Arkansas Total Care is one of the four PASSEs DHS lists. PASSE members get all non-excluded Medicaid services through their PASSE, ABA included, and Acentra sends PASSE families to their PASSE care coordinator. Unlike some PASSEs, Arkansas Total Care publishes its own Arkansas ABA criteria: clinical policy AR.CP.BH.104 (revised 07/26) and a documentation policy, AR.CP.BH.105.
AR.CP.BH.104 covers ABA when the member is between 18 months and 21; the services, “including the initial evaluation,” are prescribed, signed and dated by the member’s PCP or an affiliated provider in the PCP’s group, for no more than 12 months; and ASD is confirmed under current DSM criteria. A comprehensive diagnostic evaluation or re-evaluation must be from the last 12 months and must use at least one primary clinician tool (ABLLS, AFLS, EFL, VB-MAPP or Vineland-3, with ADOS-2, ADI-R, CARS-2 and others as optional supplements). The behavioral assessment behind an initial treatment request must be completed by a BCBA no more than 60 days before the authorization starts.[1]
The treatment plan must meet the Arkansas Medicaid manual’s billing requirements and justify hours by impairment and response, considering school (“less than 20 hours per week if attending school full-time”). Hours above six a day or 30 a week need documented clinical justification. Protocol modification (97155) should run “at least two hours per week or 5% of the direct service hours provided, whichever is greater” (one to two hours is acceptable under 10 hours a week), and caregiver training should ideally total at least two hours a month. If attendance falls below 80% of authorized hours, continued authorization needs supporting documentation.[1]
AR.CP.BH.105 requires session notes completed “prior to claim submission,” with exact start and end times and any pauses, location, service code, the rendering provider’s signature, and the signature and printed name of the supervising practitioner where applicable. Notes for 97155 must list the protocol modifications made or explain why none were needed, and a supervisor must deliver protocol modification one-on-one with the member at least monthly, not by telehealth “unless allowed by state guidelines.” Units not supported by documentation may be denied or recouped.[2][3]
The 2026 Provider and Billing Manual sets Medicaid authorization decisions at the lesser of two business days after obtaining all necessary information or 14 calendar days (urgent: one business day or three calendar days; retrospective: 30 days). Claims must be submitted within 365 calendar days of the date of service, or of the primary payer’s EOP when Arkansas Total Care is secondary; corrected claims, reconsiderations and disputes within 180 days.[2][3]
The questions that decide whether a family can start with Arkansas Total Care, and what they have to bring. Each maps onto something intake should ask on the first call.
Ages 18 months to 21 (“The member is between the age of 18 months and 21 years of age”).[1]
The comprehensive initial diagnostic evaluation or re-evaluation must have been conducted “within the last 12 months,” for initiation and continuation alike, and the BCBA behavioral assessment no more than 60 days before the initial treatment authorization starts.[1]
A licensed physician, psychologist, or other licensed professional with specialized training in diagnosing and treating ASD, or a provider otherwise authorized under state law to diagnose autism.[1]
At least one primary clinician tool: ABLLS-R, AFLS, EFL, VB-MAPP or Vineland-3 (or later editions), with optional supplements such as STAT, ADI-R, CARS-2, ASRS, ADOS-2, EarliPoint, RITA-T and CSBS DP-ITC. A parent or caregiver tool (M-CHAT-R/F, SCQ, SRS-2 and others) is optional. Medical causes must be ruled out.[1]
Yes. Services, including the initial evaluation, “must be prescribed by, with date and signature of the member’s primary care provider (PCP) or affiliated provider within the same group,” for no more than 12 months at a time.[1]
Arkansas Total Care tells providers to “refer to respective state allowances for telehealth services,” and its documentation policy bars the required monthly one-on-one protocol-modification visit by telehealth “unless allowed by state guidelines.” The state rule is that only 97155 and 97156 may be delivered by synchronous telemedicine, with parent consent; all other ABA services are in person.[1][2][7]
Medicaid standard requests: the lesser of two business days after obtaining all necessary information or 14 calendar days from receipt; expedited or concurrent: the lesser of one business day or three calendar days; retrospective: 30 calendar days. Section I § 192.003 sets the same two-business-day standard for PASSEs.[3][9]
When Arkansas Total Care is secondary, the claim must be received within 365 calendar days of the primary payer’s EOP, and the plan may not deny for timeliness when the delay came from reasonable efforts to determine liability. Under the PASSE manual, the PASSE handles coordination of benefits and must pay a previously denied claim if the primary later refused it for timely filing or missing prior authorization because the member did not disclose the other coverage; the provider has 90 days to resubmit with the primary’s documentation.[3][5]
Coverage decides whether Arkansas Total Care 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.
Arkansas Total Care’s criteria require 97155 (protocol modification) for “at least two hours per week or 5% of the direct service hours provided, whichever is greater” (one to two hours a week is acceptable below 10 hours of treatment), and treatment “delivered or supervised by an ABA-credentialed professional.” The state floor in the ABA manual also applies to PASSE members: a Medicaid-enrolled BCBA observes at least 5% of each technician’s hours and one hour every 30 days, and supervises no more than 12 BCaBAs and RBTs.[1][7][5]
Treatment hours should not exceed six hours a day or 30 hours a week unless clinical documentation justifies more (persistent severe behavior, escalating behavior, severe stereotypy, limited functional communication), and fewer than 20 hours a week when the child attends school full time. The plan may authorize less than requested if lower intensity is sufficient.[1]
Notes must be completed before the claim is submitted and carry the signature and printed name of the rendering clinician or technician and of the supervising practitioner where applicable; a note created on a later date must say why. Addenda must reference the original note and carry the author’s name, signature and credentials.[2]
The treatment plan must name the treatment setting with a rationale. Services covered under IDEA are not medically necessary, though ABA “can occur in coordination with school services.” Services delivered in lieu of school, respite or other community settings may be discontinued.[1]
Not addressed in the plan’s ABA policies or provider manual. The state manual bars concurrent billing “unless otherwise specifically provided for” and does not say in words whether 97153 and 97155 may share minutes.[1][3][7]
Ask the plan: Arkansas Total Care Provider Services, 1-866-282-6280, or your provider agreement.
Not stated in the plan’s ABA policies. The state manual requires a group to name the certified practitioner as the performing provider and every individual, RBTs included, to enroll with Arkansas Medicaid; ask the plan how it applies that on its claims.[1][7]
Ask the plan: Arkansas Total Care Provider Services, 1-866-282-6280: ask whose NPI goes in the rendering field for RBT-delivered 97153.
Yes, for PASSE members aged 18 months to 21 who meet its ABA policy AR.CP.BH.104: a PCP prescription, a confirmed ASD diagnosis, an evaluation from the last 12 months and a BCBA assessment.
Up to six hours a day and 30 a week without extra justification, and usually under 20 a week for a child in full-time school. More needs documented clinical need.
Within two business days of having all necessary information, or 14 calendar days from receipt if sooner; urgent requests within one business day or three calendar days.
The plan follows the state rule: only 97155 and 97156 by live telemedicine with parent consent; assessments and technician sessions are in person.
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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