AllCare CCO serves OHP members in Curry, Jackson and Josephine counties and two southern Douglas County ZIP codes. Its public site publishes no ABA policy, prior-authorization list or provider manual we could find, so the OHP rules carry most of this guide. What AllCare does publish is its behavioral health directed-payment notice, which commits to paying ABA at least the OHA fee-for-service rate.
AllCare’s behavioral health directed-payment notice (2025 guidance) says OHA’s minimum fee schedule directed payment "will require BH providers in A&D Residential, Applied Behavior Analysis, MH Children’s Wraparound to be paid at least the FFS State Plan fee schedule rate," and that ABA is among the services eligible for the culturally and linguistically specific services add-on (22% of the OHP fee schedule for non-rural and 27% for rural qualifying providers). OHA’s fee-for-service behavioral health fee schedule (update published 7/1/2026) pays, per 15-minute unit: 97151 $20.85, 97152 $19.81, 97153 $14.70, 97154 $13.72, 97155 $32.07, 97156 $32.07 and 97157 $8.68 (rates effective 7/1/2024). 97158, 0362T and 0373T do not appear on the schedule.[2][8][3][5][14][9][1]
We found no AllCare ABA policy, PA list or provider manual on its public site, so the OHP rules apply: the OAR 410-172-0770 evaluation and referral, Guideline Note 75, CCO authorization notice within 7 calendar days (OAR 410-141-3835), and claims within 120 days of the date of service (OAR 410-141-3565). Ask AllCare which ABA codes need authorization before you start.[2][8][3][5][14][9][1]
OHA’s managed-care billing rule binds every CCO, AllCare CCO included (OAR 410-141-3565, effective January 1, 2025). Initial claims are due "within no more than 120 days of the date of service," or within 365 days for pregnancy, retroactive eligibility, Medicare as primary payer, third-party liability and other delays not caused by the provider; a CCO "may negotiate terms within this timeframe," so your contract can set a shorter limit but not a longer one. For a timely claim that needs correction or resubmission, the CCO must allow "a minimum of 180 days after the initial adjudication date." Other insurance "must be exhausted prior to payment." On payment, CCOs "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt," make an initial determination on 99 percent within 60 days, and "may not require providers to delay claims submission." The rule sets no weekly payment cycle or submission cutoff.[1]
The questions that decide whether a family can start with AllCare CCO, and what they have to bring. Each maps onto something intake should ask on the first call.
AllCare publishes no age limit. OHP rules require ABA beyond Guideline Note 75 when medically appropriate "including individuals age 13 and older," and under 21 EPSDT bars age-group-wide denials.[5][13]
No AllCare rule. The OHP rule dates only the physical exam and hearing test (OAR 410-172-0770(1)(h)–(i)).[5]
AllCare publishes nothing different, so the OHP rule applies: a physician, psychologist, or developmental-medicine NP or PA experienced in autism (OAR 410-172-0770(1), 0760(1)).[5][4]
AllCare publishes nothing different, so the OHP rule applies: a standardized, validated tool such as the ADOS plus developmental status such as the Vineland (OAR 410-172-0770(1)(b), (g)).[5]
AllCare publishes no referral rule of its own, so the OHP rule applies. Yes. Before services, OAR 410-172-0770(1)(k) requires "A referral for ABA treatment with or without specification of hours or intensity" that includes the diagnosis and a copy of the evaluation, from a physician, psychologist, or nurse practitioner or physician associate specializing in developmental medicine who has experience diagnosing and treating autism (OAR 410-172-0760(1)).[5][4]
AllCare publishes no ABA telehealth rule of its own. The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification.[7][8]
AllCare publishes no ABA clock, so the CCO rule applies: notice "no later than seven (7) calendar days following receipt," expedited within 72 hours, one 14-day extension (OAR 410-141-3835).[9]
AllCare publishes nothing ABA-specific, so the state rule applies. Medicaid pays last. OHA must be "the payer of last resort," and "Providers shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). Bill the commercial plan first and follow its authorization rules.[12][16]
Coverage decides whether AllCare CCO 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.
AllCare publishes no ABA supervision rule, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005).[4][11][15]
AllCare publishes no ABA session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)).[6]
AllCare publishes no ABA rendering-provider rule. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)).[4]
Not published by AllCare; OHA publishes no rule either.[2]
Ask the plan: AllCare CCO provider services (888-460-0185) or your AllCare contract.
Not published by AllCare; OHA’s fee schedule sets no ABA unit maximum.[8]
Ask the plan: AllCare CCO utilization management (888-460-0185): ask how ABA units are authorized.
Not published by AllCare.[2]
Ask the plan: AllCare CCO provider services: ask which settings and place-of-service codes it pays for ABA.
Yes, as an OHP CCO it covers ABA under OHP rules, and it commits to paying ABA providers at least the OHA fee-for-service rate. It publishes no ABA-specific policy, so ask AllCare about authorization before starting.
At least the OHA fee-for-service State Plan rate under OHA’s directed payment; for example 97153 at $14.70 per 15 minutes on the July 2026 schedule.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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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