Health Alliance Plan (HAP), a Michigan-based nonprofit plan of Henry Ford Health, publishes the basics of its ABA coverage. Its public materials confirm that ABA treatment requires prior authorization and that HAP follows Michigan’s prior-authorization law, but its ABA clinical rules sit behind provider login, so more of this guide is "ask HAP" than for Blue Cross or Priority Health. HAP’s Medicaid product is HAP CareSource; for Medicaid members ABA runs through the county PIHP (see our Michigan Medicaid guide).
HAP’s Prior Authorization List Summary (reviewed July 10, 2026) lists "Applied Behavioral Analysis (ABA) Treatment" among services requiring prior authorization and refers providers to the "Coordinator Behavioral Health Management-Outpatient Authorization list for detailed information," which, like HAP’s InterQual criteria, requires a provider login. HAP’s Coordinated Behavioral Health Management (CBHM) team, (800) 444-5755, is the behavioral health contact for members. Coverage is "based on the member’s subscriber documents," so the schedule of benefits decides limits.[1][2][3]
On timing, HAP states its compliance with Michigan’s prior-authorization reform (Senate Bill 247): non-urgent requests are approved if no action is taken within 7 calendar days of submission, urgent requests within 72 hours, and new or changed prior-authorization requirements are posted 60 days ahead for non-drug benefits.[1][2][3]
Michigan’s autism mandate has two parallel statutes: MCL 500.3406s for insurers (added by 2012 PA 100, amended by 2016 PA 276, applying to policies delivered, issued or renewed beginning 180 days after its April 18, 2012 enactment) and MCL 550.1416e for health care corporation group and nongroup certificates. Both require coverage "for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders," including behavioral health treatment such as applied behavior analysis, and bar the carrier from limiting the number of visits, from denying coverage because treatment "is educational or habilitative in nature," and from applying dollar limits, copays, deductibles or coinsurance that do not apply to physical illness generally.[4][5]
Unlike newer mandates, Michigan’s still carries age and dollar ceilings the carrier may choose to apply: coverage for treatment may be limited "through 18 years of age" and to a maximum annual benefit of $50,000 through age 6, $40,000 from 7 through 12, and $30,000 from 13 through 18. Treatment must be "prescribed or ordered" by a licensed physician or licensed psychologist who finds it medically necessary, behavioral health treatment must be "provided or supervised by a board certified behavior analyst or a licensed psychologist," and the diagnosis means assessments "including the autism diagnostic observation schedule, performed by a licensed physician or a licensed psychologist." While a member is in treatment the carrier may require a treatment plan and treatment review, request the ADOS results, request that the ADOS be repeated no more than once every three years, and request an annual development evaluation. Utilization review, medical-necessity review, network requirements and coordination of benefits still apply. Exempt: self-funded ERISA employer plans (outside state insurance law), exchange qualified health plans to the extent the coverage exceeds essential health benefits, and, under 500.3406s, short-term policies of six months or less.[4][5]
Michigan licenses behavior analysts through LARA’s Board of Behavior Analysts under Part 182A of the Public Health Code (Michigan’s licensure law dates from 2016). A license requires current BACB certification in good standing sent directly from the BACB, a criminal background check, human-trafficking and implicit-bias training, and renews every four years; assistant behavior analysts have their own LARA license and supervision verification. Technicians are not licensed by the state. HAP does not publish ABA rates; they are contract terms.[6][7][8]
Michigan’s prompt-pay statute, MCL 500.2006(8), governs insured health plans (it excludes administrative-services-only arrangements): "A clean claim must be paid within 45 days after receipt of the claim by the health plan," with 12% simple annual interest after that; the plan must flag defects within 30 days, and the provider gets 45 days to fix them. A provider "must bill a health plan within 1 year after the date of service" for the claim to be a clean claim.[15]
What changes on Jan. 1, 2027. CMS records that at its September 2025 meeting the AMA CPT Editorial Panel "deleted CPT codes 0362T" and "0373T," "revised eight existing CPT codes" (97151 through 97158) and "created six new CPT codes" for adaptive behavior services; the AMA released the CPT 2027 code set on Sept. 9, 2026, with changes in effect on January 1. The ABA Coding Coalition’s 2027 guidance gives the final numbers: 97148 and add-on +97149 (behavior identification supporting assessment of harmful behavior, delivered by two technicians, additional technicians on the add-on), 97159 and add-on +97160 (adaptive behavior treatment of harmful behavior, same two-technician structure), 97173 (adaptive behavior treatment with analysis by a physician or other QHP, face-to-face with one patient) and 97180 (non-face-to-face services personally performed by the QHP, such as data review and modifying protocols). "Protocol modification" becomes "analysis" in the descriptors, and "since there is no grace period, 0362T and 0373T are invalid for dates of service on or after January 1, 2027." No state "approves" the codes themselves: they are Category I CPT codes that HIPAA requires on electronic claims, but, as the Coalition notes, HIPAA "does not, however, govern whether a payer covers a code / service, what a payer pays for a code / service, or what a payer requires to authorize" it, so each payer has to load them, price them and say how authorizations that list 0362T or 0373T carry over.[16][17][18][19]
We found no HAP notice on the 2027 adaptive-behavior codes on its provider pages as of Nov. 1, 2026. Ask HAP how it will load and price the new codes and whether authorizations that list 0362T or 0373T carry over.[16][17][18][19]
The questions that decide whether a family can start with Health Alliance Plan (HAP) — Michigan, and what they have to bring. Each maps onto something intake should ask on the first call.
HAP publishes no ABA age rule on its public site. Michigan’s mandate lets a fully insured carrier limit autism treatment coverage to members "through 18 years of age" and cap it at $50,000 a year through age 6, $40,000 for ages 7–12 and $30,000 for ages 13–18; whether a given plan uses those limits is in its certificate. Self-funded ERISA plans set their own terms.[1][4][5]
Ask the plan: HAP member benefits (certificate / schedule of benefits) at verification: fully insured vs. self-funded, and any mandate age-18 or annual-dollar limits.
HAP’s public materials state no ABA referral rule beyond prior authorization. For a fully insured Michigan policy the mandate adds an order requirement: covered treatment is care "prescribed or ordered for an individual diagnosed with 1 of the autism spectrum disorders by a licensed physician or a licensed psychologist who determines the care to be medically necessary," and the treatment plan is developed "when the treatment of an autism spectrum disorder is first prescribed or ordered." Self-funded ERISA plans sit outside the statute.[4][1]
Ask the plan: HAP member benefits (HMO referral rules) and CBHM, (800) 444-5755.
HAP publishes its compliance with Michigan’s prior-authorization law (Senate Bill 247, MCL 500.2212e): non-urgent requests "Will be approved in 7 calendar days if no action was taken from the date of the original submission," and urgent requests "Will be approved if no action was taken within 72 hours." Contracted providers submit through the HAP portal and non-contracted providers through the non-contracted provider link. The statute does not reach private self-funded employer plans, which follow ERISA (15 days, one 15-day extension; 72 hours urgent).[2][9][10]
Ask the plan: At verification confirm fully insured vs. self-funded and the HAP authorization turnaround with CBHM, (800) 444-5755.
Which plan pays first is set by Michigan’s Coordination of Benefits Act for state-regulated plans: for a dependent child whose parents are married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan covering the parent longer); for divorced or separated parents a court order assigning health coverage controls, then the order in MCL 550.253. The autism mandate adds that a member with two policies covering autism gets benefits "subject to the limits of this section when coordinating benefits." If the child also has Michigan Medicaid, HAP pays first: Medicaid is payer of last resort and "is not liable for payment of services denied because coverage rules of the primary health insurance were not followed," so get HAP’s authorization even when Medicaid (the PIHP) will pay secondary. TRICARE pays after other coverage except Medicaid (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270).[11][4][12][13][14]
Ask the plan: Ask HAP at benefits verification for the member’s coordination-of-benefits order (HAP Coordinated Behavioral Health Management, (800) 444-5755, or the HAP provider portal); self-funded plans set their own COB terms in the plan document. Record every other coverage the child has.
HAP publishes no diagnosis-recency rule. Under the Michigan mandate a fully insured plan may request the ADOS results and a repeat ADOS no more than once every three years, plus an annual development evaluation.[4][1]
Blocked on: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org).
HAP publishes no ABA-specific rule. For fully insured plans the mandate defines the diagnosis as assessments, including the ADOS, "performed by a licensed physician or a licensed psychologist."[4][1]
Blocked on: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org).
HAP publishes no instrument list. The mandate lets a fully insured carrier request "the results of the autism diagnostic observation schedule" used in the diagnosis.[4][1]
Blocked on: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org).
HAP publishes no ABA telehealth rule on its public site.[1]
Ask the plan: HAP provider portal telehealth policy or CBHM, (800) 444-5755 — ask which ABA codes may be delivered by telehealth.
Coverage decides whether Health Alliance Plan (HAP) — Michigan 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.
HAP publishes no ABA supervision standard on its public site; ABA clinical criteria sit in its behavioral health authorization list and InterQual, both behind provider login.[1][3]
Blocked on: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org).
HAP publishes no ABA concurrent-billing rule on its public site.[1][3]
Blocked on: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org).
HAP publishes no ABA hour or unit limit on its public site; authorized hours come from the behavioral health review.[1][3]
In licensed criteria: InterQual Behavioral Health criteria via HAP’s InterQual portal (request access at InterQualReq@HAP.org), or the authorization determination.
HAP publishes no ABA-specific note-signature rule on its public site (its general medical record standards apply).[1][3]
Blocked on: HAP’s Coordinated Behavioral Health Management outpatient authorization list and InterQual criteria (provider login; InterQual access via InterQualReq@HAP.org).
Yes. ABA treatment is on HAP’s prior-authorization list; the detailed behavioral health list and criteria are in the provider portal.
HAP says non-urgent requests are approved if it takes no action within 7 calendar days and urgent requests within 72 hours, per Michigan’s prior-authorization law. Self-funded employer plans follow federal ERISA timelines.
HAP CareSource is a Medicaid plan; Michigan Medicaid assigns ABA to the PIHP for the child’s county, not the health plan.
Within 45 days of receipt for a clean claim on an insured plan (MCL 500.2006(8)), with 12% interest after that. Self-funded plans are not covered.
We found no HAP notice as of Nov. 1, 2026. CPT 2027 deletes 0362T and 0373T and adds 97148/97149, 97159/97160, 97173 and 97180, so ask HAP how it will price them and handle existing authorizations.
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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