---
title: "Humana Healthy Horizons in Louisiana ABA coverage: the intake guide."
url: "https://carelu.com/payers/humana-healthy-horizons-louisiana"
markdown_url: "https://carelu.com/payers/humana-healthy-horizons-louisiana.md"
state: LA (Louisiana)
payer: Humana Healthy Horizons in Louisiana
kind: Medicaid managed care plan (MCO)
parent_program: Louisiana Medicaid (Healthy Louisiana)
description: "How Humana Healthy Horizons in Louisiana covers ABA for Medicaid members under 21: coverage policy LA.CLI.022, two-step authorization, the uniform ABA form, PA turnaround, ABA quality reviews and claims deadlines."
last_reviewed: October 2026
---

# Humana Healthy Horizons in Louisiana ABA coverage: the intake guide.

_Payer Guide · Humana Healthy Horizons · Louisiana · Last updated October 2026 · 9 primary sources_

> Healthy Louisiana plan; ABA policy LA.CLI.022 tracks the LDH manual; PA via Availity or fax 1-833-974-0059.

Humana Healthy Horizons in Louisiana (Humana Health Benefit Plan of Louisiana) joined Healthy Louisiana in 2023 and is one of the four plans that remain in 2027. Its ABA coverage policy, LA.CLI.022.003 (effective October 7, 2026; its change log records LDH-requested updates on May 5, 2026), follows the LDH manual section by section, and its 2026 provider manual adds the authorization clock and an ABA quality-monitoring program that reviews treatment records.

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. LA.CLI.022: a PA request "must be submitted by the ABA provider to conduct a functional assessment and to develop a behavior treatment plan," with the CDE [1]
- **Prior auth for treatment**: Yes. A separate authorization request for treatment must include the CDE, behavior treatment plan and IEP (or an explanation); submit on the ABA authorization form via Availity or fax 1-833-974-0059 [1][2]
- **Autism diagnosis required?**: A qualifying diagnosis: members "Diagnosed with a condition for which ABA-based therapy services are recognized as therapeutically appropriate, including but not limited to Autism Spectrum Disorder (ASD), by a QHCP" [1]

## At a glance

- **Covers ABA?:** Yes, members under 21 with a qualifying CDE
- **Prior auth:** Two steps (assessment, then treatment); 180-day maximum
- **Submit via:** Availity (preferred) or fax 1-833-974-0059
- **Decision clock:** 2 business days after information, no more than 7 calendar days
- **Timely filing:** 365 calendar days from the date of service
- **Audits:** ABA quality monitoring reviews of treatment records

## Coverage and authorization

LA.CLI.022 covers ABA for members under 21 with interfering behaviors, a qualifying diagnosis by a QHCP, a CDE and a QHCP prescription (not needed when the CDE recommends ABA). Authorization is "a two-fold process": first the functional assessment and treatment plan, with the CDE (needed only on the first request per member per provider), then treatment, with the CDE, treatment plan, IEP and waiver plan pages. A school-based plan "will not be approved until a copy of the IEP is provided," and if Humana asks for a new CDE it "will not delay the available ABA services awaiting completion of the CDE." Requests go on Humana’s copy of the uniform ABA authorization form, which asks whether there is a primary payor and lists the attachments, through Availity or by fax to 1-833-974-0059. [1][2]

## Turnaround, claims and quality reviews

The 2026 provider manual commits to deciding "Standard outpatient service prior authorization requests within 2 business days of obtaining appropriate medical information not to exceed 7 calendar days of receipt of request," with a possible 14-day extension, expedited requests within 72 hours, and retrospective reviews within 30 days of receiving the records. Claims are due within 365 calendar days of the date of service. Humana runs ABA quality monitoring, on site and by desk review, checking the CDE, the ABA prescription or referral, the qualifying diagnosis, the treatment plan, progress notes, care coordination and discharge planning, so keep those documents in every chart. [3]

## Intake gates

The questions that decide whether a family can start with Humana Healthy Horizons in Louisiana, and what they have to bring.

- **Age limit**: Under 21 ("Under 21 years of age" is the first coverage criterion). [1]
- **Diagnosis recency**: No expiry is stated. The CDE is needed only on the first request per member per provider, "All CDEs completed by QHCPs will be reviewed," and a plan-requested new CDE does not delay services. A new provider must submit a CDE with its first request. [1]
- **Who may diagnose**: Pediatricians using the MCHAT-R/F (independently at a score of 8 or more), or a pediatric neurologist, developmental pediatrician, psychologist or medical psychologist, psychiatrist, team-based pediatrician, supervised nurse practitioner, or a licensed SLP, LCSW or LPC with ASD diagnostic scope and two years’ experience (or a QHCP’s co-signature). [1]
- **Diagnostic tools required**: None required by name beyond the pediatrician’s MCHAT-R/F. The CDE needs a DSM-5 or DSM-5-TR diagnosis, history, observation and record review; autism-specific, psychopathology, cognitive and adaptive assessments are added when screening is borderline or unclear. [1]
- **Referral required?**: A prescription for ABA "ordered by a QHCP," but "If there is a recommendation in the CDE for ABA therapy, a separate prescription is not needed." Progress notes go to the PCP every 6 months and the PCP is copied on all treatment plans. [1]
- **Telehealth**: LA.CLI.022 does not address ABA telehealth; Humana’s manual says it covers services by telehealth when Medicaid program policy indicates them, and the LDH manual does. 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. [3][4]
- **Prior-auth decision time**: Standard outpatient requests within 2 business days of obtaining the needed medical information, no more than 7 calendar days after the request (extendable up to 14 days); expedited within 72 hours; retrospective reviews within 30 days of receiving records. [3][7]
- **Other insurance (who pays first)**: Humana’s manual says it collects other-coverage information because “Medicaid programs are the payer of last resort,” and its ABA form asks whether there is a primary payor. 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. [3][2][8][4][6]

## Delivery and billing rules

Coverage decides whether Humana Healthy Horizons in Louisiana 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**: LA.CLI.022 adopts the state ratio: "Supervision shall be approved on a 2:10 basis, that is two hours of supervision for every ten hours of therapy," part of it in the presence of the member and the CaBA or RLT, not when the supervisor is delivering direct therapy, and no more than 24 technicians a day or 10 CaBAs. [1]
- **Concurrent billing (97153 + 97155)**: Yes. LA.CLI.022: "One on one supervision may by be conducted and billed simultaneously and concurrently with one-on-one therapeutic behavioral services," and only when a non-licensed professional is delivering the services. [1]
- **Session-note signature**: Humana’s quality reviews check progress notes, but its policy and manual set no signature rule of their 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. [3][4]
- **Place of service**: Services "must be provided in a natural setting (e.g., home and community-based settings, including clinics and school)," school-based ABA is allowed, school plans need the IEP first, and sessions at a non-ABA facility need an addendum explaining why they cannot happen at home or at the ABA facility. LA.CLI.022.003 also lets ABA run "simultaneously with another service" (for example speech therapy) only if "the other service in question must not have a restriction that keeps it from being performed at the same time," with an addendum giving the frequency and duration of the joint sessions. [1]
- **Bill as provider**: "Payment for these services must be billed by the licensed professional" (LA.CLI.022). The LDH manual adds that the rendering provider on the claim must be the supervisor who signed the documentation. [1][4]
- **Daily limits / MUEs** _(plan-dependent)_: LA.CLI.022 publishes no unit cap; authorizations may not exceed 180 days, and hours come from the treatment plan’s weekly schedule. [1]
  - Ask the plan: Humana Healthy Horizons in Louisiana Provider Services, 1-800-448-3810: ask how ABA units are authorized and edited.

## What intake should collect for Humana Healthy Horizons in Louisiana

- **Member ID:** Confirm Humana Healthy Horizons in Louisiana on the date of service.
- **Comprehensive diagnostic evaluation:** From a QHCP with a DSM-5 or DSM-5-TR diagnosis and an ABA recommendation.
- **IEP:** Required with the treatment request, or a written reason it is unavailable; school-based plans wait for it.
- **Other insurance:** The authorization form asks about a primary payor; send its ABA decision.

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

## Common questions

### Does Humana Healthy Horizons in Louisiana cover ABA?

Yes, for members under 21 with a qualifying diagnosis (autism or another condition ABA treats), a comprehensive diagnostic evaluation and a QHCP prescription or CDE recommendation.

### Where do I send a Humana Louisiana ABA authorization?

Through Availity (preferred) or by fax to 1-833-974-0059, on Humana’s ABA authorization form with the CDE, treatment plan and IEP.

### How quickly does Humana Healthy Horizons in Louisiana decide?

Within 2 business days of getting the information it needs, and no later than 7 calendar days after the request, unless extended.

## Primary sources

1. [Humana Healthy Horizons in Louisiana — Medical Coverage Policy LA.CLI.022.003, Applied Behavior Analysis (eff. 10/07/2026; review date 05/05/2026)](https://assets.humana.com/is/content/humana/LA.CLI.022.003%20Applied%20Behavioral%20Analysis%20ed%2010.7.26pdf)
2. [Humana Healthy Horizons in Louisiana — Applied Behavioral Analysis (ABA) Authorization form](https://assets.humana.com/is/content/humana/FINAL_316907LA0923-M_3576_LA_PROV_ABA_PA_Form_LAHLRVMENpdf)
3. [Humana Healthy Horizons in Louisiana — Provider Manual 2026 (v1.0)](https://assets.humana.com/is/content/humana/2026-1-14_LA_Provider%20Manual_2026_v1.0pdf)
4. [LDH Medicaid Services Manual, Chapter 4: Applied Behavior Analysis (issued 08/22/25)](https://www.lamedicaid.com/provweb1/Providermanuals/manuals/ABA/ABA.pdf)
5. [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)
6. [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)
7. [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)
8. [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)
9. [Humana Healthy Horizons in Louisiana — Communications and network notices (provider notices + newsletter archive)](https://provider.humana.com/medicaid/louisiana-medicaid/communications-network-notices)

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.