Connecticut is one of the few states with no Medicaid managed care plans. HUSKY Health is a self-insured, managed fee-for-service program. The state pays claims through its fiscal agent, Gainwell Technologies, and contracts with administrative services organizations to run utilization management. For behavioral health, including autism services, that organization is Carelon Behavioral Health of Connecticut, acting for the Connecticut Behavioral Health Partnership of DSS, DCF and DMHAS. There is no plan to pick from the card. Every HUSKY child with ASD goes through the same rules, the same authorization portal and the same fee schedule.
Connecticut calls the benefit “Autism Spectrum Disorder (ASD) services”: a comprehensive diagnostic evaluation, a behavior assessment, a behavioral plan of care, and treatment. ABA is the main treatment. The services cover members under 21 on HUSKY A, C and D, and since October 1, 2025 HUSKY B too. Connecticut bills ABA with a mix of HCPCS and CPT codes (H0031, H0032, 97153, H2014, H0046, 97156, 97158, T1016), not the full 97151–97158 set, so build your billing setup around the state’s grid.
DSS describes HUSKY Health as “a self-insured, managed fee-for-service approach,” unlike the capitated managed care most states use. Carelon’s March 2026 briefing to the legislature’s oversight council puts it the same way: “CT Medicaid is a fee-for-service model.” DCF, DMHAS and DSS “jointly contract with and manage Carelon Behavioral Health as the Administrative Services Organization (ASO),” which it has been since 2006. The provider handbook (revised 6/2026) says the partnership covers “adults, children and families enrolled in HUSKY A, B, C, D, and DCF Limited Benefit programs, including those with other insurance.” In practice the work is split. DSS and Gainwell handle enrollment and claims. Carelon BH CT qualifies ASD providers, authorizes services through ProviderConnect, and runs ASD care coordination for families. Claims go to Gainwell, not to Carelon.[1][2][3][7][19][6]
HUSKY B (Connecticut’s CHIP) was added on October 1, 2025: “all ASD services covered under HUSKY A, C, and D are now also covered under HUSKY B.” Carelon could take HUSKY B requests from February 2026 and accepted retroactive requests back to October 1, 2025. The parent-training and case-management codes added for HUSKY B “are not subject to HUSKY B cost sharing.”[1][2][3][7][19][6]
Carelon’s ASD Services Grid (8/13/2025) lists the Connecticut codes. 90791-U5 is the comprehensive diagnostic evaluation (with -52 and -22 for shorter and longer encounters). H0031 is the behavior assessment (1 unit = 1 hour, up to 10 units over 6 months initially and up to 6 for reassessment). H0032 is treatment plan development (1 untimed unit per 6 months), and H0032-TS is program book development (3 untimed units per 6 months). 97153 is service delivery by a BCaBA or behavior technician, and H2014 is service delivery by a BCBA or clinician, both in 15-minute units, with hours set by medical necessity. H0046 is observation and direction. 97158 is group treatment. 97156 is parent training without the child, and 97156-U2 with the child, 4 units a week. T1016 is case management, such as attending PPT meetings: 96 units a year without prior authorization, then authorization from unit 97. Treatment authorizations run up to 90 days initially and up to 6 months after that.[11][5][6][9][10][8][4]
The ASD fee schedule lists these rates effective January 1, 2026, after the rate increase in PB 2026-06: 97153 $14.00 (was $12.17); H2014 $15.24; H0031 $87.98; H0032 $87.98; H0032-TS $60.70; H0046 $22.00; 97158 $3.08. Rate type ASK, used for members 20 and under, adds 97156 at $21.20 (from 7/1/2025) and T1016 at $11.33. Every code except T1016 is flagged PA “Y.” DSS pays the lowest of the fee schedule, the Medicare rate, the billed amount, your usual and customary charge, or your lowest price to anyone else, so bill your usual and customary charge.[11][5][6][9][10][8][4]
Performing providers (BCBAs, physicians, APRNs, PAs, psychologists, LCSWs, LPCs and LMFTs) must enroll in Medicaid and supervise and take “full professional responsibility for all ASD treatment services.” Only the billing provider is paid: “No BCaBA or technician may bill or receive payment from the department for ASD services.” Enrollment alone is not enough. DSS says Carelon BH CT must qualify every ASD provider first: “holding a behavioral health license in the state of Connecticut does not, by itself, qualify a clinician to provide services for individuals with ASD.” Qualification takes a DCF background-check release, a letter of intent, a CV showing years of direct ASD experience, a diploma, the current license (and BCBA certificate if applicable), two sample behavior support plans with functional assessments, and liability insurance of at least $500,000 per occurrence and $1.5 million aggregate if an agency policy does not cover you. BCBAs requalify every two years. Gainwell’s enrollment then takes 4–8 weeks. An out-of-state provider counts as a border provider only if their home residence is within 45 minutes of the Connecticut line.[4][7][17][3][16]
Technicians hired from July 1, 2025 need one of: BCaBA plus 6 months of full-time-equivalent ASD experience; RBT plus 6 months; a bachelor’s in a related field plus 6 months; an associate’s in a related field plus 6 months; or a high school diploma plus the RBT. Anyone without the experience or a related degree must finish the 40-hour RBT training within 180 days of hire and pass the RBT competency assessment within a year. Every technician needs 6 hours of ASD training a year, documented in the employee record.[4][7][17][3][16]
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.[22][23][28][24][20][17]
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. For HUSKY specifically, DSS is explicit. An in-state Medicaid provider that contracts with out-of-state practitioners for telehealth must be able to provide in-person care when needed, and “the out-of-state practitioner must hold an active CT license.” Out-of-state practitioners not contracted with an in-state Medicaid provider cannot enroll to bill telehealth, except under 42 CFR 431.52.[22][23][28][24][20][17]
The questions that decide whether a family can start with Connecticut Medicaid (HUSKY Health), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. ASD services are for “Medicaid enrolled members (HUSKY A, B, C, or D) under the age of 21.” ASD care coordination, which helps families find services, is open to HUSKY members of any age.[14][4][3]
The treatment request must include a comprehensive diagnostic evaluation from the past 12 months. If it is older, a letter confirming the ASD diagnosis from a current treating licensed provider, dated within 12 months, is required. The other documents have their own windows: medical evaluation within 12 months, behavior assessment within 6 months, behavioral plan of care within 120 days of the request. The 2015 regulation allowed a 36-month window for the diagnostic evaluation, but Carelon’s current guideline and 2026 alerts apply 12.[14][12][19][4]
Independently licensed practitioners only: psychiatrists, neurologists, pediatricians, psychologists, APRNs, LCSWs, LPCs or LMFTs working within their scope with ASD evaluation experience (Carelon’s grid also lists PAs). “Evaluations completed by provisionally licensed clinicians (LMSW, LPCA, LMFTA), Board Certified Behavior Analysts (BCBAs), or other unlicensed professionals do not meet requirements, even if co-signed by a licensed professional.”[18][11][12]
The comprehensive diagnostic evaluation must be a full neurodevelopmental review of cognitive, behavioral, emotional, adaptive and social functioning using “Validated assessment tools, such as the ADOS, CARS, or GARS,” with a summary of findings and DSM-5-TR alignment. It must also review a medical evaluation from the past 12 months. The behavior assessment must measure current functioning with a validated instrument.[18][12][13]
Yes, in substance. A licensed diagnostic practitioner must recommend the services: the behavior assessment “must be recommended by an independently licensed diagnostic practitioner,” and requests must document that recommendation, which a signed diagnostic evaluation recommending the services satisfies. The medical evaluation must come from a physician, APRN or PA within 12 months. EPSDT special-services requests need a prescription from a licensed diagnostic practitioner.[13][4]
Limited, and in person is the expectation. ASD services may be delivered by synchronous audio-video telehealth “only for procedure codes permitted in the CMAP Telehealth Table.” That table (12-26-25) lists 90791, H0031, H0046, H2014 and 97153 as telemedicine codes and T1016 as telemedicine or telephone. “Parent training (with or without the member present) is not permitted via telehealth and must be conducted in person.” Observation and direction may be done by synchronous video “as permitted under current telehealth policy.” Bill modifier GT or 95, with the place of service where the visit would have happened in person. Out-of-state telehealth practitioners need an active Connecticut license.[17][21][15][20]
Carelon decides non-urgent prospective and concurrent requests, including ASD services, “Within seven (7) calendar days,” and retrospective requests within 30 calendar days. ASD requests should be submitted “prior to or on the date of service/next date of service,” and initial ASD requests only once treatment staff are identified. This matches the federal fee-for-service limit of 7 calendar days for standard requests, effective January 1, 2026 (42 CFR 440.230(e)). Providers have 10 calendar days to start a Level I clinical appeal and 14 days for Level II.[3][26]
“Medicaid is the payer of last resort. If a HUSKY Health member has applicable third-party coverage, the benefits of these policies must be fully exhausted prior to claim submission.” The eligibility check (AEVS) shows any third-party payer. The partnership expressly serves members “including those with other insurance,” so a child with commercial ABA coverage still needs the Carelon authorization for the Medicaid secondary claim.[3][25]
Coverage decides whether Connecticut Medicaid (HUSKY Health) 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.
The performing provider must observe and direct each BCaBA or technician one-on-one, “at a frequency and duration equal to or greater than ten percent of the number of hours” of treatment they deliver, with regular direct observation of the technician working with the child. Carelon’s PA-2025-13 requires evidence of direct observation at least 10% of the time direct services occur, documented “in a separate observation and direction contact note that corresponds with the submitted claim.” Requests for more than 10% need documented extenuating circumstances.[15][16][4]
Yes, for observation and direction. The performing provider bills H0046 for observing and directing a technician only when “the performing provider is in the same location as the BCaBA or technician and the individual,” or does it by synchronous video telehealth as policy allows, and the work is for the child’s benefit. Its units are authorized together with treatment. No source read addresses billing H2014 and 97153 for the same time.[15][4][11]
No per-day cap is published. Limits are set through authorization: behavior assessment H0031 up to 10 hours per 6 months initially and up to 6 for reassessment; H0032 1 unit and H0032-TS 3 units per 6 months; parent training 97156 4 units a week, plus 4 more with documented extenuating circumstances; T1016 96 units a year before prior authorization. Treatment hours per week are requested by the provider and set by medical necessity. The fee schedule CSV has a QTY column, but DSS’s instructions say QTY “Applies only to MEDS fee schedules.”[11][5][10][9]
Every treatment session needs a clinical progress note. “The technician shall sign all clinical progress notes,” and the performing provider also signs every note for a session they observed or supervised. Notes record the services, date and time, length, location and type of setting, who took part, and who was present. Caregiver participation goes in the notes with the caregiver’s name, relationship, date, time, extent and type. Keep records for at least five years.[4][14]
Treatment “can occur in any number of settings, including but not limited to the member’s home, agencies, hospitals, and the community,” and is “generally designed to be delivered in the member’s home or other appropriate community settings.” In the home and community, an adult caregiver (18 or older) “must be present at all times.” DSS does not pay for services that are “solely educational, vocational, recreational, or social,” or for respite or child care.[14][4]
Only the enrolled billing provider is paid. Performing providers enroll separately and either bill for themselves (individual practitioner) or render under a group, clinic or outpatient hospital that bills. “No BCaBA or technician may bill or receive payment” for ASD services. Technician time goes out as 97153 under the billing provider, and the supervising clinician’s time as H2014 or H0046.[4][17][11]
Yes. HUSKY Health covers ASD services, including ABA, for members under 21 on HUSKY A, C and D, and on HUSKY B since October 1, 2025. Every service needs prior authorization from Carelon Behavioral Health of Connecticut.
None. Connecticut has no Medicaid MCOs. HUSKY Health is self-insured fee-for-service: Carelon BH CT authorizes behavioral health services, including ASD services, as the state’s administrative services organization, and Gainwell pays the claims.
From January 1, 2026: 97153 (technician) $14.00 per 15 minutes, H2014 (BCBA or clinician) $15.24 per 15 minutes, H0031 behavior assessment $87.98, H0032 plan of care $87.98, H0032-TS program book $60.70, H0046 observation and direction $22.00, 97156 parent training $21.20, 97158 group $3.08 and T1016 case management $11.33.
No. Evaluations by BCBAs, provisionally licensed clinicians or other unlicensed professionals “do not meet requirements, even if co-signed by a licensed professional.” Use an independently licensed physician, psychologist, APRN, LCSW, LPC or LMFT experienced in ASD evaluation.
Only for the codes on the CMAP Telehealth Table: 90791, H0031, H0046, H2014 and 97153 by video, and T1016 by video or phone. Parent training must be in person. Carelon expects in-person delivery as far as clinically appropriate.
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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