---
title: Partnership HealthPlan of California ABA coverage (Medi-Cal).
url: "https://carelu.com/payers/partnership-healthplan-of-california"
markdown_url: "https://carelu.com/payers/partnership-healthplan-of-california.md"
state: CA (California)
payer: Partnership HealthPlan of California (Medi-Cal)
kind: Medicaid managed care plan (MCO)
parent_program: Medi-Cal (California Medicaid)
description: "How Partnership HealthPlan of California covers Medi-Cal Behavioral Health Treatment (ABA) across 24 northern counties — BHT reviewed in-house rather than by Carelon, TARs for assessment and treatment, the yearly release of information, the 12-month documentation rule, and 7-calendar-day decisions."
last_reviewed: September 2026
---

# Partnership HealthPlan of California ABA coverage (Medi-Cal).

_Payer Guide · Partnership HealthPlan of California · Last updated September 2026 · 10 primary sources_

> COHS for 24 northern counties; BHT reviewed in-house (not Carelon); TAR for assessment and treatment; ROI with every request.

Partnership HealthPlan of California is the County Organized Health System for 24 northern counties — from Del Norte and Humboldt down through Marin, Sonoma, Napa, Solano and Yolo, and since 2024 Butte, Placer, Nevada, Sutter, Yuba and the rest of the northern valley — with about 847,000 Medi-Cal members in August 2026. In a COHS county there is no other Medi-Cal plan to choose, so every managed-care child there is a Partnership member. Mental health is delegated to Carelon Behavioral Health, but BHT is not: Partnership’s own Health Services Department reviews every BHT Treatment Authorization Request.

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 — "A Treatment Authorization Request (TAR) will be required for all BHT services," and the BHT fax cover has a separate Assessment TAR box [1][4]
- **Prior auth for treatment**: Required — initial and reauthorization TARs with the treatment plan (and goal progress on reauth), plus the BCBA’s functional behavior assessment; plan reviewed at least every six months [1][4]
- **Autism diagnosis required?**: Policy says no ("regardless of diagnosis," with ASD, ADHD, bipolar and schizophrenia as examples) — but the TAR needs "Medical or mental health diagnosis" and the fax cover’s assessment box asks for a CDE "confirming ASD diagnosis"; some diagnosis must be on the TAR [1][4]

## At a glance

- **Plan type:** County Organized Health System — sole Medi-Cal plan in 24 northern counties
- **Who reviews BHT:** Partnership itself (Carelon handles mental health only)
- **Assessment auth:** Yes — Assessment TAR
- **Treatment auth:** Yes — initial and reauthorization TARs with the treatment plan
- **Release of information:** Signed ROI with every BHT submission; valid one calendar year
- **Submit via:** Online Services portal (preferred) or fax (707) 863-4118 with the BHT cover sheet
- **Decision clock:** 7 calendar days (up to 14); 72 hours urgent

## What goes in a Partnership BHT TAR

Policy MCUP3126 (reviewed April 8, 2026) requires a TAR for all BHT. The TAR must include the "Medical or mental health diagnosis," the "Length and severity of the condition," a history and physical "including mental status, development status and/or any form of comprehensive diagnostic testing," and "The Functional Behavioral assessment conducted by a Board Certified Behavior Analyst." A signed release of information must accompany "any BHT related clinical documentation or TAR"; it is "valid for one calendar year from the date of signature," and "Failure to do so may result in a delay of service." If the documentation is missing "OR the information is beyond twelve months, Partnership may make a one-time allowance to approve a single visit in order to fulfill TAR requirements." The BHT fax cover has three boxes — Assessment TAR (with a CDE and the ROI), Initial BHT services TAR (treatment plan), Reauthorization TAR (treatment plan with goal progress). [1][2][4]

Submission: "Electronic submission will allow for more expedient processing. If online submission is not possible, the TAR may be submitted via fax (707) 863 - 4118." Retro TARs must arrive "within fifteen (15) business days of the date of service," or within 60 calendar days of a primary insurer’s denial. [1][2][4]

## Regional Center transitions and school gaps

Partnership states it "is the primary Provider of medically necessary BHT services" and must fill gaps the school district leaves; it "must not assume that BHT services included in a Member’s IEP/IHSP/IFSP are actively being provided by the LEA." A child moving from a Regional Center automatically generates a continuity-of-care request, and continuity with an out-of-network BHT provider can run up to 12 months when the member saw that provider in the prior six months — paid at no less than "the established Medi-Cal Fee for Service (FFS) rate for the applicable BHT service." Members turning 21 get a transition plan toward community agencies or the Regional Center. [1]

## Intake gates

The questions that decide whether a family can start with Partnership HealthPlan of California (Medi-Cal), and what they have to bring.

- **Age limit**: "Be under 21 years of age" (MCUP3126); members approaching 21 get a transition plan toward providers, community agencies or the Regional Center. [1]
- **Diagnosis recency**: A soft 12-month rule: "If the above documentation is not available OR the information is beyond twelve months, Partnership may make a one-time allowance to approve a single visit in order to fulfill TAR requirements." [1]
- **Who may diagnose**: The recommendation must come from "a licensed physician, surgeon or psychologist" stating BHT is medically necessary "regardless of diagnosis"; the functional behavior assessment must be "conducted by a Board Certified Behavior Analyst." [1]
- **Diagnostic tools required**: None named — the TAR needs "any form of comprehensive diagnostic testing." UM uses the policy’s own criteria, "current clinical criteria and guidelines," and (generally) InterQual. [1][2]
- **Referral required?**: No PCP referral form is required for BHT: the TAR is "to be submitted by the provider performing these services," and the fax cover also accepts a "Referral for BHT services for review." What is required is the physician/surgeon/psychologist recommendation and the signed ROI. [3][4][1]
- **Prior-auth decision time**: MCUP3041: non-urgent pre-service decisions "within seven (7) calendar days from the receipt of the request, but no later than 14 calendar days"; urgent pre-service "within 72 hours"; a TAR lacking clinical information "may be deferred/pended up to 14 calendar days." Retro TARs within 15 business days of service. Reauthorization: the treatment plan is reviewed "no less than once every six months," and the ROI must be renewed yearly. [2][1]
- **Other insurance (who pays first)**: "The primary carrier must be billed first … A copy of the EOB or RA from the primary carrier should be attached … Partnership /Medi-Cal is always the payer of the last resort." Partnership accepts retro TARs "within 60 calendar days of a denial from the primary insurance carrier" — which means it still expects its own authorization when it ends up paying behind another plan. [6][2]
- **Telehealth** _(plan-dependent)_: Partnership’s telehealth policy lets covered CPT/HCPCS services, "subject to any existing treatment authorization requirements," be delivered by telehealth when clinically appropriate, with documented consent, POS 02/10 and modifier 95 (video) or 93 (audio-only); MCUP3126 contemplates BHT "on-site at school or during remote school sessions." No BHT-specific restriction (e.g. on technician-delivered 97153) is published. [5][1]
  - Ask the plan: Partnership Health Services (BHT TAR review) — ask on the TAR whether remote 97153 is approved for this member.

## Delivery and billing rules

Coverage decides whether Partnership HealthPlan of California (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**: "Partnership only credentials Licensed Medical Professionals or BACB® certified providers … Providers who are not licensed or BACB® certified may only provide ABA services while under the supervision of a Partnership credentialed provider," and "BCaBA providers must work under the supervision of a Partnership credentialed BCBA." No numeric supervision ratio is published. [8]
- **Daily limits / MUEs**: No caps: "Blanket limitations or restrictions on benefits and services, such as caps on number of hours, are prohibited" (MCUP3126). [1]
- **Place of service**: MCUP3126: the provider "Delivers BHT services in a home or community-based setting, including clinics," with any school-based hours "proportionate to the Member’s medical need," including on-site at school or during remote school sessions. [1]
- **Bill as provider**: BHT must be delivered by a QAS Provider, Professional or Paraprofessional meeting the State Plan; Partnership credentials BCBA, BCBA-D and BCaBA (re-credentialing every 36 months), and "Individual unlicensed ABA therapists must submit to a criminal background check by Partnership" (group-employed unlicensed staff need a background check too). Contracted rates sit in each provider’s Partnership contract; non-contracted providers are paid "the State of California Medi-Cal fee-for-service rates." [1][8][7]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in MCUP3126 or MCUP3041. Partnership’s claims manual says it "follows State of California Medi-Cal Provider Manual unless otherwise stated" — and the state BHT manual is itself silent on 97153 with 97155 in the same clock time. [11][12]
  - Ask the plan: Partnership Claims Department or provider relations — ask whether 97153 and 97155 may be billed for the same minutes.

## What intake should collect for Partnership HealthPlan of California (Medi-Cal)

- **Signed release of information:** Required with every BHT TAR or clinical document; renew yearly.
- **Recommendation + diagnosis:** Physician/psychologist recommendation and whatever diagnosis applies — the TAR needs one even though policy says "regardless of diagnosis."
- **Records under 12 months old:** H&P, diagnostic testing, the BCBA’s FBA — older records only earn a one-time single visit.
- **Regional Center history:** Transitions from an RC trigger continuity of care — capture the current provider.
- **Other coverage:** Primary insurer billed first; attach its EOB/RA.

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

## Common questions

### Does Partnership HealthPlan cover ABA?

Yes — as Behavioral Health Treatment for Medi-Cal members under 21 in its 24 northern counties, reviewed by Partnership itself (not Carelon) through Treatment Authorization Requests.

### What does Partnership need with a BHT request?

A signed release of information (valid one year), a physician/surgeon/psychologist recommendation, a diagnosis, the H&P and diagnostic testing, and a BCBA’s functional behavior assessment — records older than 12 months only earn a one-time single visit.

### How fast does Partnership decide a BHT TAR?

Within 7 calendar days of receipt (up to 14 if information is missing), and within 72 hours for urgent requests.

## Primary sources

1. [Partnership MCUP3126 — Behavioral Health Treatment (BHT) for Members Under 21 (reviewed 4/8/2026)](https://public.powerdms.com/PHC/documents/1850144)
2. [Partnership MCUP3041 — Treatment Authorization Request (TAR) Review Process (reviewed 8/12/2026)](https://public.powerdms.com/PHC/documents/1850203)
3. [Partnership MCUP3041 Attachment A — Partnership TAR Requirements (rev. 8/12/2026)](https://public.powerdms.com/PHC/documents/1850202)
4. [Partnership — Behavioral Health Therapy (BHT) Fax Cover Sheet](https://edge.sitecorecloud.io/partnershipae75-partnership4b61-production30f9-46fc/media/Project/partnership-sites/partnershiphp/files/PDF/BHTFaxCover.pdf)
5. [Partnership MCUP3113 — Telehealth Services (reviewed 2/11/2026)](https://public.powerdms.com/PHC/documents/1850086)
6. [Partnership CLPM-32 — Other Primary Coverage (9/1/2025)](https://public.powerdms.com/PHC/documents/3548960)
7. [Partnership CLPM-13 — Partnership Medi-Cal Reimbursement](https://public.powerdms.com/PHC/documents/3548941)
8. [Partnership MPCR303 — Applied Behavioral Health and SUD Provider Credentialing](https://public.powerdms.com/PHC/documents/1849967)
9. [Partnership MPBP8003 — Mental Health Services (reviewed 6/10/2026; Carelon delegation)](https://public.powerdms.com/PHC/documents/3443929)
10. [CHHS Open Data — Medi-Cal Managed Care Enrollment Report (August 2026)](https://data.chhs.ca.gov/dataset/medi-cal-managed-care-enrollment-report)
11. [Partnership — Claims Manual (Section 3 policies index)](https://www.partnershiphp.org/providers/policies/section3)
12. [Medi-Cal Provider Manual — Behavioral Health Treatment (bht), Nov 2025](https://mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=bht.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.