CareSource PASSE is one of the four PASSEs DHS lists. Its Arkansas ABA medical policy (AR PASSE-MM-1227) and reimbursement policy (AR PASSE-PY-1616), both effective May 1, 2026, defer to the state: CareSource “follows Arkansas law and Arkansas Dept of Health and Human Services (DHS) guidelines in the provision of ABA services. Any information from those sources supersedes information in this policy.” In practice that means the state ABA manual’s forms and rules, reviewed by CareSource before each service.
Members must be enrolled in Arkansas Medicaid’s Child Health Services (EPSDT) program and be 18 months to 21. For each review CareSource must receive, “based on sections in the AR DHS ABA Provider Manual, Section II,” a qualifying diagnosis (§ 212.200 and Ark. Code Ann. § 20-77-124), a referral to evaluate (§ 212.300), a treatment prescription (§ 212.400), a comprehensive assessment (§ 212.500), and an individualized treatment plan “signed by the BCBA and parent or guardian” (§ 224.000), plus any guardianship papers. Documentation should describe the child’s own symptoms, not restate DSM language. A service that paused (summer break, a custody visit) is resubmitted as a continuation, not an initial request.[1][2][7]
Covered services are the state’s four: behavior identification assessment, ABA treatment, protocol modification and family treatment. Exclusions include rehabilitative services billed as ABA, education services under IDEA, ABA for Autism Waiver members, services by family or household members, “shadowing, para-professional, or companion services in any setting,” and programs in nonconventional settings such as wilderness camps. Treatment stops being medically necessary under the state discharge criteria or when caregivers do not follow through to the point that progress is compromised.[1][2][7]
PY-1616 repeats the state rules: fee-schedule payment at the lower of billed charges or the Arkansas Medicaid maximum, full units only, no rounding, separate periods in a day may be combined, and “Unless otherwise specifically stated in the ABA Provider Manual, concurrent billing is not allowed.” RBTs work under an independent practitioner enrolled in Medicaid and affiliated with the RBT’s organization, and RBT supervisors must hold BCBA or BCaBA certification. Supervision records must be kept at least seven years.[2][3][4]
The provider manual requires claims “within 365 calendar days of the date of service or discharge,” corrected claims within 180 days, and makes Medicaid the payer of last resort. The 2026 addendum gives providers 65 calendar days from an adverse notice to request reconsideration in writing.[2][3][4]
The questions that decide whether a family can start with CareSource PASSE, and what they have to bring. Each maps onto something intake should ask on the first call.
Ages 18 months to 21, enrolled in Arkansas Medicaid’s EPSDT program (MM-1227 § I.B).[1]
CareSource sets no diagnosis expiry and uses the state manual’s comprehensive assessment (§ 212.500), which must be repeated every 6 months for ages 18 months to 8 and every 12 months for ages 8 to 21.[1][7]
A “Qualified Professional,” which the policy defines as “A licensed physician, licensed psychologist, or licensed speech-language pathologist,” consistent with Ark. Code Ann. § 20-77-124.[1]
The policy defines standardized diagnostic tools as direct, evidence-based assessment tools and otherwise defers to the state: DSM criteria or one or more formalized ASD instruments, and a skills-based instrument from DHS’s accepted list in the BCBA’s assessment.[1][7]
Yes: “a referral to evaluate in accordance with section 212.300” (DMS-641 ER from the assigned PCP) and “a treatment prescription according to section 212.400” (DMS-641 TP). Under the state manual the treatment prescription is valid for up to six months for a child aged 18 months to 8 and up to 12 months for ages 8 to 21, unless the prescriber sets a shorter period, and both DMS-641 forms are posted by DHS.[1][7][11][12]
“Telemedicine Services are covered services and outlined by the State in section 223.000. Services must be appropriate for the individual member and not used as the primary method of treatment.” Under section 223.000 only 97155 and 97156 may be delivered by synchronous telemedicine, with parent consent.[1][7]
Coverage decides whether CareSource PASSE 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.
CareSource says supervision requirements “are published by the State of Arkansas and the BACB” and adds that “RBT supervisors must hold BCBA or BCaBA certification.” The state floor: a Medicaid-enrolled BCBA observes at least 5% of each technician’s treatment hours and one hour every 30 days, stays on call, approves notes before billing, and supervises no more than 12 BCaBAs and RBTs.[2][7]
CareSource publishes no unit cap of its own and follows the state manual: weekly units may not exceed the authorized number, missed units do not carry forward (week = Monday to Sunday), and one clinician may bill no more than 50 hours of ABA treatment a week.[2][7]
CareSource points to the state documentation rules (section 140.000 and section 203.200 of the ABA manual) and keeps the right to request therapy or supervision documentation, “particularly related to telehealth services.” The state rule: session notes carry the names, credentials and signatures of the staff, weekly progress notes are signed or initialed by the supervising BCBA, and the BCBA approves technician notes before the claim.[2][7]
No setting list. Excluded: programs in nonconventional settings (“wilderness camp, ranch programs”), shadowing, para-professional or companion services “in any setting,” and education services under IDEA. Telemedicine follows state section 223.000 and should not be the primary method of treatment.[1][2]
RBTs “may provide ABA under the supervision of an independent practitioner enrolled in the Medicaid program and affiliated with the organization under which the RBT is employed or contracted”; if that practitioner leaves, the RBT may not continue under them. The state manual requires the certified practitioner as the performing provider on group claims.[2][7]
“Unless otherwise specifically stated in the ABA Provider Manual, concurrent billing is not allowed,” defined as multiple practitioners billing for the same member in the same time increment. Neither CareSource nor the state manual says in words whether 97153 and 97155 may share minutes.[2][7]
Blocked on: CareSource PASSE Provider Services, 1-833-230-2100: ask in writing whether 97153 and 97155 may be billed for the same minutes.
Yes, for PASSE members aged 18 months to 21 with ASD, under medical policy MM-1227, which follows the Arkansas Medicaid ABA manual.
Yes. Every covered ABA service, starting with the behavior identification assessment, must be reviewed for medical necessity before it is delivered.
365 calendar days from the date of service; corrected claims within 180 days; reconsiderations within 65 calendar days of the adverse notice.
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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