Kaiser Permanente has contracted directly with DHCS since January 1, 2024 and served about 1.26 million Medi-Cal members across 32 counties in August 2026 — the fourth-largest Medi-Cal plan in the state. For an ABA agency, Kaiser works differently from every other plan in this directory: there is no provider-initiated prior-authorization request. A Kaiser physician refers the child, Kaiser issues a written Authorization for Medical Care to a contracted BHT provider, and the provider works inside the visits and dates on that paper. A Kaiser Medi-Cal family who calls an agency directly needs to be sent back to their Kaiser pediatrician or behavioral health department first.
The 2026 Medi-Cal member handbook covers BHT "for members under 21 years old through the Medi-Cal for Kids and Teens benefit," when it is "prescribed by a licensed doctor or psychologist, approved by us, and provided in a way that follows the approved treatment plan." Outside providers need "a referral or pre-approval." Kaiser’s Northern California provider manual explains the mechanics: a Plan Physician "may refer a Member to a non-plan Provider when the Member requires covered services … not available in Plan or cannot be provided in a timely manner," the provider receives "a written Authorization for Medical Care communication" stating "the level and scope of services authorized, and the number of visits and/or duration of treatment," and "Any additional services beyond the scope of the authorization must have prior approval … contact the referring physician." Kaiser’s Medi-Cal quick-reference guide adds that Regional Centers "refer Medi-Cal Members needing Autism Spectum Disorder (ASD)/Applied Behavioral Analysis (ABA) Services to their PCP."[1][4][2]
Kaiser Southern California’s Medi-Cal BHT criteria cover BHT "for members with an ASD diagnosis, or where following formal assessment there is suspicion of ASD that is not yet diagnosed," and separately for members without an ASD diagnosis — consistent with the state’s "regardless of diagnosis" rule. But for the non-ASD path the service must be "Provided by a licensed provider acting within the scope of their licensure," so the usual BCBA-plus-technician team fits only the ASD or suspected-ASD path. The document is labelled "UM Criteria 2024" and still cites APL 19-014, which APL 23-010 superseded; no Northern California equivalent could be retrieved.[3][9]
The questions that decide whether a family can start with Kaiser Permanente (Medi-Cal), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21: "We cover behavioral health treatment ("BHT") services for members under 21 years old through the Medi-Cal for Kids and Teens benefit."[1]
No recency rule published — the 2026 handbook, the Medi-Cal quick-reference guide and the SCAL BHT criteria were checked, and APL 23-010 sets none either. The operative date is the expiration on Kaiser’s Authorization for Medical Care.[3][9]
The recommendation comes from "a licensed physician, surgeon or psychologist" (SCAL criteria); the handbook says BHT must be "prescribed by a licensed doctor or psychologist." In practice the assessment runs through Kaiser: "If a developmental disability is suspected, the Medi-Cal Member may seek assessment and diagnosis via PCP or Regional Center."[3][1][2]
None named — the SCAL criteria refer only to a "formal assessment," and the handbook and quick-reference guide name no instrument.[3]
Yes, and it is the whole front door. Plan Physicians refer to a non-plan provider when the service is "not available in Plan or cannot be provided in a timely manner"; outside referrals are "managed at the local facility level," and out-of-network services need "a referral or pre-approval." An ABA agency cannot accept a Kaiser Medi-Cal family on its own — the family must be referred by a Kaiser physician and the agency must receive the written authorization.[4][1]
The 2026 handbook: "Under Health and Safety Code Section 1367.01(h)(1), The Permanente Medical Group has five business days from when they get the information reasonably needed to decide" (Southern California states the same 5 business days); expedited decisions "no later than 72 hours." Reauthorization: authorized services must be rendered "before the authorization expires," and the treatment plan is reviewed at least every six months.[1][4]
Kaiser’s cost-avoidance letter makes contractors "responsible for identifying the primary payor, seeking authorization from the primary payor (if authorization is required), and billing the appropriate party." "If a Medi-Cal Member has active OHC and the requested service is covered by the OHC, you must instruct the member to seek the service through the OHC carrier," but "you must not refuse to provide covered services to Medi-Cal Members as authorized by Kaiser Permanente." Every prior-authorized service needs its authorization number on the claim — so keep Kaiser’s authorization even when Kaiser is secondary.[5][6]
General rule only: "Providers may provide Telehealth services to its Medi-Cal Members" after assessing appropriateness and documenting verbal or written consent. Kaiser publishes no BHT-specific telehealth rule; what is payable remotely follows the scope of the individual authorization.[2]
Ask the plan: The Referral Questions number on the Kaiser Authorization for Medical Care — ask whether the authorized BHT codes may be delivered by telehealth.
Coverage decides whether Kaiser Permanente (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.
No caps: BHT is "not limited based on school attendance or other categorical exclusions" (quick-reference guide). Units and duration are whatever each Authorization for Medical Care states.[2][4]
SCAL criteria: "Deliver BHT services in a home or community-based setting, including clinics. Any portion … provided in school must be clinically indicated as well as proportioned." The quick-reference guide excludes "BHT services delivered in schools that are Individuals with Disabilities Education Act (IDEA) funded."[3][2]
No ratio published. The handbook says the plan is developed by a qualified BHT provider and "may be administered by a qualified BHT provider, qualified BHT service professional, or qualified BHT service paraprofessional" — the state QAS tiers — and the SCAL criteria require a licensed provider for the non-ASD path.[1][3]
Ask the plan: Your Kaiser BHT provider agreement — supervision expectations are contract terms.
Only Kaiser-contracted, Medi-Cal-enrolled providers, with the plan "developed by a Medi-Cal Network Provider who is a qualified BHT provider"; claims must carry the Kaiser authorization number. No rule on whose NPI goes on technician lines is published.[1][6]
Ask the plan: Your Kaiser BHT provider agreement — rendering vs. billing NPI for technician time.
Not addressed in any public Kaiser document read.[6]
Ask the plan: Your Kaiser BHT provider contract/billing guide (not public) or the Kaiser claims line on the authorization.
Not addressed in the public Kaiser documents read.[6]
Ask the plan: The record-keeping section of your Kaiser provider agreement.
Not until Kaiser authorizes it. A Kaiser physician must refer for BHT and Kaiser must issue a written Authorization for Medical Care to your agency; send the family to their Kaiser pediatrician or behavioral health first.
Not in Southern California’s criteria, which cover ASD, suspected ASD and non-ASD members — but for a child without ASD the service must be delivered by a licensed clinician.
Five business days from receiving the information reasonably needed (H&S 1367.01(h)(1)), and 72 hours for expedited requests.
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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