly cap on direct hours. S5111 group caregiver training is at most one session a day and "may not be requested in units"; H2014 groups need two or more members; and IEHP "will not reduce the number of medically necessary BHT hours … by the hours the Member spends at school." [4][1]
- **Place of service**: Home or community-based settings, including clinics; school "if there is prior authorization from IEHP and the school agrees," including private and charter schools, with hours across settings "proportionate to the Member’s medical need for BHT services in each setting." [1][4]
- **Bill as provider**: Codes by tier: H0031 FBA; H2019 one-to-one direct; H0032 supervision (no modifier = mid-tier, HO/HP = BCBA); H2014 social skills (any level); S5111 group caregiver training. BHT is delivered by QAS providers, professionals and paraprofessionals per the State Plan; rates are in Attachment B of the Behavioral Health Agreement. IEHP publishes no NPI or PAVE rule. [3][4][1]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: IEHP’s FAQ says H2019 and H0032 "may be billed separately," a supervisor may bill H0032 without a technician present, and H0032 may be billed more than once a day with documentation for each session — but it does not say whether H0032 and H2019 may overlap in the same clock time. [4]
  - Ask the plan: IEHP Provider Call Center 909-890-2054 — whether supervision and direct service may be billed for the same minutes.
- **Session-note signature** _(ask the plan)_: IEHP publishes no note-signature rule beyond documentation for each session and required exit reports and exit letters. [4]
  - Ask the plan: Your IEHP Behavioral Health Agreement, or IEHP’s current MC_12K3 text in its C360 policy search.

## What intake should collect for Inland Empire Health Plan (IEHP, Medi-Cal)

- **Physician or psychologist request:** A formal request describing the behavioral excesses/deficits that interfere at home or in the community — no autism diagnosis needed.
- **Medical stability:** IEHP’s criteria require the child to be medically stable.
- **Signed ROI and family agreement:** The portal attests to a verified member-signed ROI and member agreement (explain exceptions in free text).
- **School plans:** School-based hours need IEHP authorization and the school’s agreement.
- **Age:** Authorizations stop at 21 — start transition planning 60 days before.

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

## Common questions

### Does IEHP cover ABA therapy?

Yes — as Behavioral Health Treatment for Medi-Cal members under 21, "even without a diagnosis of autism spectrum disorder," on a formal request from a physician or psychologist.

### How do I request ABA from IEHP?

Through the IEHP Provider Portal "BH Referral Request" — H0031 for the FBA, then 6-month unit requests for treatment on IEHP’s progress-report template.

### How much supervision does IEHP authorize?

Up to two hours of case supervision (H0032) per 10 hours of direct treatment; more needs clinical justification.

## Primary sources

1. [IEHP Medi-Cal Provider Policy MC_12K3 — Behavioral Health Treatment (2024 chapter 12)](https://www.providerservices.iehp.org/content/dam/provider-services/en/documents/providers/provider-manual/2024/medi-cal/redline/12%20-%20COORDINATION%20OF%20CARE_03-28-24_REDLINE_.pdf)
2. [IEHP UM Authorization Guideline UM_BH 08 — Behavioral Health Treatment (rev. 11/25/2024)](https://www.providerservices.iehp.org/content/dam/provider-services-rd/en/documents/providers/provider-resources/um-criteria/behavior-health/2024/20241125%20-UM_BH%2008%20-Behavioral%20Health%20Treatment%20(BHT)%20Criteria.pdf)
3. [IEHP — Behavioral Health Treatment (BHT) Reminders (notice, 3/31/2025)](https://www.providerservices.iehp.org/content/dam/provider-services-rd/en/documents/providers/plan-updates/provider_notices/2025/03---march/20250331%20-%20Behavioral%20Health%20Treatment%20(BHT)%20Reminders.pdf)
4. [IEHP — BHT Provider FAQs (notice, 9/16/2025)](https://www.providerservices.iehp.org/content/dam/provider-services-rd/en/documents/providers/plan-updates/provider_notices/2025/09---september/20250916%20-%20BHT%20Provider%20FAQ.pdf)
5. [IEHP — 2026 Medi-Cal Provider Manual Summary of Changes (11/17/2025)](https://www.providerservices.iehp.org/content/dam/provider-services-rd/en/documents/providers/provider-manual/2026/summary-of-changes/2026%20Summary%20of%20Changes_11-17-25.pdf)
6. [IEHP 2024 Medi-Cal Provider Manual — Chapter 14, Utilization Management](https://www.providerservices.iehp.org/content/dam/provider-services/en/documents/providers/provider-manual/2024/medi-cal/redline/14%20-%20UTILIZATION%20MANAGEMENT_01-01-24%20REDLINE.pdf)
7. [IEHP 2024 Medi-Cal Provider Manual — Chapter 20, Claims Processing](https://www.providerservices.iehp.org/content/dam/provider-services/en/documents/providers/provider-manual/2024/medi-cal/approved/20%20-%20CLAIMS%20PROCESSING_01-01-24%20APPROVED.pdf)
8. [DHCS APL 23-010 (Revised 11/22/2023) — BHT Coverage for Members Under 21](https://www.dhcs.ca.gov/file/apl23-010-pdf/)
9. [CHHS Open Data — Medi-Cal Managed Care Enrollment Report (August 2026)](https://data.chhs.ca.gov/dataset/medi-cal-managed-care-enrollment-report)
10. [Medi-Cal Provider Manual — Telehealth Modalities (tele mod), Nov 2025](https://mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=telemod.pdf)
11. [DHCS APL 21-011 (Revised 8/31/2022) — Grievance and Appeals Requirements](https://www.dhcs.ca.gov/file/apl21-011-pdf/)
12. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes](https://www.ecfr.gov/current/title-42/section-438.210)
13. [DHCS APL 22-027 — Cost Avoidance and Post-Payment Recovery for Other Health Coverage](https://www.dhcs.ca.gov/file/apl22-027-pdf/)

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.