Empower Healthcare Solutions is one of the four PASSEs DHS lists. Its Provider Handbook (Version 9.08.2026) lists Applied Behavioral Analysis among the state plan services it covers, and its prior-authorization list puts every payable ABA code behind PA. Empower publishes no ABA clinical policy of its own, so the Arkansas Medicaid ABA manual supplies the rules: eligibility, PCP forms, supervision and telehealth.
Empower’s full PA code list (dated 4.24.26) carries four ABA codes, all in the “AUTISM-EPSDT” category and all marked PA required: 97151, 97153, 97155 and 97156. Those are the same four codes the Arkansas Medicaid fee schedule pays. Requests go through the provider portal or on the BH/IDD PA form, by email or fax to 800-886-6839. Empower’s handbook and UM pages publish no ABA-specific criteria, so the state ABA manual governs: EPSDT ages 18 months to 21, the DMS-641 ER referral and DMS-641 TP prescription, a BCBA comprehensive evaluation, BCBA supervision of RBTs, and telemedicine for 97155 and 97156 only.[2][1][3][6][7]
Empower decides standard authorizations within two business days of receiving all necessary clinical information and urgent ones within one business day, may extend up to two business days for missing documentation, and reviews retrospective requests (for a newly attributed member, for example) within 30 calendar days. Clean claims are due within 365 days of the date of service, and corrections or adjustment requests within 180 days of the payment or denial notice. Empower is the payer of last resort and pays nothing when the other insurer paid at or above its Medicaid allowable. A provider reconsideration is due within 30 calendar days of the adverse notice and is optional before an Arkansas Department of Health provider appeal.[3]
The questions that decide whether a family can start with Empower Healthcare Solutions, and what they have to bring. Each maps onto something intake should ask on the first call.
Empower publishes no ABA age rule, so the state rule applies: EPSDT enrollees “between eighteen (18) months and twenty-one (21) years of age.”[3][6]
No diagnosis expiry; the state manual’s BCBA reevaluation runs every 6 months (ages 18 months to 8) or 12 months (8 to 21), and the DMS-641 TP prescription expires on the same schedule.[3][6]
Empower publishes nothing different, so the state rule applies: a DMS-641 ER evaluation referral and a DMS-641 TP treatment prescription from the member’s assigned PCP. 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.[3][6][12][13]
Empower publishes no ABA telehealth rule, so the state rule applies. Only two ABA services may be delivered by telemedicine: adaptive behavior treatment with protocol modification (97155) and family adaptive behavior treatment (97156). “All other covered applied behavior analysis (ABA) therapy services must be conducted in-person,” so the 97151 assessment and technician 97153 are in-person only. Telemedicine must be synchronous, needs parent or guardian consent first, follows the Arkansas Telemedicine Act (Ark. Code Ann. § 17-80-401 to -407) and Section I § 105.190, and is paid the same as in person. Acentra’s training deck adds the billing detail: “no modifier required. Use telehealth place of service on claim.” Section I § 105.190 also says a provider treating Arkansas clients by telemedicine “shall be fully licensed or certified to practice in Arkansas.”[3][6][11][9]
Standard authorizations “Within two (2) business days of Empower’s receipt of all clinical information necessary,” urgent within one business day, retrospective reviews within 30 calendar days; an extension of up to two business days may be granted to obtain missing documentation.[3]
“Empower is a payer of last resort when any commercial or Medicare plan covers the member,” and it “will not make any payment if the amount received from the third-party insurance is equal to or greater than Empower’s Medicaid allowable amount.”[3]
Not stated by Empower. Under the state rule, qualified professionals under Ark. Code Ann. § 20-77-124 diagnose; Acentra’s list for fee-for-service is a licensed psychologist, licensed physician or SLP, with MD or DO confirmation. Ask Empower whether it applies the same list.[3][11]
Ask the plan: Empower Utilization Management via Provider Services, 855-429-1028.
Not stated by Empower. The state manual accepts DSM criteria or formalized ASD instruments and requires a skills-based instrument from DHS’s accepted list in the BCBA evaluation.[3][6]
Ask the plan: Empower Utilization Management via Provider Services, 855-429-1028.
Coverage decides whether Empower Healthcare Solutions 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.
Empower publishes no ABA supervision rule of its own, so the state rule applies. The state manual sets the floor. A BCaBA or RBT must be supervised by an Arkansas Medicaid-enrolled BCBA, who must directly observe in person at least “Five percent (5%) of the total ABA therapy treatment hours performed by the BCaBA or RBT” and at least “One (1) hour of ABA therapy treatment delivery performed by BCaBA or RBT every thirty (30) days.” Between observations the BCBA must be “on-call and immediately available” (telecommunication is enough), must review and approve the technician’s data and progress notes before any claim is submitted, and is capped at the lesser of “twelve (12) BCaBAs and RBTs at any given time” or a caseload needing no more than 25 billable hours of 97155 a week. RBTs must hold BACB certification; a trainee may be treated as an RBT for up to six months.[3][6]
Empower publishes no ABA unit limit, so the state rule applies: weekly units may not exceed the authorization, 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.[3][6]
Empower publishes no ABA note rule, so the state rule applies: names, credentials and signatures of the staff on each session note, weekly BCBA-signed progress notes, and BCBA approval of technician notes before the claim.[3][6]
Claims must carry the “NPI of billing provider and rendering provider when applicable” and the Medicaid ID of both when the provider is atypical, aligned with the state’s Master Provider Registry. The state manual requires a group to name the certified practitioner as the performing provider.[3][6]
Not addressed by Empower. The state manual bars concurrent billing “unless otherwise specifically provided for” and does not say in words whether 97153 and 97155 may share minutes.[3][6]
Ask the plan: Empower Provider Services, 855-429-1028, or ProviderRelations@empowerarkansas.com.
Empower publishes no ABA setting rule. Under the state manual, the plan of care must justify the setting, and only 97155 and 97156 may be delivered by telemedicine; PASSE benefits exclude school-based services by school employees.[3][6][4]
Ask the plan: Empower Provider Services, 855-429-1028: ask which place-of-service codes it pays for ABA.
Yes. Its handbook lists Applied Behavioral Analysis as a state plan service, and the Arkansas Medicaid ABA manual sets the rules for PASSE members aged 18 months to 21.
97151, 97153, 97155 and 97156 are all marked PA required on Empower’s April 2026 list. Submit through the portal or the BH/IDD PA form.
365 days from the date of service for the original clean claim; corrections within 180 days of the payment or denial 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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