---
title: "Arkansas Medicaid ABA coverage: the intake guide."
url: "https://carelu.com/payers/arkansas-medicaid"
markdown_url: "https://carelu.com/payers/arkansas-medicaid.md"
state: AR (Arkansas)
payer: Arkansas Medicaid
kind: State Medicaid program
description: "How Arkansas Medicaid covers ABA: an EPSDT benefit for ages 18 months to 21 under the January 2025 ABA manual, Acentra prior authorization for fee-for-service, PASSE authorization for PASSE members, PCP forms DMS-641 ER and TP, telehealth for 97155/97156 only, and published rates."
last_reviewed: October 2026
---

# Arkansas Medicaid ABA coverage: the intake guide.

_Payer Guide · Arkansas Medicaid · Last updated October 2026 · 14 primary sources_

> EPSDT ABA for ages 18 months–21: Acentra prior-authorizes fee-for-service; PASSE members go through their PASSE. Rates $15–$22.50.

Arkansas Medicaid covers applied behavior analysis as an EPSDT benefit under its own ABA Therapy provider manual, effective January 1, 2025. The beneficiary must be enrolled in Child Health Services (EPSDT) and “between eighteen (18) months and twenty-one (21) years of age,” have an autism spectrum disorder diagnosis, a PCP referral and prescription on the state’s DMS-641 forms, and a BCBA’s comprehensive evaluation showing medical necessity. Children in the Autism Waiver cannot also receive ABA therapy.

Who authorizes and pays depends on the card. Most Medicaid children are fee-for-service with a ConnectCare primary care physician, and Acentra Health, DHS’s QIO-like reviewer, handles their ABA prior authorizations. Children assessed as needing behavioral-health or developmental-disability services at Tier II or III are assigned to a PASSE (Arkansas Total Care, CareSource PASSE, Empower Healthcare Solutions or Summit Community Care), which must cover all Section II services, ABA included. Acentra says it plainly: “Beneficiaries enrolled in a PASSE must request ABA services through their assigned PASSE care coordinator.”

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes. “All behavior identification assessment services must be prior authorized” (Section II § 222.100); fee-for-service requests go to Acentra Health with form DMS-641 ER and two-prong ASD documentation. PASSE members request ABA through their PASSE care coordinator [1][8][9]
- **Prior auth for treatment**: Yes, for every ABA service (97153, 97155, 97156): “Prior authorization is required for an applied behavior analysis (ABA) therapy provider to be reimbursed” (§ 231.000). Acentra reviews the initial treatment plan and each renewal with form DMS-641 TP, after the assessment PA is approved [1][9]
- **Autism diagnosis required?**: Yes. An autism spectrum disorder diagnosis “established in accordance with Ark. Code Ann. § 20-77-124,” shown by a delineation of DSM criteria or by the results of one or more formalized ASD evaluation instruments administered by qualified professionals. A diagnosis alone does not establish medical necessity: a BCBA’s comprehensive evaluation must also show it. [1][9]

## At a glance

- **Covers ABA?:** Yes, EPSDT, ages 18 months to 21 (not ARKids First-B extended benefits; not Autism Waiver enrollees)
- **Structure:** Fee-for-service (Acentra reviews PA) or one of four PASSEs (the PASSE authorizes)
- **PCP paperwork:** DMS-641 ER evaluation referral (initial only) + DMS-641 TP treatment prescription (6 or 12 months)
- **FFS rates (per 15 min):** 97151 $20.00 · 97153 $15.00 · 97155 $22.50 · 97156 $20.00 (EP modifier; fee schedule run 1/1/25)
- **Not payable:** Group 97154 and 97158; 97152, 97157, 0362T, 0373T are not on the fee schedule
- **Telehealth:** 97155 and 97156 only; telehealth POS, no modifier
- **Licensure:** Behavior analyst registration (Act 432 of 2025); Medicaid requires BACB certification for BCBA, BCaBA and RBT
- **Timely filing:** 12 months from date of service

## Who is eligible, and who authorizes

The ABA manual limits the benefit to beneficiaries enrolled in the Child Health Services (EPSDT) program and aged 18 months to 21, with an ASD diagnosis established under Ark. Code Ann. § 20-77-124 (DSM criteria or a formalized ASD instrument given by a qualified professional). Acentra notes that “Minors on ARKids First-B are not entitled to all the extended EPSDT benefits” and that Autism Waiver enrollees “are not eligible for ABA therapy services because they receive their autism services through the waiver.” All of a child’s ABA must come from one provider: “Transitioning, alternating, or coordinating ABA therapy services concurrently among multiple ABA therapy service providers is prohibited,” though the family may still change providers. [1][8][9][6]

Fee-for-service children are reviewed by Acentra Health through its Atrezzo portal: an initial assessment request (DMS-641 ER plus the two-prong diagnosis), then a separate initial treatment request (DMS-641 TP plus the comprehensive treatment plan), then renewals. “Each PA must not be submitted until the previous PA has been approved.” PASSE members are different: the PASSE manual requires each PASSE to provide every service in the program manuals’ Section II, including EPSDT treatment, and Acentra sends PASSE families to their PASSE care coordinator. [1][8][9][6]

## The PCP forms and the BCBA evaluation

Two DHS forms carry the PCP’s part. The DMS-641 ER evaluation referral, signed by the child’s assigned Arkansas Medicaid PCP (or a substitute or same-group physician), is needed only for the initial comprehensive evaluation; a provider who takes over a child with an active prescription does not need one. The DMS-641 TP treatment prescription must be signed by the assigned PCP the first time and is valid for up to six months for children 18 months to 8 years and up to 12 months for ages 8 to 21. Acentra’s deck adds that the DMS-641 TP is valid “for a maximum of 12 months from the signature date, unless otherwise noted by the PCP.” [1][9]

Medical necessity rests on a BCBA’s comprehensive evaluation, repeated at least every six months (ages 18 months to 8) or twelve months (8 to 21). It must include history, a caregiver interview, the results of one skills-based instrument from DHS’s accepted list, a functional behavior assessment when there is interfering behavior, a domain-by-domain analysis, recommended hours with the reasoning, a recommended treatment plan and setting, and a parent home program. By signing, the BCBA certifies that ASD is the primary cause of the deficits, that only a BCBA can safely deliver or supervise the services, and that the child can learn and generalize skills. [1][9]

What a reevaluation (the renewal) must show, § 212.500 and § 222.200: the start date with the current provider and any gaps; ITP goals met, skill improvements, replacement behaviors implemented and interfering behaviors reduced since the last evaluation; any evidence of skills carrying over into natural settings; and continued medical necessity through either demonstrated progress (new skills, fewer target behaviors, or "Reducing targeted area(s) of functional deficit or delay (as demonstrated by assessment instrument scores over time)") or a list of the variables that blocked progress and how. A new DMS-641 TP is due with it; the existing prescription must expire within 60 days of the reevaluation. The manual does not require graphs. Services stop being medically necessary when the child is not progressing toward ITP goals over time, and the ITP must be updated if there has been no progress in six months. [1][9]

## Fee schedule, billing rules and claims

The Arkansas Medicaid ABA fee schedule (provider type 90, run date 1/1/25) lists four payable codes, each with the EP modifier: 97151 $20.00, 97153 $15.00, 97155 $22.50 and 97156 $20.00, per 15-minute unit. The schedule says it “reflects only procedure codes that are currently payable,” and Acentra adds that “Group services 97154 and 97158 are not reimbursable.” Medicaid pays the lower of billed charges or the maximum, and the maximum is the same for every ABA provider. [2][1][9][4][5]

The manual’s billing rules: a full unit must be rendered to bill it, partial units are not rounded up, separate periods in one day may be added together, and set-up, breaks and documentation alone are not billable. “Unless otherwise specifically provided for in this Arkansas Medicaid manual, concurrent billing is not allowed.” A group must “identify the certified practitioner as the performing provider on the claim.” Claims must reach the fiscal agent “within twelve (12) months from the date of service.” Corrections follow the same clock: adjustments go through the provider portal or form AR-004, "Requests for correction or review must be submitted to the Arkansas Medicaid fiscal agent within the 12-month timely filing deadline," and only a fiscal-agent or DMS error can be fixed after 12 months, with documentation (Section III §§ 302.510, 320.000). Remittance advices are retrieved from the provider portal or the 835; Section III publishes no check-run day or submission cut-off. EVV does not apply: Section I lists the codes subject to electronic visit verification (personal care, attendant care, respite, home health), and no ABA code is among them. [2][1][9][4][5]

## Out-of-state providers, licensure and telehealth

Providers based in Arkansas, or within 50 miles of the state line in Louisiana, Mississippi, Missouri, Oklahoma, Tennessee or Texas, may enroll as ABA providers in the usual way. A provider 50 or more miles away, or in a non-bordering state, may serve an Arkansas Medicaid child only as a limited provider under “a separate single case agreement for each Arkansas Medicaid eligible beneficiary served.” Every individual clinician, technicians included, must enroll with Arkansas Medicaid and pass the background checks in Ark. Code Ann. § 20-48-812. [1][10][11][4]

Arkansas has registered behavior analysts only since Act 432 of 2025, which protects the title “registered behavior analyst” through the Arkansas Psychology Board and allows temporary registration for short-term out-of-state practice. Medicaid’s own credential is BACB certification (BCBA, BCaBA, RBT). For telehealth, the ABA manual allows only 97155 and 97156, and Section I says a provider treating Arkansas clients by telemedicine “shall be fully licensed or certified to practice in Arkansas,” with an exception only for episodic consultation. A BCBA located in another state should confirm with Arkansas Medicaid Provider Enrollment how that rule applies to them before billing 97155 or 97156 remotely. [1][10][11][4]

## Reconsiderations and appeals

Acentra decides ABA requests within seven calendar days and reconsiderations within 30. A provider has 65 calendar days after an adverse decision to ask the reviewing agent for reconsideration, and 65 days to appeal to the Office of Medicaid Provider Appeals after the notice or the reconsideration decision; each clock “begins to run five (5) days after the date of the written notice.” A beneficiary appeal to the DHS Office of Appeals and Hearings must arrive within 30 days. Acentra issues a 65-day “Continuation of Service” approval while a family decides whether to appeal, extended if an appeal is filed. [9][4][1]

## Intake gates

The questions that decide whether a family can start with Arkansas Medicaid, and what they have to bring.

- **Age limit**: Ages 18 months to 21: the beneficiary must be enrolled in Child Health Services (EPSDT) and “between eighteen (18) months and twenty-one (21) years of age.” [1][8]
- **Diagnosis recency**: No expiry is set on the diagnosis itself. The dated clocks are the BCBA’s comprehensive reevaluation (at least every 6 months for ages 18 months to 8, every 12 months for ages 8 to 21) and the DMS-641 TP prescription (valid up to 6 or 12 months by the same age bands). A reevaluation is covered when the active prescription expires within 60 days. [1]
- **Who may diagnose**: Qualified professionals under Ark. Code Ann. § 20-77-124. Acentra lists them as a licensed psychologist (PhD, PsyD, LP, LPE, LPE-I), a licensed physician (MD, DO) or a speech-language pathologist, and also requires an MD or DO to confirm the diagnosis, either in well-child or PCP notes “documenting Autism diagnosis and how it was diagnosed” or in a letter agreeing with the evaluation. [9][1]
- **Diagnostic tools required**: Either a delineation of DSM criteria or the results of one or more formalized ASD instruments (Acentra’s examples: CARS, ADOS). The BCBA’s evaluation must also report one skills-based instrument from DHS’s accepted list; other instruments may supplement but not replace it. [1][9]
- **Referral required?**: Yes, two forms. DMS-641 ER evaluation referral from the assigned Arkansas Medicaid PCP (initial evaluation only), and a DMS-641 TP treatment prescription signed by the assigned PCP for the first course (renewals may be signed by a substitute or same-group physician). A new DMS-641 TP is not needed when the child changes PCPs; a new ER and evaluation are needed if the child loses eligibility and restarts. Who signs and how long it lasts (ABA manual §§ 212.300–212.400, eff. 1-1-25): the DMS-641 ER may be signed by the assigned PCP, a substitute physician under § 171.600, or an affiliated physician or PCP in the same Medicaid group; the initial DMS-641 TP must be signed and dated by the assigned PCP. "Unless a shorter time is specified on the treatment prescription," a prescription is valid for up to six months for a child from 18 months to 8 years old and up to 12 months from 8 to 21, by age on the prescription date. Comprehensive reevaluations need no new ER, but must fall within 60 days of an expiring DMS-641 TP. Children on a DMS-693 prescription as of January 1, 2025 keep it until it expires. Get the ER from the PCP before the initial evaluation, then the TP with the evaluation results; both forms are posted by DHS. [1][9][15][16]
- **Telehealth**: Only two ABA services may be delivered by telemedicine: adaptive behavior treatment with protocol modification (97155) and family adaptive behavior treatment (97156). “All other covered applied behavior analysis (ABA) therapy services must be conducted in-person,” so the 97151 assessment and technician 97153 are in-person only. Telemedicine must be synchronous, needs parent or guardian consent first, follows the Arkansas Telemedicine Act (Ark. Code Ann. § 17-80-401 to -407) and Section I § 105.190, and is paid the same as in person. Acentra’s training deck adds the billing detail: “no modifier required. Use telehealth place of service on claim.” Section I § 105.190 also says a provider treating Arkansas clients by telemedicine “shall be fully licensed or certified to practice in Arkansas.” [1][9][4]
- **Prior-auth decision time**: Acentra decides initial assessment, initial treatment and continued treatment requests in “Seven (7) calendar days” and reconsiderations in 30 calendar days. That matches the federal fee-for-service limit in force since January 1, 2026 (standard decisions no later than 7 calendar days, extendable by 14). Submit the assessment PA, wait for approval, then submit the treatment PA. PASSE members follow their PASSE’s clock (two business days after all information, per Section I § 192.003). [9][12][4]
- **Other insurance (who pays first)**: Medicaid pays last. Providers must bill other insurance first and record third-party payments on every claim; a $0.00 TPL entry needs the date of the primary’s denial or deductible EOB. Medicaid pays the difference between the private payment and its maximum and “will not make any payment if the amount received from the third party insurance is equal to or greater than the Medicaid allowable rate,” and the family owes no insurance cost share for a Medicaid-covered service from a Medicaid provider (Section I § 131.000; Section III; 42 CFR 433.139). [4][5][13]

## Delivery and billing rules

Coverage decides whether Arkansas Medicaid 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**: The state manual sets the floor. A BCaBA or RBT must be supervised by an Arkansas Medicaid-enrolled BCBA, who must directly observe in person at least “Five percent (5%) of the total ABA therapy treatment hours performed by the BCaBA or RBT” and at least “One (1) hour of ABA therapy treatment delivery performed by BCaBA or RBT every thirty (30) days.” Between observations the BCBA must be “on-call and immediately available” (telecommunication is enough), must review and approve the technician’s data and progress notes before any claim is submitted, and is capped at the lesser of “twelve (12) BCaBAs and RBTs at any given time” or a caseload needing no more than 25 billable hours of 97155 a week. RBTs must hold BACB certification; a trainee may be treated as an RBT for up to six months. [1]
- **Daily limits / MUEs**: Weekly, not daily. Treatment “performed during a week cannot exceed the prescribed or authorized number of units per week,” missed units “do not carryforward and cannot be made up,” and a week runs Monday through Sunday. “A single clinician cannot perform more than fifty (50) billable hours of ABA therapy treatment services per week.” A supervising BCBA may carry no more than 25 billable hours of 97155 a week across their caseload. [1]
- **Session-note signature**: Each 97153 session note needs the names, credentials and signatures of the staff who delivered it, plus “Weekly (or more frequent) progress notes signed or initialed by the supervising board-certified behavior analyst.” The supervising BCBA “must review and approve the data collection and progress notes” of each BCaBA or RBT “prior to submitting a claim.” 97155 and 97156 notes carry the BCBA’s name and signature. Electronic signatures are accepted under Ark. Code § 25-31-103. [1]
- **Place of service**: The manual sets no list of allowed settings. The evaluation and treatment plan must state the recommended setting and “how and why” it suits the child, and goals must move skills progressively from a clinic or controlled setting into the child’s natural environments. Only 97155 and 97156 may be delivered by telemedicine (telehealth POS, no modifier). School-based services by school employees are excluded from the PASSE benefit. [1][9][6]
- **Bill as provider**: A group “must identify the certified practitioner as the performing provider on the claim.” Every individual delivering ABA for a group, RBTs included, must enroll individually with Arkansas Medicaid, and 97151, 97155 and 97156 must be performed by an enrolled BCBA. [1]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Arkansas Medicaid Provider Assistance Center or DMS (the ABA manual’s policy office), or Acentra Health Provider Relations (arkansaspr@acentra.com, 888-660-3831 option 3): ask in writing whether 97153 and 97155 may be billed for the same minutes. [1]

## What intake should collect for Arkansas Medicaid

- **Which Medicaid card:** Fee-for-service (Acentra) or a PASSE (Arkansas Total Care, CareSource PASSE, Empower, Summit). PASSE members request ABA through their care coordinator.
- **Assigned PCP:** The child’s Arkansas Medicaid assigned PCP signs the DMS-641 ER referral and the first DMS-641 TP prescription.
- **Diagnosis report:** An ASD evaluation (for example CARS or ADOS) by a licensed psychologist, physician or SLP, plus the PCP’s written agreement with the diagnosis.
- **Age and program:** Ages 18 months to 21 only. Ask whether the child is in the Autism Waiver (no ABA therapy) or ARKids First-B (limited EPSDT).
- **Other insurance:** Bill the commercial plan first; Medicaid pays only up to its maximum after the primary pays.

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

## Common questions

### Does Arkansas Medicaid cover ABA therapy?

Yes, as an EPSDT benefit for children aged 18 months to 21 with an autism spectrum disorder diagnosis, under the ABA Therapy manual effective January 1, 2025. Children in the Autism Waiver get autism services through the waiver instead.

### Is ABA run by the PASSEs or fee-for-service in Arkansas?

Both, depending on the child. Fee-for-service children are prior-authorized by Acentra Health. Children in a PASSE (Arkansas Total Care, CareSource PASSE, Empower, Summit Community Care) get ABA through the PASSE, which authorizes and pays it.

### What does Arkansas Medicaid pay for ABA?

Per 15-minute unit: 97151 $20.00, 97153 $15.00, 97155 $22.50, 97156 $20.00 (EP modifier). Group codes 97154 and 97158 are not reimbursable, and 97152, 97157, 0362T and 0373T are not on the fee schedule.

### Can Arkansas Medicaid ABA be done by telehealth?

Only 97155 (BCBA protocol modification) and 97156 (family training), live video, with parent consent, billed with the telehealth place of service and no modifier. The assessment and technician sessions must be in person.

### Can a BCBA licensed in another state treat an Arkansas Medicaid child?

Providers within 50 miles of the Arkansas line in a bordering state can enroll normally; others need a single case agreement per child. For telehealth, Section I requires providers treating Arkansas clients to be “fully licensed or certified to practice in Arkansas,” so confirm with Provider Enrollment first. Arkansas’s 2025 registration law offers temporary registration for short-term practice.

### What is the timely filing limit and is EVV required?

Claims must reach the fiscal agent within 12 months of the date of service. EVV does not apply to ABA: Section I’s EVV code list covers personal care, attendant care, respite and home health only.

## Primary sources

1. [Arkansas Medicaid — Applied Behavior Analysis Therapy Provider Manual, Section II (transmittal ABATHERAPY-NEW-23, effective 1-1-25)](https://humanservices.arkansas.gov/wp-content/uploads/ABATHERAPY_II.docx)
2. [Arkansas Medicaid — Applied Behavior Analysis (ABA) Therapy Fee Schedule, Provider Type 90 (run date 1/1/25)](https://humanservices.arkansas.gov/wp-content/uploads/ABATHERAPY-fees.pdf)
3. [Arkansas DHS — Applied Behavior Analysis (ABA) Therapy provider manual page (Sections I–V, update log)](https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/billing-manuals-rate-sheets/abatherapy-prov/)
4. [Arkansas Medicaid Provider Manual, Section I — General Policy (sections updated through 7-1-26)](https://humanservices.arkansas.gov/wp-content/uploads/Section_I.docx)
5. [Arkansas Medicaid Provider Manual, Section III — Billing Procedures](https://humanservices.arkansas.gov/wp-content/uploads/Section_III.docx)
6. [Arkansas Medicaid — PASSE Program Provider Manual, Section II (latest transmittal PASSE-1-25, 7-1-26)](https://humanservices.arkansas.gov/wp-content/uploads/PASSE_II.docx)
7. [Arkansas DHS — Help choosing a PASSE (the four PASSEs, phone numbers and websites)](https://humanservices.arkansas.gov/divisions-shared-services/medical-services/healthcare-programs/passe/help-choosing-medical-plan/)
8. [Acentra Health (Arkansas DHS QIO-like reviewer) — EPSDT: Applied Behavior Analysis (ABA)](https://ar.acentra.com/applied-behavioral-analysis-aba)
9. [Acentra Health — Applied Behavior Analysis provider training deck (updated November 2025, posted 1/2026)](https://ar.acentra.com/wp-content/uploads/sites/12/2026/01/Acentra-ABA-PPT-1.2.26.pdf)
10. [Act 432 of 2025 (HB 1245) — Arkansas Behavior Analyst Registration Act, Ark. Code § 17-97-601 et seq. (enrolled text, approved 4/3/25)](https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FACTS%2F2025R%2FPublic%2FACT432.pdf)
11. [BACB — U.S. Licensure of Behavior Analysts (Arkansas: 2025, AR Psychology Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
12. [42 CFR 440.230(e) — State Medicaid agency prior-authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-B/section-440.230)
13. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
14. [Arkansas DHS Medical Services — Official Notices (index of Medicaid official notices)](https://humanservices.arkansas.gov/divisions-shared-services/medical-services/official-notices/)
15. [Arkansas Medicaid — Form DMS-641 ER, ABA Therapy Services Evaluation Referral (18 months to 21 years)](https://humanservices.arkansas.gov/wp-content/uploads/DMS-641-ER.pdf)
16. [Arkansas Medicaid — Form DMS-641 TP, ABA Therapy Services Treatment Prescription (18 months to 21 years)](https://humanservices.arkansas.gov/wp-content/uploads/DMS-641-TP.pdf)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.