Hawaii runs Medicaid as Med-QUEST and delivers almost all of it through QUEST Integration (QI), a single managed-care program whose plans are AlohaCare, HMSA, Kaiser Permanente, ʻOhana Health Plan and UnitedHealthcare Community Plan. Two things make Hawaii intake different from the mainland. The vocabulary is its own: Med-QUEST issues its ABA guidance under the heading Intensive Behavioral Therapy, so a search for "ABA policy" misses the document that governs. And the operative document is a numbered provider memo rather than an administrative rule — QI-2431 / FFS 24-13, dated December 31, 2024, which replaced QI-2301 / FFS 23-01 and is still the current ABA memo on Med-QUEST’s index.
The memo is specific. It names who may diagnose, allows up to a 26-week trial of ABA before a definitive diagnosis, lets plans require PA for the assessment, requires PA for treatment in hours per week for up to 26 weeks, sets supervision at one to two hours per ten RBT hours, allows 97153 and 97155 to be billed concurrently, makes Medicaid secondary to all other insurance, and publishes FFS rates. The plan network is also changing: ʻOhana Health Plan leaves QUEST on December 31, 2026, and its members move to another plan on January 1, 2027.
Med-QUEST issues ABA guidance to the QI plans and to fee-for-service through paired provider memos. The current pair is QI-2431 and FFS 24-13, dated December 31, 2024, titled "Coverage of Intensive Behavioral Therapy (IBT) for Treatment of Children Under 21 Years of Age with Autism Spectrum Disorder (ASD): Guidelines for Applied Behavioral Analysis (ABA)." It restates the EPSDT duty — QI plans must provide medically necessary IBT, "which include ABA, for children under 21 years of age" — and attaches three documents: the access guideline (Attachment A), a process flow chart (Attachment B), and FFS codes and rates (Attachment C). The guideline says it aligns with the current CASP practice guidelines for funders, and that ABA "is not a long-term service and support (LTSS), respite, or home and community-based service (HCBS)."[1][2]
Because the guidance is issued to plans rather than adopted as a rule, it changes by memo number. As of September 23, 2026 the Med-QUEST memo index still lists QI-2431 as the current ABA memo; the separate telehealth memo was reissued as QI-2527 on December 8, 2025.[1][2]
Screening happens at the PCP’s EPSDT visits and needs no PA. The diagnosis "shall be made by" a developmental behavioral pediatrician, developmental pediatrician, neurologist, pediatrician, psychiatrist, psychologist, or another licensed practitioner with specialized expertise in ASD, using "evidence-based assessments." The diagnostic evaluation needs no PA, "but QI health plans may require a referral from the PCP," and extra psychological testing may need PA. If the diagnosing provider suspects ASD but needs more evaluation, the child "may qualify for up to a 26-week trial of ABA prior to diagnosis," with extensions possible; the request carries the working diagnoses (for example developmental delay or a language disorder) and documentation of the delays.[1]
The initial assessment and treatment plan are done by a diagnosing provider or a licensed behavior analyst (BCBA or BCBA-D), and "may require PA from the QI plan." The rendering provider submits the assessment and treatment plan to the plan "for PA before treatment begins." The plan must include each goal with a standardized measurement system (VB-MAPP and ABLLS-R are the examples), an anticipated timeline and hours per goal, and confirmation that services come from a provider licensed and actively enrolled in Hawaii Medicaid. Interim progress assessments are due at least every 26 weeks, and the continuation request is due "at least two weeks before the end of the approved treatment period." Plans may ask for them more often.[1]
Med-QUEST sets the benefit; each QI plan runs its own authorization "established (MQD reviewed and approved) policy for PA," so the plan name is a required intake field. What the plans publish differs. AlohaCare issued its own ABA medical policy, MP-37, effective March 22, 2026, and its PA lookup requires authorization for every ABA code including 97151. ʻOhana’s PA list covers 97151 through 97158. UnitedHealthcare Community Plan sends ABA to Optum through Provider Express. HMSA lists ABA therapy on its QUEST precertification list. Kaiser Permanente authorizes outside-provider services through its Authorization and Referral Management department.[1][9][13][14][15][16][17][6][8]
ʻOhana Health Plan is leaving. Med-QUEST’s March 4, 2026 auto-assignment memo says ʻOhana "does not intend to renew its QI contract beginning January 1, 2027" and stopped new auto-assignments to it, cutting the number of plans from five to four in Honolulu and Maui counties and from four to three in Hawaiʻi and Kauaʻi counties. ʻOhana’s provider FAQ sets a special open enrollment of October 1–20, 2026, with new plans starting January 1, 2027 under QUEST transition-of-care rules. For an ʻOhana family starting ABA now, plan for a change of payer in January.[1][9][13][14][15][16][17][6][8]
Attachment C (revised 12/2024) publishes the FFS ABA rates "as of 2025," per 15 minutes: 97151 (LBA, HO) $28.52; 97152 (BCaBA, HN) $20.24; 0362T (LBA) $54.71; 97153 $17.66 (the HM RBT rate; Med-QUEST’s December 2024 FAQ lets LBAs and BCaBAs bill 97153 at that rate); 97155 LBA $35.94 and BCaBA $20.24; 97156 LBA $46.20 and BCaBA $25.01; group codes 97154, 97157 and 97158 paid per member or family by group size (modifiers UN through US); 0373T LBA $35.94, BCaBA $20.24, RBT $17.66. The rates came from the 2023 Milliman rate study, and Med-QUEST’s October 2024 presentation said the legislature funded them for calendar year 2025 only, with 2026 subject to a new appropriation. We did not find a later ABA rate memo, so confirm the current FFS schedule before quoting. QI plans "may reimburse providers ... at rates higher than" FFS; plan rates are negotiated.[1][4][3][7]
Billing rules in the memo: payment goes to the licensed practitioner or the agency that employs or contracts with them; a rendering provider bills one member at a time except for group services; and when several providers treat a member at once, only one may bill — except that 97153 (RBT under an LBA) and 97155 (LBA, or BCaBA under an LBA) may be billed concurrently when both codes’ criteria are met and they carry different modifiers. Not covered: custodial care, a member who is not medically stable, services by family or household members, treatment delivered as LTSS, HCBS or respite, experimental treatment, and "services provided outside of the State."[1][4][3][7]
The questions that decide whether a family can start with Hawaii Medicaid (Med-QUEST / QUEST Integration), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. The memo covers EPSDT-eligible members "under 21 years of age" with ASD; the Early Intervention Program serves ages 0–3 alongside the QI plan, which still provides comprehensive ABA.[1]
No recency window. The memo asks for an ASD diagnosis but sets no maximum age for it; a qualified rendering provider "may request a re-evaluation of the ASD diagnosis" if the child’s presentation no longer seems to meet the criteria.[1]
Developmental behavioral pediatrician, developmental pediatrician, neurologist, pediatrician, psychiatrist, psychologist, or "other licensed practitioner with specialized expertise in ASD" (APRNs and LCSWs bill with TD and AJ modifiers). Plans may narrow this — AlohaCare’s MP-37 lists only the first six.[1][9]
No instrument named: diagnosing providers must "use evidence-based assessments." The treatment plan must track each goal with a standardized measurement system such as VB-MAPP or ABLLS-R. Plans may add requirements — AlohaCare requires ADOS-2, CARS-2 or ADI-R.[1][9]
Each QI plan decides ABA PAs, so the federal managed-care limit applies: for rating periods starting on or after January 1, 2026, standard decisions within "7 calendar days after receiving the request for service" (extendable by up to 14 days) and expedited decisions within 72 hours. FFS is held to the same 7-day/72-hour limit under 440.230(e). The memo adds the ABA timing: send the continuation request at least two weeks before the approved period ends, and the plan "must evaluate and determine the PA in a timely fashion so that there are no breaks in medically necessary services." Some plan manuals still print the old 14-day standard (AlohaCare, September 2025).[10][11][1][19]
No PA for the diagnostic evaluation, but "QI health plans may require a referral from the PCP." After diagnosis, the diagnosing provider refers the child to a rendering provider, and the plan must help find one on request.[1]
Ask the plan: The member’s QI plan — ask whether a PCP referral is needed for the diagnostic evaluation and for ABA.
The ABA memo defers to MQD’s telehealth policy, QI-2527 (Dec 8, 2025): audio-video telehealth billed with modifier 95, GT or GQ, by providers eligible to bill Hawaii Medicaid, for services appropriate to the modality. ABA codes are not on the suggested-code list, though "other codes may also be billed." A provider that cannot offer in-person care must tell the family, each time, that they have a right to it. Place of service and plan limits are set by each QI plan; Optum’s 2022 UnitedHealthcare Community Plan orientation, for example, allowed only 97155 and 97156 by BCBAs, billed with POS 02.[1][5][18]
Ask the plan: The member’s QI plan — ask which ABA codes it pays via telehealth, with which modifier and POS.
Medicaid pays last: the memo says "Medicaid is secondary to all other insurance coverage," and families and providers "should check with their QI health plan on coordination of benefits." Bill the commercial plan first (for a child under 14 on a state-regulated plan, Luke’s Law applies there). The memo does not say whether the QI plan’s own PA is still needed when it pays second; AlohaCare, for one, requires an appeal of most primary denials before it will review. TRICARE pays after other coverage except Medicaid, so Medicaid pays last there too; CHAMPVA is the last payer after other health insurance.[1][12][19][20][21]
Ask the plan: Ask the QI plan whether it requires its own ABA prior authorization when it is the secondary payer, and what primary-plan documentation it needs.
Coverage decides whether Hawaii Medicaid (Med-QUEST / QUEST Integration) 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 licensed behavior analyst (BCBA-D or BCBA) supervises BCaBAs and RBTs and is responsible for clinical direction, supervision and case management. Case supervision "generally consists of at least one to two hours for every 10 hours of all RBT service hours with at least one of the two hours being direct supervision," direct supervision "must always be provided at least 5% of all BCaBA and RBT service delivery hours," and supervision of unlicensed staff must meet current BACB guidelines.[1]
Allowed for 97153 and 97155 only. When several rendering providers treat a member at the same time only one may bill, but "an exception is made to allow concurrent billing for procedure codes 97153 and 97155" when both codes’ criteria are met and they carry different modifiers: 97153 by an RBT under an LBA, 97155 by an LBA or by a BCaBA under an LBA. Med-QUEST’s December 2024 FAQ declined requests to allow other concurrent pairs.[1][4]
Services go where they address the behaviors found in the assessment — "a clinic, member’s home, or other community settings," named in the treatment plan. In school, the Department of Education provides educationally necessary ABA under the IDEA and the IEP, and the QI plan coordinates services outside school. Services outside Hawaii are not covered. Telehealth follows the separate MQD telehealth memo.[1][5]
For services by an LBA, BCaBA or RBT, the QI plan "shall reimburse the licensed practitioner or agency that contracts with or employs" them. Rendering providers must be licensed in Hawaii, enrolled in Hawaii Medicaid and BACB-certified, and BCaBAs and RBTs must work under an LBA. Claims carry credential modifiers: HO (LBA), HN (BCaBA), HM (RBT), and UN–US for group size; physicians and other QHPs doing assessment or treatment use AF, AH, TD or AJ.[1]
The memo sets no per-day or per-week unit cap. Hours are requested per week for up to 26 weeks and approved plan by plan; extra hours may be requested for school-aged members when school is not in session. Plans set their own review thresholds (AlohaCare MP-37 needs "strong clinical justification" above 30–40 hours a week), and Med-QUEST’s rate-study meetings recorded that one MCO had a much lower assessment-hours limit.[1][9][3]
Ask the plan: The member’s QI plan — ask for its weekly-hour review threshold and any assessment-unit limit before submitting.
The memo sets no session-note signature rule. It requires treatment plans and progress assessments with goal data and confirmation that the rendering provider is licensed and enrolled. Plans set the note rules: AlohaCare requires start/stop times and the signatures of the rendering RBT or BCaBA and the supervising LBA.[1][9]
Ask the plan: The member’s QI plan provider manual or ABA policy (AlohaCare MP-37; the other plans’ provider services lines).
Yes. Med-QUEST covers ABA as Intensive Behavioral Therapy under memo QI-2431 / FFS 24-13 for members under 21 with ASD, delivered through the member’s QUEST Integration plan. A child with suspected ASD may get a trial of up to 26 weeks before a definitive diagnosis.
IBT is the heading Med-QUEST files the benefit under; the memo’s subtitle is "Guidelines for Applied Behavioral Analysis." Searching Hawaii Medicaid documents for "ABA" alone can miss it.
It depends on the plan. The memo says assessment "may require PA from the QI plan." AlohaCare and ʻOhana list 97151 and 97152 as PA codes. The diagnostic evaluation needs no PA, though a plan may want a PCP referral.
ʻOhana leaves QUEST on December 31, 2026. Members choose a new plan in a special open enrollment (October 1–20, 2026) or are assigned one, and the new plan starts January 1, 2027 under QUEST transition-of-care rules.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 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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