---
title: "InterCommunity Health Network CCO ABA coverage: the intake guide."
url: "https://carelu.com/payers/intercommunity-health-network-cco"
markdown_url: "https://carelu.com/payers/intercommunity-health-network-cco.md"
state: OR (Oregon)
payer: InterCommunity Health Network CCO (IHN-CCO)
kind: Medicaid managed care plan (MCO)
parent_program: Oregon Health Plan (Coordinated Care Organizations)
description: "How IHN-CCO covers ABA for OHP members in Benton, Lincoln and Linn counties: prior approval for every ABA code including the assessment, review criteria, decision timeframes, and its ABA minimum fee schedule."
last_reviewed: October 2026
---

# InterCommunity Health Network CCO ABA coverage: the intake guide.

_Payer Guide · InterCommunity Health Network CCO · Last updated October 2026 · 20 primary sources_

> Benton/Lincoln/Linn CCO (Samaritan): every ABA code including 97151 on the 2026 PA code list; ABA rates kept at or above OHA FFS.

InterCommunity Health Network CCO (IHN-CCO), administered by Samaritan Health Plans, serves OHP members in Benton, Lincoln and Linn counties. Its 2026 Prior Approval List names "Applied behavioral therapy (ABA) services," and its 2026 code list spells out the codes, so the assessment needs approval here.

This plan administers the **Oregon Health Plan (Coordinated Care Organizations)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Oregon Health Plan (Medicaid) guide](https://carelu.com/payers/oregon-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes: IHN’s 2026 Prior Authorization Code List puts 97151 and 97152 under "Applied Behavioral therapy (ABA) services," and the 2026 Prior Approval List requires prior approval for ABA services [3][2]
- **Prior auth for treatment**: Yes: 97153–97157 (and 99366/99368) are on the same 2026 code list [3][2]
- **Autism diagnosis required?**: Yes. IHN reviews against the Prioritized List, guideline notes and OARs and publishes no ABA criteria of its own, so the OHP rule applies: ASD on the HERC ASD line or stereotyped movement disorder with self-injury (OAR 410-172-0770) [4][9][18]

## At a glance

- **Covers ABA?:** Yes, under OHP rules
- **Service area:** Benton, Lincoln and Linn counties
- **Prior auth:** All ABA codes, 97151–97157 (plus 99366/99368), per the 2026 code list
- **Review criteria:** Prioritized List, guideline notes, OARs, plan policies, MCG
- **Rates:** ABA fee schedule kept no lower than OHA’s FFS behavioral health rate (directed payment)
- **Decision clock:** Handbook (2025) prints 14 days; OAR 410-141-3835 now sets 7

## Prior approval and review criteria

IHN-CCO’s 2026 Prior Approval List includes "Applied behavioral therapy (ABA) services," and the IHN Prior Authorization List Code List (effective January 1, 2026) lists under that heading 97151, 97152, 97153, 97154, 97155, 97156 and 97157, plus the team-conference codes 99366 and 99368. Samaritan’s Utilization Management and Service Authorization Handbook (2025) lists its criteria sources: the OHA Prioritized List, guideline notes, Oregon Administrative Rules, statutes, Samaritan coverage policies and MCG guidelines. That handbook prints IHN-CCO timeframes of 14 days standard and 72 hours expedited; OAR 410-141-3835, effective July 1, 2026, requires CCO notice within 7 calendar days for standard requests. [2][3][4][13][5][12]

On rates, Samaritan’s behavioral health provider page says that under OHA’s 2023 directed payment IHN-CCO "will adopt/maintain the fee schedule for A&D Residential, Applied Behavior Analysis and Mental Health Children’s Wraparound services at no lower than the OHA State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate in effect at the date of service," and that its contracts carry "lesser of billed charges" language, so bill at a rate that captures any increase. OHA’s fee-for-service behavioral health fee schedule (update published 7/1/2026) pays, per 15-minute unit: 97151 $20.85, 97152 $19.81, 97153 $14.70, 97154 $13.72, 97155 $32.07, 97156 $32.07 and 97157 $8.68 (rates effective 7/1/2024). 97158, 0362T and 0373T do not appear on the schedule. [2][3][4][13][5][12]

## Claim filing and payment rules for IHN-CCO

OHA’s managed-care billing rule binds every CCO, IHN-CCO included (OAR 410-141-3565, effective January 1, 2025). Initial claims are due "within no more than 120 days of the date of service," or within 365 days for pregnancy, retroactive eligibility, Medicare as primary payer, third-party liability and other delays not caused by the provider; a CCO "may negotiate terms within this timeframe," so your contract can set a shorter limit but not a longer one. For a timely claim that needs correction or resubmission, the CCO must allow "a minimum of 180 days after the initial adjudication date." Other insurance "must be exhausted prior to payment." On payment, CCOs "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt," make an initial determination on 99 percent within 60 days, and "may not require providers to delay claims submission." The rule sets no weekly payment cycle or submission cutoff. [1]

## Intake gates

The questions that decide whether a family can start with InterCommunity Health Network CCO (IHN-CCO), and what they have to bring.

- **Age limit**: IHN publishes no age limit. OHP rules require ABA beyond Guideline Note 75 when medically appropriate "including individuals age 13 and older," and under 21 EPSDT bars age-group-wide denials. [4][9][17]
- **Diagnosis recency**: IHN publishes no recency rule. The OHP rule dates only the physical exam and hearing test (OAR 410-172-0770(1)(h)–(i)). [4][9]
- **Who may diagnose**: IHN publishes nothing different, so the OHP rule applies: a physician, psychologist, or developmental-medicine NP or PA experienced in autism (OAR 410-172-0770(1), 0760(1)). [4][9][8]
- **Diagnostic tools required**: IHN publishes nothing different, so the OHP rule applies: a standardized, validated tool such as the ADOS plus developmental status on assessments such as the Vineland (OAR 410-172-0770(1)(b), (g)). [4][9]
- **Referral required?**: IHN adds no referral rule of its own, so the OHP rule applies. Yes. Before services, OAR 410-172-0770(1)(k) requires "A referral for ABA treatment with or without specification of hours or intensity" that includes the diagnosis and a copy of the evaluation, from a physician, psychologist, or nurse practitioner or physician associate specializing in developmental medicine who has experience diagnosing and treating autism (OAR 410-172-0760(1)). [4][9][8]
- **Telehealth**: IHN publishes no ABA telehealth rule of its own. The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification. [4][11][12]
- **Other insurance (who pays first)**: IHN’s documents read add nothing ABA-specific, so the state rule applies. Medicaid pays last. OHA must be "the payer of last resort," and "Providers shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). Bill the commercial plan first and follow its authorization rules. [4][16][21]
- **Prior-auth decision time** _(plan-dependent)_: Samaritan’s 2025 UM handbook prints IHN-CCO timeframes of 72 hours expedited and 14 days standard. OAR 410-141-3835 (effective July 1, 2026) requires CCO notice "no later than seven (7) calendar days following receipt," so expect 7. [4][13]
  - Ask the plan: Samaritan Health Plans care management for IHN-CCO: confirm the current standard decision timeframe.

## Delivery and billing rules

Coverage decides whether InterCommunity Health Network CCO (IHN-CCO) 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**: IHN publishes no ABA supervision rule, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005). [2][8][15]
- **Session-note signature**: IHN publishes no ABA session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)). [4][10]
- **Bill as provider**: IHN publishes no ABA rendering-provider rule. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)). [3][8]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in IHN’s prior approval list, code list or UM handbook. [3][4]
  - Ask the plan: Samaritan Health Plans provider services for IHN-CCO, or your IHN-CCO contract.
- **Daily limits / MUEs** _(ask the plan)_: IHN publishes no ABA unit or hour limit. [3][4]
  - Ask the plan: Samaritan Health Plans care management (IHN-CCO authorizations): ask how ABA units are authorized.
- **Place of service** _(ask the plan)_: IHN publishes no ABA setting rule. [3]
  - Ask the plan: Samaritan Health Plans provider services for IHN-CCO: ask which settings and place-of-service codes it pays for ABA.

## What intake should collect for InterCommunity Health Network CCO (IHN-CCO)

- **Member ID:** Confirm IHN-CCO (Benton, Lincoln or Linn county) on the date of service.
- **Prior approval for the assessment:** 97151 and 97152 are on IHN’s 2026 PA code list: request approval before assessing.
- **Diagnostic evaluation and referral:** Meets OAR 410-172-0770; referral from a physician, psychologist, or developmental-medicine NP/PA.
- **Other insurance:** Bill commercial coverage first; OHP is the payer of last resort.

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

## Common questions

### What is IHN-CCO’s timely filing limit for ABA claims?

120 days from the date of service under OAR 410-141-3565 (365 days for exceptions such as retroactive eligibility, Medicare or other insurance primary); your contract may set a shorter limit. Corrections and resubmissions get at least 180 days from the initial adjudication.

### Does IHN-CCO require prior authorization for the ABA assessment?

Yes. IHN’s 2026 code list includes 97151 and 97152 under ABA services, so request approval before the assessment.

### What does IHN-CCO pay for ABA?

Contracted rates, which IHN says it keeps no lower than the OHA fee-for-service behavioral health rate for ABA. The OHA open-card rate for 97153 is $14.70 per 15 minutes.

## Primary sources

1. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, DMAP 143-2024, eff. 01/01/2025): §§ (1)(a)–(c), (6), (8)(b), (8)(d)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
2. [InterCommunity Health Network CCO — 2026 Prior Approval List](https://samhealthplans.org/wp-content/uploads/sites/3/2026-prior-approval-list-ihn-cco.pdf)
3. [IHN Prior Authorization List Code List (effective January 1, 2026)](https://samhealthplans.org/wp-content/uploads/sites/3/2026-Prior-Auth-CPT-or-HCPCS-Codes-IHN-CCO-Providers.pdf)
4. [Samaritan Health Plans — Utilization Management and Service Authorization Handbook (2025)](https://samhealthplans.org/utilization-management-and-service-authorization-handbook?type=pdf)
5. [Samaritan Health Plans — Behavioral health providers (IHN-CCO directed payments incl. ABA minimum fee schedule)](https://samhealthplans.org/providers/behavioral-health-providers/)
6. [Samaritan Health Plans — Authorizations (IHN-CCO prior approval lists and forms)](https://samhealthplans.org/providers/care-management/authorizations/)
7. [OHA — Coordinated Care Organization (CCO) Plans (CCO list by county, read from the page’s CCO Plan Details list)](https://www.oregon.gov/oha/HSD/OHP/Pages/Plans.aspx)
8. [OAR 410-172-0760 — Applied Behavior Analysis (OHA, eff. 01/09/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0760)
9. [OAR 410-172-0770 — Individual Eligibility for Applied Behavioral Analysis Treatment (OHA, DMAP 12-2017)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0770)
10. [OAR 410-172-0620 — Documentation Standards, Medicaid behavioral health (OHA, eff. 6/26/2015)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0620)
11. [OAR 410-172-0850 — Telemedicine for Behavioral Health (OHA, DMAP 67-2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0850)
12. [OHA — OHP Fee-for-Service Behavioral Health Fee Schedule, Applied Behavior Analysis tab (update published 7/1/2026)](https://www.oregon.gov/oha/HSD/OHP/DataReportsDocs/bh-fee-schedule0726.xlsx)
13. [OAR 410-141-3835 — CCO Service Authorization (OHA, eff. 07/01/2026)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3835)
14. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, eff. 01/01/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
15. [OAR 824-040-0010 — Training and Supervision of registered behavior analysis interventionists (eff. 2/1/2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-040-0010)
16. [OAR 410-120-1280 — Billing (third-party resources; OHA as payer of last resort)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-120-1280)
17. [OHA — EPSDT Provider Guide (March 2026)](https://www.oregon.gov/oha/HSD/OHP/Tools/EPSDT-Provider-Guide.pdf)
18. [HERC — Prioritized List Guideline Notes, 10/1/2026 (Guideline Note 75 ABA for ASD, Line 192; Guideline Note 126 ABA for self-injurious behavior, Line 436)](https://www.oregon.gov/oha/HPA/DSI-HERC/PrioritizedList/10-1-2026GL.txt)
19. [IHN-CCO — News & Articles (dated news index)](https://ihntogether.org/how-we-serve/news/)
20. [Samaritan Health Plans (IHN-CCO administrator) — News & Articles (incl. quarterly provider webinars)](https://samhealthplans.org/about-samaritan-health-plans/news/)
21. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?part=433&section=433.139)

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.