---
title: "Healthy Blue Louisiana ABA coverage: the intake guide."
url: "https://carelu.com/payers/healthy-blue-louisiana"
markdown_url: "https://carelu.com/payers/healthy-blue-louisiana.md"
state: LA (Louisiana)
payer: Healthy Blue (Louisiana Medicaid)
kind: Medicaid managed care plan (MCO)
parent_program: Louisiana Medicaid (Healthy Louisiana)
description: "How Healthy Blue covers ABA for Louisiana Medicaid members under 21 until it leaves Healthy Louisiana on December 31, 2026: precertification of every ABA code, weekly units, claims, and how authorizations carry over to the new plan."
last_reviewed: October 2026
---

# Healthy Blue Louisiana ABA coverage: the intake guide.

_Payer Guide · Healthy Blue · Louisiana · Last updated October 2026 · 11 primary sources_

> Leaving Healthy Louisiana 12/31/2026: all ABA codes need precert via Availity or fax; new plans honor its PAs up to 60 days.

Healthy Blue (Community Care Health Plan of Louisiana, a Blue Cross Blue Shield licensee) is a Healthy Louisiana plan until December 31, 2026, when its Medicaid contract ends. Its members can choose a new plan from October 15 to November 16, 2026, or will be assigned one, starting January 1, 2027. Until then it covers ABA under the LDH manual with every ABA code on its precertification list.

For an ABA agency the transition is the main event. The receiving plan must honor Healthy Blue authorizations for up to 60 days or until they end, and you must have a new request in with the new plan before that window closes.

This plan administers the **Louisiana Medicaid (Healthy Louisiana)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Louisiana Medicaid (Healthy Louisiana) guide](https://carelu.com/payers/louisiana-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes. "All ABA services require prior authorization," and the July 2026 PA list marks 97151 and 97152 "Precertification is Required" for Medicaid [1][2]
- **Prior auth for treatment**: Yes: 97153–97158, 0362T and 0373T are on the PA list; request through Availity or fax 844-432-6028, or call 844-521-6942 [1][2]
- **Autism diagnosis required?**: A qualifying diagnosis after a CDE: the manual’s ABA population is individuals "diagnosed with a condition for which ABA-based therapy services are recognized as therapeutically appropriate by a qualified healthcare professional" [1]

## At a glance

- **Covers ABA?:** Yes, members under 21, through December 31, 2026
- **Prior auth:** All ABA codes (97151–97158, 0362T, 0373T)
- **Submit via:** Availity, fax 844-432-6028, or 844-521-6942 (ABA team 844-406-2389)
- **Units:** Paid against weekly approved units (2026 notice)
- **Timely filing:** 365 days from the date of service, honored through run-out
- **After 12/31/2026:** New plan honors Healthy Blue PAs up to 60 days or to their end date

## ABA under Healthy Blue

Healthy Blue’s provider manual (April 2026 posting) gives ABA its own chapter. Its network includes licensed psychologists and medical psychologists, behavior analysts licensed by the Louisiana Behavior Analyst Board, certified assistant behavior analysts and registered line technicians, serving members under 21 with a CDE, a qualifying diagnosis and a QHCP prescription. Member records must hold the CDE and its components, and the licensed professional must "conduct monthly meetings with family members." The plan "follows the Louisiana Medicaid Applied Behavioral Analysis Fee Schedule." "All ABA services require prior authorization," by phone (844-521-6942, any time), on the provider website or Availity, or by fax to 844-432-6028; the ABA team’s line is 844-406-2389. The July 2026 PA list shows precertification required for every ABA code for Medicaid members. [1][2][3]

A state-approved Healthy Blue notice tells providers that ABA "reimbursement will be based on weekly approved units rather than total authorized units," and that "Claims submitted with units exceeding the weekly limit will be considered ineligible for reimbursement." The copy LDH posted (February 2026) leaves the effective date blank, so ask the plan whether it applies to your dates of service. [1][2][3]

## Leaving Healthy Louisiana: what happens to ABA authorizations

LDH’s Informational Bulletin 26-12 (September 1, 2026) sets the transition rules. "HBL prior authorizations will be honored for up to 60 days (or through the authorization end date, whichever occurs first) by the receiving MCO," and the receiving plan "is prohibited from denying prior authorization solely on the basis of the provider being an out-of-network provider." Providers must submit concurrent or new requests to the new plan before the Healthy Blue authorization ends or within 60 days, whichever is first. MEVS shows new plan assignments by November 23, 2026 for dates of service from January 1, 2027. Healthy Blue keeps processing claims through the 365-day timely filing allowance, handles disputes and medical-necessity decisions for services before January 1, 2027, and keeps its provider call center open through June 30, 2028. Providers contracted only with Healthy Blue should contract with one or more of the four remaining plans. [4][5]

## Intake gates

The questions that decide whether a family can start with Healthy Blue (Louisiana Medicaid), and what they have to bring.

- **Age limit**: Under 21: the ABA network serves "Adolescents and children under 21 years of age." [1]
- **Diagnosis recency**: The plan publishes no recency rule, so the state’s applies. No expiry. "MCOs shall not deny services based solely on the age of the CDE," and "The CDE only needs to be included in the first PA request per member per provider." The MCO "shall deny service if no CDE exists," and if it asks for a new CDE it "shall not deny or delay available ABA services while waiting for a CDE." A family that switches ABA providers needs the CDE sent again with the new provider’s first request. [1][6]
- **Who may diagnose**: The plan requires a CDE "performed by a qualified health care professional (QHCP)" and does not list them, so the LDH list applies. A qualified health care professional (QHCP). Pediatricians may diagnose using the MCHAT-R/F and clinical judgment (a score of 8 or more lets them diagnose independently; 3–7 means a follow-up interview, then diagnose or refer). The subspecialists are a pediatric neurologist, developmental pediatrician, psychologist or medical psychologist, psychiatrist, a pediatrician working with a qualified interdisciplinary team, a nurse practitioner supervised by one of those specialists, or a licensed SLP, LCSW or LPC whose scope includes ASD differential diagnosis and who has two years of diagnostic experience or works under a QHCP who co-signs the CDE. [1][6]
- **Diagnostic tools required**: No named instrument. When the diagnosis or need is unclear, the CDE must add autism-specific, psychopathology, cognitive and adaptive-behavior assessments, as appropriate. [1]
- **Referral required?**: The network serves members "who have a prescription for ABA-based therapy services ordered by a qualified healthcare professional"; under the state rule a CDE that recommends ABA serves as that prescription. [1][6]
- **Telehealth**: Healthy Blue’s ABA chapter publishes no telehealth rule of its own and refers to the LDH manual. Yes, with prior authorization. The LDH manual lists 97151–97158 as codes that "can be performed via telehealth," with reimbursement rules otherwise unchanged; services must be "rendered or directed by a RLT, LBA, or CaBA" over "an interactive audio/visual telecommunications system." Reassessments and treatment plans may be done remotely "only if the same standard of care can be met," and RLT supervision "may be conducted via telehealth in lieu of the LBA/CaBA being physically present." 0362T and 0373T are not on the telehealth list. "Telehealth requires PA for services," and approved PAs can be amended to add units or reflect reassessment goals. The chapter names no telehealth place-of-service code or modifier, so each MCO’s billing rules decide those. [1][6]
- **Other insurance (who pays first)**: Healthy Blue publishes nothing different from the state rule. Medicaid pays last (42 CFR 433.139). The LDH manual lets the MCO "bypass the prior authorization (PA) process and acknowledge the PA granted by the primary insurer" when another insurer covers ABA. The MCOs tightened this in November 2025: with the new uniform ABA form, if the primary insurance covers ABA, "Medicaid will remain the payor of last resort, and the authorization will be placed in a pending status until primary coverage is confirmed," so send the primary insurer’s approval or denial with the Medicaid request. [10][6][8]
- **Prior-auth decision time** _(plan-dependent)_: We found no ABA decision clock in Healthy Blue’s manual. Federal law caps a Medicaid managed care standard authorization decision at 7 calendar days for rating periods starting on or after January 1, 2026 (one 14-day extension allowed). After December 31, 2026, the receiving plan must honor Healthy Blue authorizations for up to 60 days. [9][4]
  - Ask the plan: Healthy Blue Provider Services, 844-521-6942, or the ABA team, 844-406-2389: ask the standard ABA turnaround.

## Delivery and billing rules

Coverage decides whether Healthy Blue (Louisiana Medicaid) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: The manual says ABA is "rendered by an ABA assistant or technician under the supervision of a board-certified behavior analyst" and publishes no ratio of its own; it points providers to the LDH manual, whose ratio applies. Louisiana Medicaid sets the ratio in the ABA manual chapter: supervision "shall be approved on a 2:10 basis; that is two hours of supervision for every ten hours of therapy," part of it "must be done in the presence of the beneficiary" and the CaBA or registered line technician (RLT), and it "will not be approved if the licensed supervising professional is delivering the direct therapy." The licensed supervising professional "shall supervise no more than 24 technicians a day" (more if a CaBA is on the team) and "no more than 10 CaBAs." If technician services are in the plan, supervision by a licensed behavior analyst must be part of it. [1][6]
- **Concurrent billing (97153 + 97155)**: Healthy Blue publishes no ABA concurrent-billing rule and refers providers to the LDH manual, which allows it. Yes. The LDH manual says: "One-on-one supervision may by be conducted and billed simultaneously and concurrently with one-on-one therapeutic behavioral services. Supervision can only occur when a non-licensed professional is providing the therapeutic behavioral services." In practice that is 97155 alongside 97153 when an RLT or CaBA is delivering the session. [1][6]
- **Session-note signature**: The manual sets record contents (CDE, treatment plan, monthly family meetings) but no signature rule of its own, so the LDH manual applies. Start and stop times are required "for every code billed" (at the start of the session, after any break of 12 minutes or more, and on a switch of billing code). "The person delivering the service must sign, date, and include their credentials in the documentation for each day and distinct session," and the daily log must also carry the "Name, signature, and credentials for supervising BCBA who is also rendering provider for billing." For an RLT session, recorded data can replace the narrative. Records are kept at least six years. [1][6]
- **Place of service**: The plan publishes no setting rule of its own and refers to the LDH manual. Services "must be provided in a natural setting (e.g., home and community-based settings, including clinics and school)," and school-based ABA by ABA providers is allowed. A treatment plan that puts services in a school "will not be approved until an IEP is provided" to the MCO. Sessions at a "non-ABA facility" (any place other than the home that does not offer ABA as a primary service) need an addendum explaining why they cannot happen at home or at the ABA facility. A change of setting mid-authorization needs a treatment-plan addendum. Overlap with other therapies (speech, OT, PT, waiver services): ABA may be delivered "simultaneously with another service, if allowed per medically unlikely edits and coding guidelines," only when "the other service in question must not have a restriction that keeps it from being performed at the same time as another service," and the treatment-plan addendum must give the frequency and duration of sessions when the ABA provider and the other provider are both present and what the other provider needs to implement the skill. [1][6]
- **Bill as provider**: The plan publishes no ABA rendering rule of its own and refers to the LDH manual. The supervisor. "When billing for ABA services, the rendering provider on the claim form must be the provider that provided supervision for those services and signed documentation indicating that they supervised the services being billed for on the claim," and "Payment for services must be billed by the licensed professional" (an LBA, licensed psychologist or licensed medical psychologist). RLTs are not billed as rendering providers. [1][6]
- **Daily limits / MUEs** _(plan-dependent)_: Healthy Blue pays ABA against weekly approved units: claims "should reflect the units rendered within each week, up to the weekly medically necessary limit," and units over the weekly limit are not reimbursed. The filed notice leaves the effective date blank. [3]
  - Ask the plan: Healthy Blue Provider Services, 844-521-6942: confirm the effective date of weekly-unit billing and each authorization’s weekly units.

## What intake should collect for Healthy Blue (Louisiana Medicaid)

- **Member ID and plan for 2027:** Confirm Healthy Blue for dates through 12/31/2026, and which plan the child chose or was assigned for 1/1/2027 (MEVS shows it by 11/23/2026).
- **Comprehensive diagnostic evaluation:** Required in the record; resend it with the first request to the new plan.
- **Current authorization end date:** The new plan honors it for up to 60 days or to its end date; diary the new request before then.
- **Other insurance:** Medicaid pays last; send the primary insurer’s ABA decision.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Is Healthy Blue leaving Louisiana Medicaid?

Yes. Healthy Blue’s Medicaid contract ends December 31, 2026. Members can pick a new plan from October 15 to November 16, 2026, or are assigned one, effective January 1, 2027.

### What happens to my child’s Healthy Blue ABA authorization in 2027?

The new plan must honor it for up to 60 days or until it ends, whichever is first, even if your ABA provider is out of its network. The provider must send a new request to the new plan before then.

### Does Healthy Blue require prior authorization for ABA?

Yes, for every ABA code, including the 97151 assessment. Submit through Availity, by fax to 844-432-6028, or by phone at 844-521-6942.

## Primary sources

1. [Healthy Blue Louisiana — Medicaid Provider Manual (April 2026 posting)](https://provider.healthybluela.com/docs/gpp/LA_CAID_ProviderManual.pdf?v=202604141511)
2. [Healthy Blue Louisiana — Prior Authorization List (as of 07/06/2026)](https://provider.healthybluela.com/docs/gpp/LA_HBPAlist.pdf?v=202607202015)
3. [Healthy Blue — Streamlined ABA claim process: weekly approved units (LAHB-CD-097207-25, state-approved copy posted by LDH 2/20/2026)](https://ldh.la.gov/assets/medicaid/MCPP/2_20_26/LAHB-CD-097207-25-CPN96709_EXPRESS-ABA-Claim-Processing_STATE_APP.pdf)
4. [LDH Informational Bulletin 26-12 — Important Information Regarding Healthy Blue Transition (September 1, 2026)](https://ldh.la.gov/assets/docs/BayouHealth/Informational_Bulletins/2026/IB26-12.pdf)
5. [LDH — Medicaid Health Plan Transition 2027 (Healthy Blue exit)](https://www.ldh.la.gov/medicaid/medicaid2027)
6. [LDH Medicaid Services Manual, Chapter 4: Applied Behavior Analysis (issued 08/22/25)](https://www.lamedicaid.com/provweb1/Providermanuals/manuals/ABA/ABA.pdf)
7. [Louisiana Medicaid Applied Behavioral Analysis Fee Schedule (dates of service on or after July 1, 2022)](https://www.lamedicaid.com/provweb1/fee_schedules/ABA_FS_Current.pdf)
8. [Louisiana Healthcare Connections — Uniform ABA Prior Authorization Form Now Available (11/17/25)](https://www.louisianahealthconnect.com/newsroom/uniform-aba-prior-authorization-form-now-available.html)
9. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
10. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
11. [Healthy Blue Louisiana — Provider News (provider news archive)](https://providernews.healthybluela.com/)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.