---
title: "Arkansas Total Care ABA coverage: the intake guide."
url: "https://carelu.com/payers/arkansas-total-care"
markdown_url: "https://carelu.com/payers/arkansas-total-care.md"
state: AR (Arkansas)
payer: Arkansas Total Care
kind: Medicaid managed care plan (MCO)
parent_program: Arkansas Medicaid (PASSE program)
description: "How Arkansas Total Care, a PASSE, covers ABA for Arkansas Medicaid members: its own policy AR.CP.BH.104 (revised 07/26), PCP prescription, diagnostic evaluation within 12 months, hour ceilings, documentation rules, two-business-day decisions and 365-day timely filing."
last_reviewed: October 2026
---

# Arkansas Total Care ABA coverage: the intake guide.

_Payer Guide · Arkansas Total Care · Arkansas · Last updated October 2026 · 11 primary sources_

> Centene PASSE with its own Arkansas ABA policy (AR.CP.BH.104): PCP prescription, 6 hrs/day–30 hrs/week ceiling without extra justification, 2-business-day decisions.

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.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Not for network providers. Arkansas Total Care’s Pre-Auth Check (queried October 18, 2026) returns "Pre-authorization required for non-participating providers only." for 97151 and 97152, and "This is not a covered service." for 0362T. The tool’s result is not a guarantee of payment, and the policy still lists behavioral assessment among the requests it reviews, so non-participating providers must request authorization [10][1]
- **Prior auth for treatment**: Only for non-participating providers, per the Pre-Auth Check (queried October 18, 2026): 97153, 97154, 97155, 97156 and 97158 return "Pre-authorization required for non-participating providers only.", 97157 returns "Pre-authorization required for all providers.", and 0373T is "not a covered service." AR.CP.BH.104 still sets the medical-necessity criteria for initial and continued treatment, and AR.CP.BH.105 requires that "Prior authorization approval for ABA services has been obtained, if required," so services remain subject to medical-necessity review. Re-check the tool before each new case: its answers change without notice [10][1][2]
- **Autism diagnosis required?**: Yes: a confirmed ASD diagnosis under current DSM criteria, with severity level and specifiers, “established by a licensed physician, psychologist, or other licensed professional with specialized training in diagnosis and treatment of ASD, or a provider otherwise authorized under state law to diagnose autism” (AR.CP.BH.104) [1]

## At a glance

- **Covers ABA?:** Yes, ages 18 months to 21, when medically necessary under AR.CP.BH.104
- **Prescription:** Signed and dated by the member’s PCP or a provider in the PCP’s group; up to 12 months
- **Hours:** Up to 6 hours/day and 30 hours/week without extra justification; under 20/week if in school full time
- **Decision clock:** Lesser of 2 business days after all information or 14 calendar days; urgent 1 business day or 3 days
- **Timely filing:** 365 calendar days from date of service (or from the primary EOP)
- **Provider Services:** 1-866-282-6280

## Arkansas Total Care’s ABA criteria

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]

## Documentation, claims and decisions

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]

## Intake gates

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

- **Age limit**: Ages 18 months to 21 (“The member is between the age of 18 months and 21 years of age”). [1]
- **Diagnosis recency**: 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]
- **Who may diagnose**: 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]
- **Diagnostic tools required**: 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]
- **Referral required?**: 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]
- **Telehealth**: 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]
- **Prior-auth decision time**: 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]
- **Other insurance (who pays first)**: 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]

## Delivery and billing rules

Coverage decides whether Arkansas Total Care 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**: 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]
- **Daily limits / MUEs**: 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]
- **Session-note signature**: 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]
- **Place of service**: 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]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: 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.
- **Bill as provider** _(ask the plan)_: 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.

## What intake should collect for Arkansas Total Care

- **PCP prescription:** Signed and dated by the member’s PCP or a provider in the PCP’s group, covering the initial evaluation too; no more than 12 months.
- **Diagnostic evaluation:** From the last 12 months, with severity level and at least one primary clinician tool (VB-MAPP, Vineland-3, ABLLS, AFLS or EFL).
- **School schedule:** Full-time school usually means under 20 hours a week of ABA in the plan’s criteria.
- **Other insurance:** Bill the primary first; Arkansas Total Care must receive the secondary claim within 365 days of the primary EOP.

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

## Common questions

### Does Arkansas Total Care cover ABA?

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.

### How many ABA hours will Arkansas Total Care approve?

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.

### How fast does Arkansas Total Care decide an ABA request?

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.

### Can Arkansas Total Care ABA be delivered by telehealth?

The plan follows the state rule: only 97155 and 97156 by live telemedicine with parent consent; assessments and technician sessions are in person.

## Primary sources

1. [Arkansas Total Care Clinical Policy AR.CP.BH.104 — Applied Behavior Analysis (last revised 07/26)](https://www.arkansastotalcare.com/content/dam/centene/artotalcare/policies/clinical-policies/AR.CP.BH.104.pdf)
2. [Arkansas Total Care Clinical Policy AR.CP.BH.105 — Applied Behavioral Analysis Documentation Requirements (last revised 07/26)](https://www.arkansastotalcare.com/content/dam/centene/artotalcare/policies/clinical-policies/AR.CP.BH.105.pdf)
3. [Arkansas Total Care — 2026 Provider and Billing Manual](https://www.arkansastotalcare.com/content/dam/centene/artotalcare/pdfs/508_ARTC25-H-287_2026-ARTC-Provider-Manual.pdf)
4. [Arkansas Total Care — Clinical and payment policies (index; the Pre-Auth Check tool is linked from the provider pages)](https://www.arkansastotalcare.com/providers/resources/clinical-payment-policies.html)
5. [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)
6. [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/)
7. [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)
8. [Acentra Health (Arkansas DHS QIO-like reviewer) — EPSDT: Applied Behavior Analysis (ABA)](https://ar.acentra.com/applied-behavioral-analysis-aba)
9. [Arkansas Medicaid Provider Manual, Section I — General Policy (sections updated through 7-1-26)](https://humanservices.arkansas.gov/wp-content/uploads/Section_I.docx)
10. [Arkansas Total Care — Pre-Auth Check tool (Medicaid/PASSE; queried 2026-10-18 through the tool’s JSON endpoint)](https://www.arkansastotalcare.com/providers/resources/pre-auth.html)
11. [Arkansas Total Care — Provider news (provider notices archive)](https://www.arkansastotalcare.com/providers/providernews.html)

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.