ConnectiCare is Connecticut’s home-grown carrier and, in 2026, “a wholly owned subsidiary of Molina Healthcare, Inc.” It now runs three lines that work differently. Commercial members have IDs starting with “K” and stay on ConnectiCare’s existing policies, portal and payer ID 06105 through the end of 2026. Marketplace (exchange) and Medicare members follow Molina-based processes, with payer ID MLNCT for 2026 dates of service. For ABA, one thing holds across all three: “Optum Behavioral Health will continue to coordinate and manage behavioral health and substance abuse services for all our members.”
ConnectiCare’s integration notice (updated 5/12/2026) splits members by ID. For commercial members (“K” IDs), “providers should continue to follow ConnectiCare’s existing policies and processes … through the end of 2026,” and 2026 commercial claims use payer ID “06105.” Marketplace and Medicare members follow Molina-based operations from January 1, 2026: prior authorization through Availity and claims to payer ID “MLNCT.” Behavioral health is a vendor service for every line, managed by Optum (888-946-4658, providerexpress.com). ConnectiCare’s medical coverage criteria page points to Optum Behavioral Health’s clinical resources for behavioral health criteria.[1][2][3][4]
Both 2026 preauthorization lists send ABA to Optum. The commercial list (effective 1/1/2026, reviewed 6/26/2026) says “Preauthorization is obtained through OptumHealth Behavioral Solutions (OHBS) if services are provided by a Behavioral Health Provider. Call 1-800-349-5365,” and lists 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T under “ABA Therapy codes.” The Marketplace 2026 list marks 97153–97158 and 0373T PA “Y,” with the note “For services rendered by a Behavioral Health Provider, contact OptumHealth Behavioral Solutions (OHBS).” Neither list includes 97151.[1][2][3][4]
Connecticut’s autism mandate is two parallel statutes: § 38a-514b for group policies and § 38a-488b for individual policies. Each requires coverage “for the diagnosis and treatment of autism spectrum disorder,” which the law treats as an illness. Covered treatments must be medically necessary and “identified and ordered by a licensed physician, licensed psychologist or licensed clinical social worker,” following a treatment plan written by a licensed behavior analyst, physician, psychologist or licensed clinical social worker after a comprehensive evaluation or reevaluation. “Behavioral therapy,” which expressly includes applied behavior analysis, is covered when it is “Provided to children less than twenty-one years of age” and “provided or supervised by (i) a licensed behavior analyst, (ii) a licensed physician, or (iii) a licensed psychologist.” Supervision is defined as “at least one hour of face-to-face supervision” for every ten hours of behavioral therapy. From January 1, 2027, the age limit rises: Public Act 25-3 of the November 2025 special session changes the text to individuals “under twenty-six years of age.” The statute bans visit limits “on any basis other than a lack of medical necessity” and cost-sharing heavier than for other medical conditions. The 2015 amendment (June Sp. Sess. P.A. 15-5) deleted the old coverage limit, so no dollar cap remains. Two utilization-review protections help intake: outside inpatient care, the carrier may review the treatment plan “not more than once every six months” unless the treating clinician agrees or changes the plan, and “the results of a diagnosis shall be valid for a period of not less than twelve months.” Coverage can still carry the policy’s ordinary terms (coordination of benefits, network rules, limits on services by family or household members). Nothing in the statute requires a plan to pay for special education under an IEP. The mandate binds fully insured policies issued in Connecticut. Self-funded employer plans fall under ERISA instead.[6][7]
Yes. Connecticut licenses behavior analysts, and the license is required to practice. Conn. Gen. Stat. § 20-185j(a) says: “No person may practice behavior analysis unless licensed pursuant to section 20-185k or 20-185l.” Licensure began July 1, 2018 and is run by the Department of Public Health. The route is simple for a current BCBA. Under § 20-185k, DPH “shall grant a license as a behavior analyst to any applicant who furnishes evidence satisfactory to the commissioner that such applicant is certified as a behavior analyst by the Behavior Analyst Certification Board.” The application is online only and costs $350. DPH verifies the BCBA online and requires verification of every other state license you hold or have held. The license renews every year for $180, with current BACB certification and a one-time two hours of training on PTSD, suicide-risk, depression and grief screening and suicide prevention, then repeated every six years. Section 20-185l adds licensure by endorsement for people licensed in a state with substantially similar or higher requirements. Several people do not need the license (§ 20-185j(c)): a BCaBA “working under the supervision of a behavior analyst” under BACB standards; anyone who “implements an intervention based on behavior analysis under the supervision of a behavior analyst” (RBTs and technicians); students in an accredited program under direct supervision; course instructors; family members carrying out a plan; and other licensees acting within their own scope who do not call themselves behavior analysts. The license matters for payment too. The commercial mandate covers behavioral therapy only when it is provided or supervised by a licensed behavior analyst, physician or psychologist, so a BCBA without a Connecticut license cannot be the supervising clinician on a fully insured Connecticut plan.[11][12][13][14][6]
Telehealth from another state does not get around the license. Under § 19a-906(a)(12)(A), a “telehealth provider” means a provider “licensed pursuant to title 20,” the title that contains the behavior analyst chapter. A separate route let behavior analysts licensed in another state treat Connecticut patients by telehealth after registering with DPH and applying for a Connecticut license. In the 2026 Supplement that route applies only “on or before June 30, 2025.” Section 19a-906(j) lets a telehealth provider serve a patient “from any location to a patient in any location,” but only “subject to compliance with … state licensing standards.” A Connecticut agency that contracts with an out-of-state telehealth provider who has no DPH license must check that provider’s DPH registration (§ 19a-906(k)). Our reading, as of the 2026 Supplement: a BCBA must hold a Connecticut license to treat a member located in Connecticut, in person or by telehealth. We did not review 2026-session public acts. Confirm with DPH (dph.counselorsteam@ct.gov) before relying on any exception.[11][12][13][14][6]
Connecticut’s prompt-pay rule is in its unfair claim settlement statute, § 38a-816(15). An insurer must pay a claim within 60 days of receipt if filed on paper and within 20 days if filed electronically. If information is missing, it must list every deficiency within 30 days (paper) or 10 days (electronic), then pay within 30 or 10 days of receiving what it asked for. A late claim carries interest “at the rate of fifteen per cent per annum.” The statute defines “health care provider” to include anyone licensed under chapters 375 to 383c, a range that takes in licensed behavior analysts (chapter 382a). It applies to insured policies. Self-funded ERISA plans follow federal claim rules instead. ConnectiCare publishes no ABA rate table. For a public benchmark, Connecticut Medicaid’s ASD fee schedule (rates effective January 1, 2026) pays 97153 at $14.00 per 15 minutes. Commercial contracts are negotiated separately.[10][20]
The questions that decide whether a family can start with ConnectiCare (Connecticut), and what they have to bring. Each maps onto something intake should ask on the first call.
ConnectiCare requires preauthorization through Optum, not a physician referral, for ABA treatment codes. For a fully insured Connecticut plan, §§ 38a-514b(c) and 38a-488b(c) cover ABA only when it is “identified and ordered by a licensed physician, licensed psychologist or licensed clinical social worker” and follows a treatment plan by a licensed behavior analyst, physician, psychologist or LCSW. Get that order before the first request. Self-funded ERISA plans are outside the statute.[3][6]
ConnectiCare publishes no ABA age limit. For fully insured Connecticut plans, the mandate covers behavioral therapy for children under 21 today and for individuals under 26 from January 1, 2027 (Nov. Sp. Sess. P.A. 25-3). It has no dollar cap. Self-funded ERISA plans are outside the statute, so the plan’s funding type decides whether this applies.[6][7]
Ask the plan: Live benefits verification: insured vs. self-funded, then the plan’s own terms.
ConnectiCare publishes no rule. Insured Connecticut plans must treat a diagnosis as valid for at least 12 months unless the treating clinician sets a shorter period.[6]
Ask the plan: Optum for ConnectiCare, 1-800-349-5365.
ConnectiCare publishes no rule. The statute defines diagnosis as assessment by a licensed physician, psychologist or LCSW.[6]
Ask the plan: Optum for ConnectiCare, 1-800-349-5365.
ConnectiCare publishes none of its own. Optum’s ABA criteria ask for at least one validated tool (for example ADOS-2, ADI-R or CARS-2), but whether ConnectiCare plans use those criteria unchanged is not stated.[5][2]
Ask the plan: Optum for ConnectiCare, 1-800-349-5365.
ConnectiCare publishes no ABA telehealth rule. For a fully insured Connecticut plan, § 38a-526a (group; § 38a-499a for individual policies) requires coverage of care “provided through telehealth, to the extent coverage is provided for such advice, diagnosis, care or treatment when provided through in-person consultation between the insured and a health care provider licensed in the state.” A plan may not exclude a service “solely because such service is provided only through telehealth … provided telehealth is appropriate for the provision of such service,” and any utilization review must use the same criteria as for in-person care. The section’s own list of “telehealth provider” professions does not name behavior analysts (chapter 382a), so ask the carrier how it treats ABA under it. Self-funded employer plans are outside the statute.[8]
Ask the plan: Optum for ConnectiCare: ask which ABA codes it pays by telehealth and with which POS/modifier.
Depends on how the plan is funded. Fully insured Connecticut plans fall under § 38a-591d. For a non-urgent prospective or concurrent request, the carrier must decide “not later than seven calendar days after the date the health carrier receives such request.” It may extend once by up to five calendar days for circumstances beyond its control, or by up to fifteen if the clinician says the service will not start for at least three months. Retrospective requests get 30 days. Urgent requests are decided within 24 hours. A concurrent urgent request to extend a course of treatment counts only if made at least 24 hours before the current authorization ends. After a medical-necessity denial, the carrier must offer your clinician a conference with a clinical peer, who has authority to reverse the denial. Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions “not later than 15 days after receipt of the claim,” one 15-day extension, urgent care within 72 hours. ConnectiCare/Optum publishes no Connecticut-specific ABA turnaround.[9][15]
Ask the plan: At benefits verification ask whether the plan is fully insured (Connecticut-regulated) or self-funded (ERISA), and what reauthorization lead time ConnectiCare/Optum expects.
ConnectiCare is primary to Connecticut Medicaid. HUSKY Health is “the payer of last resort,” and if a member has third-party coverage “the benefits of these policies must be fully exhausted prior to claim submission” to Medicaid (42 CFR 433.139). So be in the commercial network and get its authorization as well as the Carelon BH CT authorization. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)). CHAMPVA is “the last payer” (38 CFR 17.270). Connecticut’s autism statutes let insured coverage carry the policy’s ordinary coordination-of-benefits terms (§ 38a-514b(f)). We did not read Connecticut’s coordination-of-benefits regulation, so get the order between two parents’ plans from the carriers.[16][17][18][19][6]
Ask the plan: Ask ConnectiCare at benefits verification for the member’s coordination-of-benefits order between both parents’ plans, and record every other coverage the child has (HUSKY, TRICARE, CHAMPVA).
Coverage decides whether ConnectiCare (Connecticut) 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.
ConnectiCare publishes no ABA supervision rule of its own. On insured Connecticut plans, the mandate requires behavioral therapy to be provided or supervised by a licensed behavior analyst, physician or psychologist, with at least one hour of face-to-face supervision per ten hours.[6][3]
Not addressed in ConnectiCare’s published documents.[3]
Ask the plan: Optum for ConnectiCare, 1-800-349-5365, or your Optum/ConnectiCare agreement.
No ConnectiCare ABA unit cap is published. Insured Connecticut plans may not limit visits except for lack of medical necessity.[3][6]
Ask the plan: Optum for ConnectiCare, 1-800-349-5365: ask how units are authorized and which unit edits apply.
Not addressed in ConnectiCare’s published ABA documents.[3]
Blocked on: ConnectiCare commercial provider manual (medical record review standards) or Optum for ConnectiCare.
Not addressed by ConnectiCare. Insured Connecticut plans need not pay for special education and related services under an IEP.[6]
Ask the plan: Optum for ConnectiCare, 1-800-349-5365: ask which place-of-service codes it pays for ABA.
ConnectiCare publishes no rule on whose NPI a technician’s ABA service is billed under. Commercial 2026 claims use payer ID 06105; Marketplace and Medicare use MLNCT.[1]
Ask the plan: Optum for ConnectiCare: ask whether technician services bill under the supervising BCBA and which modifiers apply.
Optum Behavioral Health, which manages behavioral health for all ConnectiCare members. The 2026 commercial list gives 1-800-349-5365 for preauthorization; the vendor contact is 888-946-4658 / providerexpress.com.
Marketplace and Medicare members do, from January 1, 2026 (Availity, payer ID MLNCT). Commercial members with “K” IDs stay on ConnectiCare’s existing policies and payer ID 06105 through the end of 2026.
97151 is on neither 2026 list, but 97152 appears among the ABA codes on the commercial list and Optum’s criteria require PA for ABA unless otherwise specified, so ask Optum before the assessment.
Yes. Conn. Gen. Stat. § 20-185j says “No person may practice behavior analysis unless licensed.” A current BCBA gets the license from DPH by showing BACB certification ($350, renewed yearly), and § 20-185l offers licensure by endorsement. RBTs, technicians and BCaBAs working under a licensed behavior analyst’s supervision do not need their own license. Telehealth into Connecticut also requires the Connecticut license: the telehealth statute (§ 19a-906) defines a telehealth provider as someone licensed under title 20, and its temporary route for out-of-state behavior analysts applied only on or before June 30, 2025 (2026 Supplement text). On a fully insured plan, the autism mandate covers behavioral therapy only when it is provided or supervised by a licensed behavior analyst, physician or psychologist.
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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