---
title: Sunflower Health Plan ABA coverage (KanCare MCO).
url: "https://carelu.com/payers/sunflower-health-plan-kansas"
markdown_url: "https://carelu.com/payers/sunflower-health-plan-kansas.md"
state: KS (Kansas)
payer: Sunflower Health Plan (KS)
kind: Medicaid managed care plan (MCO)
parent_program: KanCare (Kansas Medicaid)
description: "How Sunflower Health Plan (Centene) administers KanCare autism services — the Autism Authorization Request Form, named assessment instruments, the 6-month diagnosis-validation rule, the Kan Be Healthy screen gate, and 6-month continuation reviews."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Sunflower Health Plan ABA coverage (KanCare MCO).

_Payer Guide · Sunflower Health Plan · Last updated September 2026 · 6 primary sources_

> Autism Auth Request Form, named assessment tools, 6-month dx rule, Kan Be Healthy screen gate.

Sunflower Health Plan, Centene's KanCare plan, administers the CCTS/IIS autism-services benefit under its own clinical policy KS.CP.01 — which mirrors the state's 50 hours/year CCTS and 25 hours/week IIS soft limits but layers real plan-specific requirements on top: a dedicated Autism Authorization Request Form, named assessment instruments, the 6-month diagnosis-validation rule, and a uniquely Kansas gate — the Kan Be Healthy (EPSDT) screen. Two of those regularly stall authorizations silently, so both belong in the first intake conversation.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — completed Autism Authorization Request Form with physician recommendation, diagnosis validated within 6 months, plus a standardized assessment and a skills-based assessment [1]
- **Prior auth for treatment**: Required — focused (10–25 h/wk) or comprehensive (25–40 h/wk) plans; 6-month continuation reviews and annual full reassessment; Kan Be Healthy screen within the past year [1][2]
- **Autism diagnosis required?** _(plan-dependent)_: Yes — ASD (F84.x per Sunflower's coding table), validated by an MD or licensed psychologist within the last 6 months; per KMAP Bulletin 26140 (eff. 11/1/2026), members 20 and under also need that diagnosis from a Kansas BSRB-licensed clinical psychologist or qualified physician using a validated tool (2-yr grace period for existing diagnoses) [1][3]
  - Ask the plan: Unresolved conflict, not a missing document: KMAP Bulletin 26140 (reissued 8/31/2026, eff. 11/1/2026) says a member diagnosed by a qualified diagnostician is eligible for ABA "without the need for a re-evaluation" and with "no time limit," while Sunflower KS.CP.01 (last reviewed 06/2019) still requires an MD or licensed psychologist to have validated the diagnosis within the last 6 months. Ask the member's MCO (Sunflower, UnitedHealthcare/Optum or Healthy Blue) which rule its UM team applies at initial authorization.

## At a glance

- **Plan type:** KanCare MCO (Centene), contracted 2025–2027
- **Prior auth:** Required — Autism Authorization Request Form + physician recommendation
- **Diagnosis recency:** ASD validated by MD/licensed psychologist within the last 6 months
- **Kan Be Healthy gate:** EPSDT screen within the past year required for Medicaid members
- **Hour tiers:** Focused 10–25 h/wk, comprehensive 25–40 h/wk; state soft limits (50 h/yr CCTS, 25 h/wk IIS) underneath
- **Review cadence:** 6-month continuations (updated skills assessment); annual full reassessment

## The authorization packet Sunflower actually wants

KS.CP.01 drives authorization off a fully completed Autism Authorization Request Form with a dated provider signature, and the packet is specific: a physician recommendation or prescription; the original autism diagnosis validated within the last 6 months by an MD or licensed psychologist; a criterion-referenced standardized assessment (Vineland-3, ADOS, CARS, ADI-R, GARS, or ASDS); and a skills-based assessment (VB-MAPP, ABLLS, AFLS, or ASRS). Treatment plans are classified focused (10–25 hours/week) or comprehensive (25–40 hours/week), against the state soft limits of 50 hours/year of CCTS and 25 hours/week of IIS — exceeding them takes additional documentation. Continuation reviews land every 6 months with an updated skills-based assessment; annual reviews require the full standardized-plus-skills battery. One caveat worth knowing: the posted policy version was last reviewed 06/2019, so confirm current requirements through the portal when stakes are high. [1][3]

A new state-level layer applies on top of that packet: KMAP Bulletin 26140, effective 11/1/2026, requires that for members 20 and under the ASD diagnosis itself come from a Kansas BSRB-licensed clinical psychologist or a qualified physician, documented against DSM criteria/severity using a validated diagnostic tool (e.g., ADOS, CARS). It doesn't replace the 6-month currency rule above — it adds a credential/tooling check on who made the diagnosis. Members already diagnosed by a non-compliant provider have a 2-year grace period. [1][3]

## The Kan Be Healthy gate — and other intake tripwires

Medicaid members must have a current Kan Be Healthy (EPSDT) screen completed within the past year by a physician, APRN, PA, or credentialed RN — and the policy is explicit that this is not the same as a well-child exam (the requirement is waived for Ambetter members). Families often need a PCP visit before ABA can be approved, which makes screen status a day-one intake question rather than a submission-day discovery. Same story for the 6-month diagnosis-validation rule: if the diagnostic report is older, plan the refresh before the auth, not after the denial. Sunflower applies this same clinical policy across its KanCare, Medicare, and Ambetter lines, with state Medicaid provisions taking precedence on conflict; submission runs through Sunflower's standard secure portal/Availity PA channels — no dedicated ABA portal is named in the policy. [1]

## Intake gates

The questions that decide whether a family can start with Sunflower Health Plan (KS), and what they have to bring.

- **Age limit**: KS.CP.01 sets no age criterion of its own — the bound comes from the benefit it administers. CCTS and IIS are State Plan services "under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions," and KMAP Bulletin 26140 fixes the diagnostician rule for "individuals aged 20 years and younger." The policy does require the treatment plan to consider "the member's age, school attendance requirements, and other daily activities" when setting hours. [1][4][3]
- **Diagnosis recency**: Sunflower's own rule is six months: "Psychological evaluation – MD or licensed psychologist has evaluated w/in last 6 months for current validation of Autism diagnosis." Read it against the posted policy's vintage and against the newer state rule: the KS.CP.01 version on the plan's site was last reviewed 06/2019, while KMAP Bulletin 26140 (reissued 8/31/2026, effective 11/1/2026) states that a member diagnosed by a qualified diagnostician is eligible for ABA "without the need for a re-evaluation... [and] no time limit on how soon they begin autism treatment." The policy itself concedes the hierarchy: "for Medicaid members, when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence." [1][3]
- **Who may diagnose**: KS.CP.01 requires the diagnosis to have been validated by an MD or a licensed psychologist. Since KMAP Bulletin 26140, for members age 20 and younger the ASD diagnosis must come from a Kansas Behavioral Sciences Regulatory Board (BSRB) licensed clinical psychologist or a qualified physician, with a multidisciplinary approach preferred. The bulletin lists the qualifying provider type/specialty codes: 11/112 Psychologist, 31/316 Family Practitioner, 31/318 General Practitioner, 31/326 Neurologist, 31/339 Psychiatrist, 31/345 General Pediatrician (Developmental), 31/349 Exempt License Physician and 31/351 Indian Health Services. A qualifying BSRB clinical psychologist needs a doctoral degree in psychology or equivalent training plus two years of supervised experience delivering BSRB-approved psychological services; qualifying physicians — developmental/behavioral pediatricians, psychiatrists, neurologists and primary care physicians — need documented additional training in ASD diagnosis, which Optum notes "may be subject to periodic audit/inquiry." [1][3]
- **Diagnostic tools required**: Sunflower wants two assessments in the packet, each from a named list: a criterion-referenced standardized assessment — "Vineland-III, ADOS, CARS, ADI-R, GARS, ASDS" — and a skills-based assessment — "VB-MAPP, ABLLS, AFLS, ASRS." Continuation reviews at six months need an updated skills-based assessment; the annual review needs the full standardized-plus-skills battery. The diagnostic evaluation must document DSM criteria and symptom severity level and must rest on "a validated ASD diagnostic assessment tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS)." Screening tools — M-CHAT, ABC, ASSQ, RITA-T, STAT — "have clinical value in recognizing children at risk of having ASD, but the diagnosis of ASD must rest on validated diagnostic tools such as those listed above." Recommended additions: a cognitive evaluation using CAT/CLAMS, MSEL or Bayley (a school district's validated cognitive testing may be used), and an adaptive measure such as ABAS or Vineland. [1][3]
- **Referral required?**: Three documents, not one. KS.CP.01 requires a "doctor recommendation of services/prescription/order to treat"; a fully completed Autism Authorization Request Form "including dated provider signature"; and a current Kan Be Healthy (EPSDT) assessment "completed by a physician, APRN, PA or credentialed RN," within the past year, which the policy states explicitly is not the same assessment as a well-child exam (the Kan Be Healthy requirement does not apply to Ambetter members). Missing the screen is the quiet reason authorizations stall. [1]
- **Prior-auth decision time**: Sunflower's 2026 manual: "For standard service authorizations, the decision and notification will be made within 7 calendar days from receipt of the request," extendable "by up to 14 additional calendar days" if the member or provider asks or Sunflower justifies needing more information. Urgent/expedited requests are decided "within 72 hours of the receipt of the request." They must come with a physician attestation of urgency and may be downgraded to routine. The clock runs from receipt, but missing clinicals "can result in a denial." The Autism Prior Authorization Request Form returns incomplete forms and says "Information older than 30 days will be considered outdated and will not be accepted for review." Timing guidance: request "at least five days prior to the scheduled service delivery date (keeping in mind a possible 7-day turnaround time)." Reauth is at least every 6 months, with an annual KAN Be Healthy recommendation. [7][8][9]
- **Other insurance (who pays first)**: "Sunflower is always the payer of last resort." Bill the other insurer first, then send Sunflower the balance with the primary EOB on paper, or line-level COB data on electronic claims. Tertiary claims go on paper with both EOBs. Pay-and-chase is limited to "preventive and prenatal services," so ABA is not included. When the primary pays, no Sunflower authorization is needed to coordinate. Sunflower will NOT pay the balance if the primary denied for "no authorization or lack of medical necessity, untimely filing and duplicate denial," so follow the commercial plan's PA rules. The practical rule: "If the primary insurer denies for non-administrative reasons, the provider would be required to obtain an authorization for any service Sunflower Health Plan would require an authorization for if we were the primary payer," and Sunflower encourages getting it up front for "Noncovered Service" and "Benefits Exhausted" denials. For ABA against a commercial plan with a cap or exclusion, get the Sunflower PA in parallel. [7][10]

## Delivery and billing rules

Coverage decides whether Sunflower Health Plan (KS) 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**: KS.CP.01 builds supervision into the hour count rather than into a ratio: focused plans run "10 – 25 hours per week including 1:1 direct and indirect, group, supervision and caregiving training," and comprehensive plans "25 - 40 hours per week inclusive of all 1:1 direct and indirect, group, supervision, and caregiver training." No supervision percentage or caseload cap is published, so the state floor governs — IIS technicians work under the direction of a BCBA or other qualified CCTS practitioner, and RBT-credentialed staff carry the BACB minimum. [1][5]
- **Daily limits / MUEs**: No per-day unit ceiling. Sunflower works in weekly tiers against the state's soft limits: focused ABA 10–25 hours per week, comprehensive 25–40, with "soft limit or no more than 50 hours per year of BCBA/Autism Specialist and no more than 25 hours per week of 1:1 support. Additional documentation will be required to exceed those soft limits." Daily intensity is explicitly individualized: "hours of therapy per day are individualized with the goal of increasing or decreasing the intensity of therapy as the member's ability to tolerate and participate permits." [1][2]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in KS.CP.01, and not published at state level either. [1]
  - Ask the plan: Sunflower provider services and Centene's payment policies on sunflowerhealthplan.com; submissions run through the standard secure portal / Availity PA channels.
- **Bill as provider** _(ask the plan)_: Not addressed in KS.CP.01. The binding rule is the state's: every group and every individual — each BCBA and each RBT — must hold their own KMAP ID before an MCO can pay, with a separate enrollment for each service location, and new hires must be KMAP-enrolled before anything can be billed under their NPI. [1][6]
  - Ask the plan: Sunflower provider services for the plan's rendering/billing convention; KMAP enrollment governs who may appear on the claim.

## What intake should collect for Sunflower Health Plan (KS)

- **Diagnosis date + diagnosing clinician:** Must be validated by an MD or licensed psychologist within the last 6 months — schedule the refresh early if it's stale.
- **Kan Be Healthy screen status:** EPSDT screen within the past year (not a well-child exam) — the silent auth-staller; route the family to their PCP if missing.
- **Physician recommendation/prescription:** Required in the Autism Authorization Request packet.
- **Assessment instruments on file:** One standardized (Vineland-3, ADOS, CARS, ADI-R, GARS, ASDS) + one skills-based (VB-MAPP, ABLLS, AFLS, ASRS).
- **Requested intensity tier:** Focused (10–25 h/wk) vs. comprehensive (25–40 h/wk); exceeding the state soft limits needs extra documentation.

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

## Verification of benefits (VOB) data

How Sunflower Health Plan (KS) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 01285
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none — KS.CP.01 describes direct PA/claims handling with no named BH administrator for ABA — inferred "none".
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97152 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97153 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS or IIS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97154 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS or IIS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97155 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97156 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97158 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |

Code notes:

- **97151:** Comprehensive assessment, now billed under CCTS. Billable under this service since the 1/1/2017 State Plan CCTS/IIS transition. Verify via: Sunflower secure portal/Availity PA channels — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.
- **97152, 97155, 97156:** Billable under this service since the 1/1/2017 State Plan CCTS/IIS transition. Verify via: Sunflower secure portal/Availity PA channels — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.
- **97153:** Originally IIS-only (technician-delivered 1:1); CCTS was also authorized to bill this code effective 7/1/2024. Billable under this service effective 7/1/2024 — a later addition to the original 1/1/2017 CCTS/IIS code set. Verify via: Sunflower secure portal/Availity PA channels — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.
- **97154, 97158:** Billable under this service effective 7/1/2024 — a later addition to the original 1/1/2017 CCTS/IIS code set. Verify via: Sunflower secure portal/Availity PA channels — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.

### Medicaid rates

Source: KMAP interactive fee-schedule lookup is the stated source of truth but is not machine-accessible (SSO wall). Last dated anchor: KMAP Bulletin 18259 set 97151 at $17.50/15-min unit effective 1/1/2019; KMAP Bulletin 19029 raised rates effective 4/1/2019 without publishing amounts; the 7/1/2022 BH increase (Bulletin 22128) explicitly excluded 9715x codes; the FY2024/2025/2026 HCBS rate bulletins (checked this pass) cover only BI/TA/I-DD HCBS waiver services and the separate HCBS Autism waiver code T2040, not State Plan CCTS/IIS. Every code below except 97151 is unverified. Effective 2019-01-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $17.50 (stale 2019 anchor — raised 4/1/2019 by an unpublished amount; current figure unverified) | 15min | — |

### Contacts

- **Provider services phone:** 1-877-644-4623 (TTY 711)
- **Hours:** Monday–Friday, 8 a.m.–5 p.m. CT for Provider Relations/Customer Service; the same toll-free number also serves as Sunflower’s 24/7 member nurse line.
- **Portal:** [Availity Essentials](https://www.availity.com)
- **Fax:** 844-824-7705 (Behavioral Health prior-authorization fax, per the plan’s Provider Quick Reference Guide)

Questions to ask on a verification call:

- Are Sunflower’s ABA unit caps, POS allowances, and telehealth modifiers the same as the state KanCare CCTS/IIS baseline, or does Sunflower apply its own limits?
- What is the current per-unit reimbursement rate for 97152 through 97158 under Sunflower’s KanCare contract?
- Does eligibility checking return real-time or batch results for payer ID 01285?
- Is ABA administered directly by Sunflower, or through a behavioral-health carve-out vendor?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/policies/clinical-policies/KS.CP.01-Applied-Behavioral-Analysis.pdf (accessed 2026-07-23)
- https://www.kmap-state-ks.us/Documents/EDI/2017-05_270-271-DXC.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/pdfs/Sunflower-QRG.pdf (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-17129.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-19029.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-18259.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-221280.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-24116.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-25122.html (accessed 2026-07-23)
- https://portal.kmap-state-ks.us/PublicPage/ProviderPricing/FeeSchedules (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does Sunflower Health Plan cover ABA therapy?

Yes — as KanCare's CCTS/IIS autism-services benefit under EPSDT, with prior authorization via the Autism Authorization Request Form, a physician recommendation, and named standardized plus skills-based assessments.

### What is the Kan Be Healthy requirement?

Sunflower requires Medicaid members to have a current Kan Be Healthy (EPSDT) screen completed within the past year by a physician, APRN, PA, or credentialed RN — explicitly not the same as a well-child exam. Missing it silently stalls the authorization.

### How recent must the autism diagnosis be for Sunflower?

Validated within the last 6 months by an MD or licensed psychologist at initial authorization — build the diagnostic refresh into intake for families with older reports. As of KMAP Bulletin 26140 (eff. 11/1/2026), members 20 and under also need that diagnosis to come from a Kansas BSRB-licensed clinical psychologist or a qualified physician using a validated diagnostic tool; existing non-compliant diagnoses get a 2-year grace period.

### How many ABA hours does Sunflower authorize?

Plans run focused (10–25 hours/week) or comprehensive (25–40 hours/week), on top of the state soft limits — 50 hours/year of CCTS and 25 hours/week of IIS — which can be exceeded with additional documentation.

## Primary sources

1. [Sunflower KS.CP.01 — Applied Behavioral Analysis (clinical policy)](https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/policies/clinical-policies/KS.CP.01-Applied-Behavioral-Analysis.pdf)
2. [KMAP Bulletin 19029 — Rate Increase for Autism Services (state CCTS/IIS limits)](https://www.sunflowerhealthplan.com/newsroom/kmap-19029.html)
3. [KMAP Bulletin 26140 — ASD diagnosis credential requirement (issued 8/12/2026; reissued 8/31/2026, eff. 11/1/2026)](https://www.sunflowerhealthplan.com/newsroom/kmap-26140.html)
4. [KMAP Bulletin 17129 — Additional State Plan Services (CCTS/IIS under EPSDT, eff. 1/1/2017)](https://www.sunflowerhealthplan.com/newsroom/kmap-17129.html)
5. [KMAP Bulletin 20147 — Autism CCTS & IIS provider qualification changes (eff. 4/3/2020)](https://www.sunflowerhealthplan.com/newsroom/kmap-20147.html)
6. [KMAP Bulletin 21013 — CCTS/IIS provider enrollment clarification](https://www.sunflowerhealthplan.com/newsroom/kmap-21013.html)
7. [Sunflower Health Plan Provider Manual (KDHE-approved Feb 27, 2026)](https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/pdfs/Sunflower_ProviderManual.pdf)
8. [Sunflower Autism (Non-Waiver) Prior Authorization Request Form (KDHE-approved 4/15/2025)](https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/pdfs/Autism-Prior-Auth.pdf)
9. [42 CFR 438.210(d) — MCO authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
10. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/section-433.139)

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.