A family saying "we have Select Health" in Utah could mean two structurally different things, and getting it right changes where the ABA request goes. SelectHealth Community Care is one of Utah Medicaid's four ACOs (alongside Health Choice Utah, Healthy U, and Molina) — and Utah Medicaid carves ABA out of every ACO to state fee-for-service, so a Community Care member's ABA request never touches Select Health at all; it goes straight to Utah Medicaid, exactly as our Utah Medicaid guide describes. Select Health also separately sells commercial insurance — employer group and individual/marketplace plans, branded simply "Select Health" — and for those members, Select Health runs its own ABA clinical policy, its own prior-authorization form, and its own utilization-management team. Select Health (the parent brand) is a wholly owned subsidiary of Intermountain Health. This guide covers both paths.
Select Health's own Medicaid Provider Summary describes SelectHealth Community Care as one of three government/managed products it runs alongside Select Health Medicare and Select Health Share, "available to eligible members living in all Utah counties." Its Provider Reference Manual separately defines a "Fee-For-Service Medicaid member" as anyone whose needed service is covered by Medicaid rather than the ACO plan — the same carve-out mechanism our Utah Medicaid guide documents for all four ACOs — and its Appendix B for Community Care states plainly that "Select Health Community Care policies typically align with State of Utah Medicaid policy." Select Health's own published carved-out-services list names mental-health medications, emergency transportation, long-term care, apnea monitors, and dental — it doesn't explicitly name ABA/autism services, so treat the FFS routing as inherited from Utah Medicaid's own carve-out policy (already verified in our Utah Medicaid guide) rather than a Select Health-authored statement. Either way, the operational answer for intake is the same: for a Community Care member, don't call Select Health for ABA — go straight to Utah Medicaid.[1][2][3]
For employer-group, self-funded, and individual/marketplace members, Select Health runs its own numbered medical policy — Policy #630, "Applied Behavior Analysis (ABA)" — which Select Health's February 2026 Policy Update Bulletin confirms was revised effective January 1, 2026 (the bulletin describes reorganized medical-necessity criteria and removal of an FEHB-plan exception, but the policy PDF itself returned a maintenance error at every attempt during this review — treat specific diagnostic or hour-based criteria as unverified until confirmed directly with Select Health). What is independently confirmed from Select Health's own live 2026 ABA Preauthorization Form: it distinguishes an initial request (diagnostic evaluation report required) from a concurrent/continuation request (updated treatment plan with progress data required), and Utah decisions on commercial plans are due within 14 days absent expedited review. The form also collects a detailed weekly ABA schedule (day, time, setting — office/home/other), school and other-therapy schedules, and IEP/ISP/504/ARD status — build that into your intake packet before submitting.[4][5]
Select Health's ABA Preauthorization Form routes requests by email, split cleanly by line of business: commercial (large/small employer, self-funded, individual) goes to commercialUMintake@imail.org (fax 801-442-0825); Select Health Community Care (Medicaid/CHIP) goes to medicaidUMintake@imail.org (fax 801-442-0625) — relevant only for the non-ABA services Community Care still administers, since ABA itself routes to Utah Medicaid, not this address; Select Health Medicare goes to medicareUMintake@imail.org (fax 801-442-0302), with a 14-day decision window across all states. Select Health also runs an online "Preauth & Care Plan Tool," where some requests qualify for auto-approval, and a general 24/7 preauthorization help desk at 800-442-4566. General provider support for commercial plans runs through 800-222-6358.[5][6]
Utah Code § 31A-22-642 requires ASD diagnosis-and-treatment coverage in the individual and large-group markets — small-group plans are not named by the statute. Select Health's own ABA Preauthorization Form lists "Commercial Plans (Large/Small Employer, Self-Funded, Ind.)" as a single routing category, meaning Select Health's ABA intake process is unified across market segments even though the mandate's protections (no age limit, no hour cap for plans entered or renewed since 1/1/2020) legally apply only to individual and large-group business — small-group and self-funded ERISA plans sit outside the mandate. We found no Select Health page that discusses mandate compliance or breaks out market segment explicitly, so confirm a given member's market segment (individual, small-group, large-group, or self-funded) as part of benefits verification rather than assuming mandate protections apply. Also worth knowing: starting before July 1, 2027, Utah requires every health benefit plan — Select Health included — to publicly report autism-assessment wait times, PA practices, and average ABA hours/cost to the Insurance Department annually.[7][5]
No Select Health-specific ABA fee schedule (commercial or Community Care) was found published. For Community Care members, ABA rides Utah Medicaid FFS entirely, so the relevant benchmark is Utah Medicaid's own published PRISM rates ($19.67 per 15-minute unit on 97153; $37.51 on 97151/97155/97156, effective 7/1/2026) — not a Select Health rate at all. For commercial members, rates are contract-negotiated and live in your participating-provider agreement.[8]
The questions that decide whether a family can start with Select Health (Utah), and what they have to bring. Each maps onto something intake should ask on the first call.
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the diagnosis may be rendered by any clinician authorized under the scope of their licensure and trained in the use and interpretation of the selected assessment tool. For commercial members the Utah mandate's definition is narrower and stricter: a board-certified neurologist, psychiatrist or pediatrician with ASD experience, or an experienced licensed psychologist.[9][11][7]
Commercial members: Select Health's own 2026 ABA Preauthorization Form sets the clock — "Once Select Health receives this form, we have the following decision time frames to make a benefit determination (unless an expedited review is requested): For Commercial Plans: 14 days (Utah)." Expedited review is available only if the standard time frame could seriously jeopardize life, health or the ability to regain maximum function, or leave severe pain unmanaged. Utah requires fully insured plans' adverse-determination procedures to comply with 29 CFR 2560.503-1, which caps an urgent pre-service decision at 72 hours after receipt. From January 1, 2027 Utah Code 31A-22-650 (SB 319, 2026) tightens insurers to "no later than seven calendar days after the day on which the insurer receives all necessary information," and 72 hours for urgent care. Select Health separately distinguishes an initial request (diagnostic evaluation report) from a concurrent request (updated treatment plan with progress data). Community Care (Medicaid) members: the plan's manual gives 14 calendar days standard and 72 hours urgent for its own preauthorizations, but this guide records ABA as routing to Utah Medicaid fee-for-service, where the state's clock applies instead.[5][2][12][13][14]
Ask the plan: Select Health Health Services, 800-442-5305: the reauthorization lead time for ABA concurrent requests, which neither the form nor the manual states.
Commercial members follow the standard order in Select Health's manual, which tracks Utah's COB rule. For a child on both parents' plans, "The benefits of the plan of the parent whose birthday falls earlier in the calendar year are determined before those of the plan of the parent whose birthday falls later in the year" (month and day only; same birthday goes to the plan that covered the parent longer). Divorced or separated parents: a court decree naming the responsible parent controls; joint custody without one uses the birthday rule. "Because of the government's role in subsidizing care for members enrolled in CHAMPUS/TRICARE and MEDICAID, these policies are always considered secondary to another plan" — so Select Health commercial pays before a child's Medicaid or TRICARE. When Select Health is secondary, the COB information must reach it "within 12 months after the claim was processed by the primary plan." Community Care (Medicaid) members: Medicaid is payer of last resort; for ABA routed to fee-for-service, Utah Medicaid's own TPL rules apply (other coverage exhausted first, 6-month transition to an in-network provider).[2][15][9]
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — no upper age limit, PRISM showing ages 1 and older including adult plans. For Select Health commercial members, the Utah mandate sets the floor where it applies: Utah Code § 31A-22-642 imposes no age limit on individual and large-group plans entered or renewed since 1/1/2020, but small-group plans are not named by the statute and self-funded ERISA plans are exempt.[8][10][7]
Ask the plan: A live benefits verification of the member's market segment (individual, small-group, large-group or self-funded) — the mandate's protections do not reach small-group or self-funded business.
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — an order or prescription for ABA from a licensed clinician authorized to prescribe it is required in the initial packet and renewed annually. For commercial members, Select Health requires preauthorization on its own ABA Preauthorization Form (commercialUMintake@imail.org, fax 801-442-0825), with Utah decisions due within 14 days absent expedited review; no separate physician referral requirement is published.[9][5]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — telehealth covers supervision and parent training but not technician-delivered 97153/97154 or QHP-delivered group 97158, synchronous only, POS 02. For commercial members the form collects a weekly ABA schedule by setting (office, home, other) rather than stating a telehealth rule.[9][11][5]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
No recency window is published on either side. Utah Medicaid states none (see our Utah Medicaid guide), and Select Health's commercial ABA Preauthorization Form distinguishes an initial request, which requires the diagnostic evaluation report, from a concurrent request, which requires an updated treatment plan with progress data — without dating the diagnosis.[5][9]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — no specific instrument is mandated, but the DSM-5 determination must rest on evidence-based standardized measures and the completed tool accompanies the initial PA. For commercial members, Select Health's ABA Preauthorization Form requires the diagnostic evaluation report on an initial request; the instrument criteria inside Policy #630 could not be retrieved.[9][5]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
Coverage decides whether Select Health (Utah) pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — limits are set per 26-week authorization period, not per day (97153 up to 780 hours; 97155 plus H0032 capped at 84 combined hours). On the commercial side the Utah mandate removed hour caps for individual and large-group plans entered or renewed since 1/1/2020 — the 600-hours-a-year floor survives only on legacy pre-2020 plans — but small-group and self-funded plans sit outside the statute.[9][7]
Ask the plan: A live benefits verification — annual maximums and any plan-level hour limits are plan-specific, and Policy #630 could not be retrieved.
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — home, community and clinic settings are payable across the same day, while IEP-listed school services route to the School-Based Skills Development benefit instead. For commercial members, Select Health's ABA Preauthorization Form collects a full weekly schedule by setting (office, home, other) plus school and other-therapy schedules and IEP/ISP/504/ARD status, which is how setting is actually adjudicated.[9][5]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the QHP must supervise at least 10% of technician or assistant-analyst direct-service time, at least half of it direct supervision. No Select Health commercial supervision standard is publicly retrievable.[9][11]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — 97155 contemplates the QHP simultaneously directing a technician with the member present, while a behavior analyst personally delivering 97153/97154 may not also bill analyst-level services. No Select Health commercial concurrent-billing rule is publicly retrievable.[9][11]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the treatment plan must carry the name and signature of the QHP who conducted the assessment and developed it, with an attestation of medical necessity. No Select Health commercial documentation or signature standard is publicly retrievable.[9][11]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — technicians and assistant analysts work under a QHP who is responsible for all work performed, with credential modifiers (HP, HO, HN) on supervision codes and group-size modifiers on group codes; enrolment runs through state PRISM, not Select Health. No Select Health commercial claim-attribution rule is publicly retrievable.[9][11]
Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
Depends which Select Health. SelectHealth Community Care (the Medicaid ACO) never administers ABA — it rides Utah Medicaid's fee-for-service carve-out. Select Health commercial (employer/individual) plans cover ABA under the plan's own Policy #630, with prior authorization required.
To Utah Medicaid directly, not to Select Health. ABA is carved out of all four Utah Medicaid ACOs (including SelectHealth Community Care) to state fee-for-service — see our Utah Medicaid guide.
Select Health's ABA Preauthorization Form, emailed to commercialUMintake@imail.org (fax 801-442-0825 as backup). Decisions on Utah commercial plans are due within 14 days.
No published fee schedule exists for either product. Community Care members' ABA is paid at Utah Medicaid's own PRISM rates (not a Select Health rate); commercial rates are negotiated in your participating-provider agreement.
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.
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