Cascade Health Alliance (CHA) is the OHP CCO for most of Klamath County. Its behavioral health authorization grid lists ABA for autism spectrum disorder as requiring prior authorization every six months.
CHA’s Behavioral Health Auth Grid (revision 6/24/2026) lists "Applied Behavioral Analysis (ABA) for Autism Spectrum Disorder (ASD)" as "YES," with "PA every 6 months for codes: 97151, 97152, 97153, 97154, 97155, 97156"; 97157 and 97158 are not named. The grid tells providers to check MMIS for eligibility first, and says authorization "does not guarantee reimbursement." CHA’s provider manual (revised 5/2026) sets prior-authorization decisions at "Standard: 7days" and "Urgent: 72 hours," lists the licensed assistant behavior analyst among credentialed practitioner types, and encourages use of the provider portal.[1][2]
Claims must be received "within 120 days from the date of service per OAR 410-141-3565 (1)," or within 365 days when CHA is secondary. CHA "pays or denies at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days." "CHA is always payor of last resort": bill other coverage first, attach the primary EOP, and submit within 365 days of the primary’s processing date; CHA pays the Medicaid allowable minus the primary’s payment.[1][2]
The questions that decide whether a family can start with Cascade Health Alliance, and what they have to bring. Each maps onto something intake should ask on the first call.
CHA 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 (CHA’s grid notes MD review for EPSDT members).[1][5][13]
CHA publishes no recency rule. The OHP rule dates only the physical exam and hearing test (OAR 410-172-0770(1)(h)–(i)).[1][5]
CHA 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)).[1][5][4]
CHA 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)).[1][5]
CHA adds 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)).[1][5][4]
CHA 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.[2][7][8]
Prior authorizations: "Standard: 7days," "Urgent: 72 hours"; CHA may extend a standard decision by up to 14 calendar days when the member or provider requests it.[2][9]
"CHA is always payor of last resort. Bill all prior resources (third-party liability, or TPL) before billing CHA." Include the primary EOP and file within 365 days of the primary’s processing date; CHA pays the Medicaid allowable minus the primary’s payment, and nothing more if the primary paid at least that much.[2][12]
Coverage decides whether Cascade Health Alliance 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.
CHA 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).[2][4][11]
CHA 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)).[2][6]
CHA 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)).[2][4]
Not addressed in CHA’s BH auth grid or provider manual.[1][2]
Ask the plan: CHA Provider Services, 541-883-2947.
CHA publishes no ABA unit or hour limit; authorizations run six months.[1]
Ask the plan: CHA Provider Services, 541-883-2947: ask how ABA units are set within the six-month authorization.
CHA publishes no ABA setting rule.[1]
Ask the plan: CHA Provider Services, 541-883-2947: ask which settings and place-of-service codes it pays for ABA.
Yes. Its BH auth grid requires PA every six months for 97151 through 97156, including the assessment.
120 days from the date of service, or 365 days when CHA is the secondary payer.
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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