Inland Empire Health Plan is the local initiative for Riverside and San Bernardino counties — 1,366,393 Medi-Cal members in August 2026, the third-largest plan in the state (Molina is the other plan in both counties). "IEHP provides and covers all medically necessary Behavioral Health Treatment (BHT) services" itself: authorizations go through IEHP Behavioral Health on its Provider Portal, not the member’s IPA, under a Behavioral Health Agreement with rates in its Attachment B. IEHP’s policy text (MC_12K3) is the 2024 version; IEHP’s 2025 summary of changes lists it as unchanged and the 2026 summary as a minor wording update.
IEHP’s evaluation criteria (UM_BH 08) need an ASD diagnosis, suspected ASD, or a determination that BHT is medically necessary; medical stability; and "a formal request from a physician or psychologist requesting BHT Services that outlines the member excesses and/or deficits of behaviors that significantly interfere with home or community activities." Everything is authorized: H0031 for the FBA, H2019 for one-to-one direct service, H0032 for supervision and parent training (no modifier for a mid-tier supervisor, HO/HP for a BCBA), H2014 for social skills groups and S5111 for multi-family caregiver groups. Requests go through the portal "BH Referral Request" in 6-month units ("# of hours per week x 4 units x 26 weeks = Qty"), and units must match the treatment plan, which must use IEHP’s "ABA (BHT) 6-Month and Exit Progress Report Template" with all 11 APL 23-010 elements. School services go in the treatment plan and are allowed "if there is prior authorization from IEHP and the school agrees," including private and charter schools.[2][1][3][4][5]
Two access rules for providers: the initial assessment appointment "must be offered within ten (10) business days of authorization being approved," and "Authorizations for BHT will not extend past the Member’s 21st birthday" — within 60 days of it the provider "must initiate the transition process to an alternative funding source (e.g., Regional Center, County Services, or Department of Rehabilitation)." Revised treatment plans are faxed to IEHP BH at 909-890-5763; Provider Call Center 909-890-2054.[2][1][3][4][5]
The questions that decide whether a family can start with Inland Empire Health Plan (IEHP, Medi-Cal), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21: "Authorizations for BHT will not extend past the Member’s 21st birthday," and within 60 days of it the provider "must initiate the transition process to an alternative funding source (e.g., Regional Center, County Services, or Department of Rehabilitation)." No minimum age.[1]
A "licensed physician, surgeon or psychologist" (MC_12K3); UM_BH 08 says "physician or psychologist."[1][2]
The requirement is a formal request from a physician or psychologist describing the behaviors that interfere at home or in the community; PCPs, IPAs and BH providers route it through IEHP’s portal BH web forms. No separate PCP referral route is specified for BHT.[2][1]
"Medi-Cal Members with Other Health Coverage (OHC) must utilize their OHC for covered services prior to accessing their Medi-Cal benefits"; IEHP does not process claims when the eligibility record shows OHC (other than codes A or N) "unless the Provider presents proof that all sources of payment have been exhausted," and payment "will not exceed the Member’s OHC cost sharing amount." IEHP does not say whether its own BHT authorization is needed while it is secondary. (Source: IEHP’s 2024 claims chapter.)[7][13]
IEHP publishes no age limit on the recommendation or diagnosis (checked MC_12K3, UM_BH 08 and the 2025 BHT notices), and APL 23-010 sets none; the treatment plan must be "revised and modified every six months."[2][8]
Ask the plan: IEHP Provider Call Center (909-890-2054) — how recent the physician or psychologist request must be.
IEHP names no required instrument; the treatment plan must include assessment "dates, scores, descriptions and assessment summaries."[3]
Ask the plan: IEHP Behavioral Health (909-890-2054) — whether a particular adaptive or skills instrument is expected in the FBA.
IEHP publishes no BHT telehealth rule (MC_12K3’s reference to "virtual school sessions" is about the school setting); the Medi-Cal telehealth rule applies, which does not settle technician-delivered direct service by video.[1][10]
Ask the plan: IEHP Behavioral Health (909-890-2054) — which BHT codes it will authorize by telehealth.
IEHP’s routine Medi-Cal decision times sit in an attachment ("UM Timeliness Standards – Medi-Cal") that could not be retrieved; its UM chapter allows extension "by up to fourteen (14) calendar days" and urgent decisions "within seventy-two (72) hours," and IEHP treats ABA as routine (expedited is for loss of life or limb or a delayed transition from acute or skilled care). The state ceiling applies: APL 21-011 (five business days, 14 calendar days maximum) and, from January 1, 2026, 42 CFR 438.210(d) (7 calendar days). Reauthorization: 6-month periods, requested before the authorization expires.[6][4][11][12]
Blocked on: IEHP attachment "UM Timeliness Standards – Medi-Cal" (IEHP provider manual Section 14, now in its C360 policy search) or the IEHP Provider Call Center 909-890-2054.
Coverage decides whether Inland Empire Health Plan (IEHP, Medi-Cal) 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.
"H0032 and H0032-HO/HP will be approved for up to two hours of case supervision for every 10 hours of direct treatment" (20%); more needs individualized clinical justification. The ratio applies to H2019 + H2014 combined and to H0032 + H0032-HO combined. A bachelor’s-level mid-tier supervisor needs "twelve semester units in Applied Behavior Analysis (ABA) and one year of experience"; a BCaBA can bill H0032, H2019 and H2014.[4]
No daily or weekly cap on direct hours. S5111 group caregiver training is at most one session a day and "may not be requested in units"; H2014 groups need two or more members; and IEHP "will not reduce the number of medically necessary BHT hours … by the hours the Member spends at school."[4][1]
Home or community-based settings, including clinics; school "if there is prior authorization from IEHP and the school agrees," including private and charter schools, with hours across settings "proportionate to the Member’s medical need for BHT services in each setting."[1][4]
Codes by tier: H0031 FBA; H2019 one-to-one direct; H0032 supervision (no modifier = mid-tier, HO/HP = BCBA); H2014 social skills (any level); S5111 group caregiver training. BHT is delivered by QAS providers, professionals and paraprofessionals per the State Plan; rates are in Attachment B of the Behavioral Health Agreement. IEHP publishes no NPI or PAVE rule.[3][4][1]
IEHP’s FAQ says H2019 and H0032 "may be billed separately," a supervisor may bill H0032 without a technician present, and H0032 may be billed more than once a day with documentation for each session — but it does not say whether H0032 and H2019 may overlap in the same clock time.[4]
Ask the plan: IEHP Provider Call Center 909-890-2054 — whether supervision and direct service may be billed for the same minutes.
IEHP publishes no note-signature rule beyond documentation for each session and required exit reports and exit letters.[4]
Ask the plan: Your IEHP Behavioral Health Agreement, or IEHP’s current MC_12K3 text in its C360 policy search.
Yes — as Behavioral Health Treatment for Medi-Cal members under 21, "even without a diagnosis of autism spectrum disorder," on a formal request from a physician or psychologist.
Through the IEHP Provider Portal "BH Referral Request" — H0031 for the FBA, then 6-month unit requests for treatment on IEHP’s progress-report template.
Up to two hours of case supervision (H0032) per 10 hours of direct treatment; more needs clinical justification.
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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