Kansas Medicaid doesn't call it ABA. Since January 1, 2017, the benefit lives in the State Plan under EPSDT as two "Autism Services": Consultative Clinical and Therapeutic Services (CCTS) — the BCBA-level tier covering assessment, treatment planning, supervision, and family training — and Intensive Individual Supports (IIS), the technician-level 1:1 tier. Understanding that vocabulary is half the intake battle, because authorizations, provider enrollment, and limits are all organized around the CCTS/IIS split. Delivery runs entirely through KanCare's managed care organizations — Sunflower Health Plan, UnitedHealthcare Community Plan, and (since January 1, 2025) Healthy Blue Kansas — with KMAP fee-for-service policy as the baseline underneath. Aetna Better Health of Kansas is gone: it lost the KanCare 3.0 contract and its members moved to Healthy Blue on 1/1/2025.
ABA moved from the old HCBS Autism waiver into the Medicaid State Plan under EPSDT effective January 1, 2017, split into two services. CCTS ("Autism Specialist Services," provider type 11, specialty 403) is the analyst tier — billed under 97151, 97152, 97155, and 97156 — and carries an approved soft limit of 50 hours per year. IIS (specialty 404) is the technician-delivered 1:1 tier billed under 97153, initially authorized up to 25 hours per week with additional hours available on medical necessity. Effective 7/1/2024 the billing map widened: CCTS may also bill 97153, 97154, and 97158, and IIS may also bill 97154. A separate small HCBS Autism waiver still exists for very young children.[1][4][7]
Kansas also has unusual non-certified provider pathways: CCTS can be delivered by a master's-level professional with a KDADS HCBS director letter plus state-approved training, and IIS by a non-RBT with a high-school diploma, 40 hours of ABA training, and a KDADS validation letter, supervised by a BCBA. But the credentialing bottleneck to plan around is KMAP enrollment: every group AND every individual provider — each BCBA and each RBT — must be screened and enrolled in KMAP with their own KMAP ID before any MCO can pay them, and each service location requires separate enrollment.[1][4][7]
KanCare is comprehensive statewide managed care — effectively all ~458,000 beneficiaries sit with one of three MCOs under contracts running 1/1/2025 through 12/31/2027 (renewable to 2029): Sunflower Health Plan (Centene), UnitedHealthcare Community Plan (behavioral health via Optum), and Healthy Blue Kansas, the new entrant. Aetna Better Health of Kansas, which served KanCare 2019–2024, was not selected — its members auto-transitioned to Healthy Blue on 1/1/2025 unless they chose Sunflower or UHC. Any directory still listing Aetna Better Health as an active KanCare plan is stale. PA and payment run through the MCOs with KMAP FFS policy as the floor; a secondary source reports KanCare MCOs must pay in-network providers at least 100% of the FFS rate (we could not verify this against the contract itself).[8][16]
At the state-policy level, CCTS — which includes the assessment function, now billed 97151 — requires a recommendation by a physician or other licensed practitioner and is subject to prior authorization; each MCO operates its own PA intake. The tripwire to design intake around is now who made the diagnosis, not how old it is (see below). The one exception is Sunflower: its KS.CP.01 policy (last reviewed 06/2019) still says an MD or licensed psychologist must have validated the ASD diagnosis within the last 6 months, although that policy no longer appears on Sunflower's clinical-policy index (which lists Centene's CP.BH.104 instead) and both Centene documents defer to state Medicaid provisions on conflict — so for a Sunflower member with an older report, ask Sunflower UM before ordering a re-evaluation. Reauthorization runs at minimum every 6 months (Optum layers a monthly provider progress review on top), and Sunflower adds its own Kansas-specific gate: a current Kan Be Healthy (EPSDT) screen within the past year. Capture diagnosis date and screening status at first contact, not at submission.[1][17][18][2][22][23][24]
KMAP Bulletin 26140, issued 8/12/2026 and reissued 8/31/2026, effective for dates of service on or after 11/1/2026, sets the state rule: for members age 20 and under, the ASD diagnosis must come from a Kansas BSRB-licensed clinical psychologist or a qualified physician (family/general practice, neurology, psychiatry, developmental pediatrics, Indian Health Services), documented against DSM criteria and severity level using a validated diagnostic tool such as ADOS or CARS. It replaces a recency clock rather than adding to one: once diagnosed by a qualified diagnostician, a member is eligible for ABA "without the need for a re-evaluation of their autism spectrum disorder diagnosis. There is also no time limit on how soon they begin autism treatment." Optum/UHC's July 2026 Kansas criteria reproduce that text verbatim and carry no 6-month rule. Members already in treatment who were diagnosed by a non-qualifying diagnostician get two years to obtain an updated diagnosis, which "does not need to involve a complete diagnostic evaluation" — worth flagging to families with an older diagnostician on file so it isn't a surprise at the two-year mark. KMAP notes MCO implementation dates "may vary" from the bulletin date.[1][17][18][2][22][23][24]
We won't quote most current Kansas autism-services rates, because we couldn't verify them. The last public anchor for most codes is the CPT crosswalk effective 1/1/2019, which set 97151 at $17.50 per 15-minute unit — and that was then raised effective 4/1/2019 by a bulletin that did not publish the new amounts. Notably, the 7/1/2022 behavioral-health rate increase did NOT include the 9715x autism codes. One code has a newer, verified figure: effective 7/1/2024, KMAP Bulletin 24125 — the same bulletin that widened CCTS billing to 97153/97154/97158 and IIS billing to 97154 — states verbatim that "the service rate for code 97153 will be increased for applied behavioral analysis to $65/hour ($16.25 per unit, 15 minutes)." No comparably dated figure was found for 97151, 97152, 97154, 97155, 97156, or 97158. The source of truth for everything else is the KMAP interactive fee-schedule lookup (Reference Codes on the KMAP portal, which redirects to a login wall on every automated attempt); UHC/Optum explicitly commits to reimbursing at the Kansas Medicaid autism-services rates, so the KMAP lookup doubles as your MCO benchmark. Treat any other dollar figure circulating for Kansas ABA as unverified until you've pulled it from that lookup yourself.[3][4][5][6]
Kansas is one of the few states where RBT certification is genuinely optional for Medicaid work. Since April 3, 2020, IIS technicians (KMAP type 11, specialty 404, billing 97153) qualify one of two ways: hold an RBT certificate, or complete the state-equivalent pathway — age 18+, high-school diploma or equivalent, 40 hours of ABA training including 8 hours of supervised intervention work and 3 hours of ethics (plus at least 1 hour each in criterion-referenced assessment, social skills, parent training, and program development), an initial competency assessment, and an acceptance letter from the KDADS HCBS Autism Program Manager or HCBS Director. That letter is individually issued, so it adds onboarding lead time; either track requires annual training to stay qualified. Technicians don't need a BSRB license — K.S.A. 65-7503 expressly exempts autism specialists and IIS providers under the state autism program from behavior analyst licensure. If you hire on the RBT track, the BACB's own floor still applies: the 40-hour training completed over 5–180 days, a competency assessment within 90 days of applying, and both a criminal background check and an abuse-registry check passed within 180 days of application payment.[10][11][12][13][14][15]
The state layer is a five-part enrollment screening package. Under the same April 2020 policy, every individually enrolling CCTS and IIS applicant must demonstrate a clean background across checks of Kansas Bureau of Investigation (KBI) records, the Adult Protective Services and Child Protective Services registries, the Nurse Aide Registry, and a motor-vehicle screen — that last one is a Kansas oddity, so collect driving records at onboarding. The bulletins don't publish a re-check cadence, and the KMAP HCBS Autism manual (which reportedly also requires proof of background checks and insurance at enrollment) sits on a portal we couldn't reach during research — confirm current screening details with KMAP provider enrollment directly. Layer federal exclusion screening on top regardless: check every hire against the HHS-OIG LEIE (and SAM.gov) at hire and monthly, since employing an excluded individual draws civil monetary penalties.[10][11][12][13][14][15]
At the supervisor tier, licensure has been mandatory since July 1, 2016: practicing ABA in Kansas requires a Licensed Behavior Analyst — or a Licensed Assistant Behavior Analyst under LBA supervision — through the Behavioral Sciences Regulatory Board under K.S.A. 65-7501 et seq. CCTS enrollment (type 11, specialty 403) takes a BSRB-licensed BCBA, BCBA-D, or BCaBA, or — another Kansas-specific alternative — a master's-level professional with documented ASD experience, state-approved training, and a KDADS letter. IIS technicians must work under the direction of a BCBA or qualified CCTS practitioner, but no Kansas-specific observation percentage or tech-per-supervisor ratio appears in any accessible primary source — for RBT-certified staff, the BACB's 5%-of-hours monthly supervision minimum (two face-to-face contacts per month, one individual, one observing service delivery) is the operative floor. The BSRB's own site was unreachable during our research, so confirm renewal and CE specifics with the board. Plan-level, Optum/UHC adds the real extras: KanCare ABA providers must hold a KMAP ID, carry $1M-per-occurrence / $1M-aggregate professional liability coverage, and contract separately with Optum's Kansas ABA network — and KMAP itself warns that MCO implementation dates can lag state policy, so verify each MCO's rollout individually. The MCO documents we reviewed add no staff-level background checks beyond the state baseline.[10][11][12][13][14][15]
Both, in that order — and never “neither.” Kansas does not let a technician ride under the supervising BCBA's number. The technician is a KMAP provider in their own right: KMAP General Bulletin 21013 enrolls Intensive Individual Supports as “provider type/specialty of 11/404,” qualified by a “Certificate as Registered Behavior Technician (RBT) OR A letter signed by the KDADS HCBS Autism Waiver Program Manager or HCBS Director,” plus the five-part background check. Optum's KanCare getting-started guide spells out the sequence for a group: “The group and individual health care professionals must be enrolled with KMAP and must have a KMAP ID to bill for Medicaid services. Your group must be enrolled and have a KMAP ID before your individual ABAs or RBTs can enroll,” choosing “Individual within a Group” as the organizational type, and “when you hire new ABAs or RBTs, you must enroll them through KMAP before you can bill Medicaid under the employee's NPI number.” Each individual is enrolled separately for each service location.[11][7][25][26]
The MCO step comes second. For UnitedHealthcare Community Plan, “Once KMAP approves your enrollment, KMAP will notify us and Optum Behavioral Health will retrieve the application and documentation,” then credentials (Optum is “allowed 60 days to credential” and 30 days to contract) — and “You must have an executed contract with Optum Behavioral Health to begin to see UnitedHealthcare Community Plan members.” IIS enrollees submit their RBT certificate or, if not RBT-certified, the KDADS letter, and “All providers must present proof of relevant background checks and insurance coverage.” Sunflower and Healthy Blue both route network entry through KMAP first, but neither publishes an ABA-specific rule on technicians. Healthy Blue's June 2026 manual limits its credentialing scope to practitioners "licensed, certified, or registered by the state to practice independently (without direction or supervision)" and lists "Certified Behavioral Analysts" under a separate certification process — technicians are not on its list. Sunflower's 2026 manual says "All providers wishing to participate in the Sunflower KanCare network must enroll through KMAP first" and "You must be contracted and credentialed by Sunflower before providing services," without saying whether that reaches each technician. Ask each plan's network team before a new RBT's first session.[11][7][25][26]
Kansas licenses the practice: “no person shall practice applied behavior analysis in this state unless they are” a licensed behavior analyst, a licensed assistant behavior analyst under LBA supervision, a supervised trainee, or a licensed psychologist (K.S.A. 65-7503(a)). The exemptions cover people providing services under IDEA or Section 504 and providers qualified under the HCBS autism waiver, not out-of-state analysts. The statute does not say in terms whether video sessions with a child located in Kansas are practice “in this state,” so the safe plan is a Kansas LBA (Behavioral Sciences Regulatory Board) before the first remote session.[12]
For KanCare, enrollment runs through KMAP. We have not verified KMAP’s rules for enrolling an out-of-state ABA provider, so ask KMAP provider enrollment before treating a KanCare member from another state.[12]
KanCare ABA claims go to the member’s managed care plan, and each plan publishes its own clock. Sunflower’s February 2026 manual: "Original provider claims (first-time claims) must be received by Sunflower within 180 calendar days from the date of service"; as secondary payer, within 180 days of the primary payer’s final determination; corrected claims within 365 calendar days of the notification of payment. It pays a Medicaid clean claim within 30 days, or a longer timeframe allowed by law or the provider agreement. To dispute a payment, an optional reconsideration must be requested within 120 calendar days of the notice of action (resolved within 30 calendar days), and a provider appeal filed in writing within 60 calendar days of the notice of action or reconsideration decision, each with three days added for mailing.[25][26][27]
Healthy Blue’s June 2026 manual: "Generally, paper and electronic claims must be filed within 180 days," corrected claims and other rebilling within 365 days of the date of service, and retroactive-eligibility claims within 180 calendar days of the eligibility determination; your contract’s own filing period controls where it differs. A claim payment reconsideration (optional) is accepted by phone, online or in writing "within 120 calendar days (plus an additional three (3) calendar days to allow for mailing/sending) of the date on the Explanation of Payment (EOP)." UnitedHealthcare Community Plan’s 2026 KanCare manual: "Our standard timely filing requirement is 180 days from the date of service" (your participation agreement may set another), and "The standard turnaround time for clean claims is 30 business days from date of receipt." A claim reconsideration is due within 120 calendar days of the notice of action and an appeal within 63 calendar days of the notice of action (or of the reconsideration resolution); the appeal does not have to wait for the reconsideration to finish. Kansas electronic visit verification (AuthentiCare) is scoped to HCBS personal care and home health services; the three plans’ manuals do not apply it to ABA (CCTS/IIS).[25][26][27]
KMAP moved the autism services onto CPT codes in 2019. Bulletin 18259 end-dated the old Category III codes on December 31, 2018 and replaced them from January 1, 2019 with 97151, 97152, 97153, 97155 and 97156. Bulletin 24125 then let CCTS providers (PT/PS 11/403) bill 97153, 97154 and 97158, and IIS providers (11/404) bill 97154 alongside 97153, for dates of service from July 1, 2024. Neither bulletin lists a HCPCS H-code for CCTS or IIS. The complete allowed-code list sits in Section 8400 of the KMAP Mental Health and Professional fee-for-service manuals, which are a human retrieval from the KMAP portal. Until that is checked, bill the CPT codes the bulletins name, and confirm any H-code with the member’s MCO before using it.[3][6]
The questions that decide whether a family can start with KanCare (Kansas Medicaid), and what they have to bring. Each maps onto something intake should ask on the first call.
Age 20 and under. CCTS and IIS moved out of the Autism waiver into the State Plan effective January 1, 2017 "under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions"; Bulletin 20147 describes them as covered "under the State Plan Services for EPSDT participants and Title XXI members"; and Bulletin 26140 fixes the diagnostician rule for "individuals aged 20 years and younger." Optum's Kansas Medicaid criteria state the bound outright: "the member is age 20 and under."[1][10][2]
Two rules now point in opposite directions, and the newer one is the state's. KMAP Bulletin 26140 — reissued 8/31/2026 with its effective date moved from September 1 to November 1, 2026 — states that once an individual is diagnosed by a qualified diagnostician under that policy, "they are eligible for autism treatment, including applied behavioral analysis (ABA) therapy, without the need for a re-evaluation of their autism spectrum disorder diagnosis. There is also no time limit on how soon they begin autism treatment... following their diagnosis of autism spectrum disorder." Optum's current State Mandates supplement (BH803ABASTM72026, July 2026 — its revision log reads "07/21/2026 Interim Review: KS Medicaid") carries that language verbatim for Kansas Medicaid members and states no 6-month validation rule anywhere in the document. Sunflower's KS.CP.01, last reviewed 06/2019, still requires that an "MD or licensed psychologist has evaluated w/in last 6 months for current validation of Autism diagnosis" — but that policy no longer appears on Sunflower's clinical-policy index, which (checked 9/27/2026) lists Centene's CP.BH.104 (revised 02/26) as its Medicaid ABA policy. CP.BH.104 accepts a comprehensive diagnostic evaluation "conducted in the past three years" for treatment initiation, defers to "state-defined ABA criteria" for Medicaid plans, and, like KS.CP.01, says that where state Medicaid provisions conflict, "state Medicaid coverage provisions take precedence." Members already in treatment who were diagnosed by a non-qualifying diagnostician have two years to obtain an updated diagnosis, which "does not necessarily need to involve a complete diagnostic evaluation."[2][17][18]
Since KMAP Bulletin 26140, for members age 20 and younger the ASD diagnosis must come from a Kansas Behavioral Sciences Regulatory Board (BSRB) licensed clinical psychologist or a qualified physician, with a multidisciplinary approach preferred. The bulletin lists the qualifying provider type/specialty codes: 11/112 Psychologist, 31/316 Family Practitioner, 31/318 General Practitioner, 31/326 Neurologist, 31/339 Psychiatrist, 31/345 General Pediatrician (Developmental), 31/349 Exempt License Physician and 31/351 Indian Health Services (the KMAP-hosted PDF of the updated bulletin omits 31/349, which Sunflower's repost and Optum's criteria both list — confirm an exempt-license physician with the MCO). A qualifying BSRB clinical psychologist needs a doctoral degree in psychology or equivalent training plus two years of supervised experience delivering BSRB-approved psychological services; qualifying physicians — developmental/behavioral pediatricians, psychiatrists, neurologists and primary care physicians — need documented additional training in ASD diagnosis, which Optum notes "may be subject to periodic Optum audit/inquiry."[2][18]
The diagnostic evaluation must document DSM criteria and symptom severity level and must rest on "a validated ASD diagnostic assessment tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS)." Screening tools — M-CHAT, ABC, ASSQ, RITA-T, STAT — "have clinical value in recognizing children at risk of having ASD, but the diagnosis of ASD must rest on validated diagnostic tools such as those listed above." Recommended additions: a cognitive evaluation using CAT/CLAMS, MSEL or Bayley (a school district's validated cognitive testing may be used), and an adaptive measure such as ABAS or Vineland.[2][18]
Required at the state level: "coverage requires that a recommendation be made by a physician or other licensed practitioner and is subject to a prior authorization (PA) process." MCOs add to it — Sunflower requires a "doctor recommendation of services/prescription/order to treat" inside the Autism Authorization Request packet, plus a current Kan Be Healthy (EPSDT) screen completed within the past year by a physician, APRN, PA or credentialed RN, which the policy is explicit is not the same thing as a well-child exam.[1][17]
KMAP lists the ABA codes as telehealth-eligible. General Bulletin 21234 made place of service 10 (telehealth in the patient's home) valid from 1/1/2022, "in addition to existing POS code 02 (telehealth provided other than in a patient's home)," and its list of procedure codes allowed with POS 10 includes 97151, 97152, 97153, 97155 and 97156. So the CCTS assessment (97151/97152), technician IIS (97153), supervision with protocol modification (97155) and family guidance (97156) may be billed as telehealth; 97154, 97157 and 97158 are not on that list. Kansas law sets the floor: the telemedicine act "shall also apply to the Kansas medical assistance program," which may not "exclude an otherwise covered healthcare service from coverage solely because such service is provided through telemedicine" when a healthcare provider delivers it, though it may limit coverage to medically necessary services and may not require a member to use telemedicine instead of in-person care (K.S.A. 40-2,213). The bulletins set no in-person minimum for supervision. KMAP notes that MCO implementation "may vary from the date noted in the KMAP bulletins."[19][20]
KanCare authorizes ABA (CCTS/IIS) only through the member's MCO, so the managed-care clock governs. Federal law caps a standard decision at 7 calendar days after the MCO receives the request, for rating periods starting on or after January 1, 2026. KanCare's rating periods run by calendar year, so the 7 days apply now; before 2026 the cap was 14. The MCO may extend by up to 14 more calendar days if the provider or family asks, or if it justifies needing more information. An expedited decision is due "no later than 72 hours after receipt of the request for service" when the standard clock could seriously jeopardize the child's health or ability to attain, maintain or regain maximum function. Sunflower and Healthy Blue print 7 days and 72 hours in their 2026 manuals. UnitedHealthcare's 2026 KanCare manual still prints a 14-day standard. Reauthorization runs at least every 6 months. How far ahead to file it is set by each MCO, not the state: Sunflower says request "at least five days prior" to service, and Healthy Blue accepts recertification requests up to 60 calendar days before expiry.[28][29][25][26][27]
Ask the plan: The member's MCO for the reauthorization lead time it applies to ABA. The KMAP fee-for-service manuals on portal.kmap-state-ks.us could not be opened.
KanCare pays last. Any other coverage the child has (a parent's employer or marketplace plan, TRICARE, CHAMPVA) is billed first. Only the balance goes to the MCO, with the primary payer's EOB or remittance codes. Under 42 CFR 433.139(b), when other coverage is on file the claim is rejected back to the provider "for a determination of the amount of liability." The pay-and-chase exception covers preventive pediatric care: Healthy Blue names "preventive pediatric care, including KAN Be Healthy" and prenatal care, and Sunflower names "preventive and prenatal services." Treat ABA as bill-the-primary-first. TRICARE pays before Medicaid, because federal rules exclude Medicaid from TRICARE's double-coverage plans. Sunflower and Healthy Blue both deny the Medicaid balance when the primary denied for an administrative reason (no authorization, untimely filing), so follow the commercial plan's PA and network rules exactly. Sunflower spells out the practical step: if the primary denies ABA as non-covered or benefits exhausted, a Sunflower authorization is required, and it "encourage[s]" getting one up front for those denials.[30][31][25][26][27]
Ask the plan: The KMAP General TPL Payment Provider Manual (portal.kmap-state-ks.us, unreachable) for state-level TPL billing detail.
Coverage decides whether KanCare (Kansas Medicaid) 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.
Direction, not a ratio. IIS technicians (provider type 11, specialty 404) qualify either by "certification as a Registered Behavior Technician (RBT) under the supervision of a BCBA" or through the state-equivalent pathway — 18 or older, high-school diploma, 40 hours of ABA training including 8 hours of supervised intervention work and 3 hours of ethics plus at least one hour each of criterion reference, social skills training, parent training and program development, an initial competency assessment, and an acceptance letter signed by the KDADS HCBS Autism Waiver Program Manager or HCBS Director. Either way "this provider works under the direction of the BCBA or other Qualified CCTS Practitioner" and must "meet all annual training requirements as specified by certification." No Kansas observation percentage or technician-per-supervisor ratio appears in any accessible primary source, so the BACB's 5%-of-monthly-hours floor is the operative number for RBT-credentialed staff.[10][11]
Kansas publishes annual and weekly soft limits, not per-day ceilings. "The approved State Plan soft limits for the Consultative Clinical and Therapeutic Services (CCTS) remain in effect at an annual amount of 50 hours. The approved State Plan soft limits for Intensive Individual Supports (IIS) also remain in effect with an initial authorization of up to 25 hours per week. For these services, additional hours can be authorized based on a demonstration that the medical necessity criteria are being met." On top of that, Optum's Kansas Medicaid criteria cap the individualized treatment plan at "no more than 40 hours per week."[4][18]
Every individual bills under their own NPI, and every individual needs their own KMAP ID first. The group and the individual health care professionals "must be enrolled with KMAP and must have a KMAP ID to bill for Medicaid services. Your group must be enrolled and have a KMAP ID before your individual ABAs or RBTs can enroll," and "when you hire new ABAs or RBTs, you must enroll them through KMAP before you can bill Medicaid under the employee's NPI number." KMAP also requires a separate enrollment for each location from which services will be rendered. CCTS enrolls as provider type 11, specialty 403; IIS as 11/404.[7][11]
Not published. The KMAP bulletins set the code split — CCTS (type 11, specialty 403) bills 97151, 97152, 97155 and 97156, and since 7/1/2024 also 97153, 97154 and 97158; IIS (specialty 404) bills 97153 and since 7/1/2024 also 97154 — but state no rule on billing two codes for the same clock time.[10][7]
Blocked on: The KMAP Mental Health Fee-for-Service Provider Manual (portal.kmap-state-ks.us was unreachable at this review), and each MCO — Sunflower, Optum and Healthy Blue run their own claim editing.
No signature rule could be sourced. The MCO documents require a dated provider signature on the authorization request form rather than on the session note, and the KMAP provider manuals that would carry charting and signature standards sit on a portal that did not respond at this review.[17]
Blocked on: The KMAP Mental Health Fee-for-Service Provider Manual and the KMAP HCBS Autism manual (portal.kmap-state-ks.us unreachable at this review), plus each MCO's provider manual.
No payable-setting list is published. The service definitions imply the settings — IIS "help the child acquire and maintain the skills needed to successfully function in the home and community" — but no KMAP bulletin names place-of-service codes or states whether school-based delivery is billable. Optum's Kansas Medicaid criteria do exclude "services provided in a PRTF/hospital setting" and any service "being provided in duplicate through any other source/setting."[7][18]
Blocked on: The KMAP Mental Health Fee-for-Service Provider Manual (portal unreachable at this review) and the member's MCO.
Yes — but Kansas doesn't label it ABA. It's covered under EPSDT for members age 20 and under as two services: CCTS (the BCBA tier, soft limit 50 hours/year) and IIS (the technician 1:1 tier, initially authorized up to 25 hours/week, more on medical necessity), with prior authorization through the member's MCO.
Sunflower Health Plan, UnitedHealthcare Community Plan (Optum behavioral health), and Healthy Blue Kansas — the new plan effective 1/1/2025. Aetna Better Health of Kansas lost its contract; its members moved to Healthy Blue on 1/1/2025.
Under KMAP Bulletin 26140 (eff. 11/1/2026) there is no recency rule: once a qualified diagnostician has made the diagnosis, the member is eligible "without the need for a re-evaluation" and there is "no time limit on how soon they begin autism treatment." Optum/UHC's July 2026 Kansas criteria say the same, and Healthy Blue publishes no rule of its own. The exception to check is Sunflower: its older KS.CP.01 policy (last reviewed 06/2019) still says 6 months, though Sunflower now lists Centene's CP.BH.104 as its Medicaid ABA policy — ask Sunflower before ordering a re-evaluation.
As of KMAP Bulletin 26140 (eff. 11/1/2026), for members age 20 and under the diagnosis must come from a Kansas BSRB-licensed clinical psychologist or a qualified physician, documented against DSM criteria/severity using a validated tool such as ADOS or CARS. Once a qualified diagnostician has made the diagnosis, no re-evaluation is needed; existing members diagnosed by a non-compliant provider get a 2-year window to obtain an updated diagnosis.
The RBT enrolls with KMAP individually — IIS provider type 11, specialty 404, as “Individual within a Group” under an already-enrolled group, once per service location — and claims go out under the RBT's own NPI: “when you hire new ABAs or RBTs, you must enroll them through KMAP before you can bill Medicaid under the employee's NPI number.” Then the MCO credentials them: for UnitedHealthcare Community Plan, Optum retrieves the KMAP application, credentials within 60 days and contracts within 30. Sunflower and Healthy Blue also require KMAP enrollment first, but neither publishes a technician-level credentialing rule (Healthy Blue's manual limits credentialing to independently practicing licensed/certified practitioners), so confirm with their network teams. A non-RBT technician can still enroll with the KDADS letter instead of the RBT certificate.
Mostly not reliably published. One exception: 97153 is verified at $16.25/15-minute unit ($65/hour) effective 7/1/2024 (KMAP Bulletin 24125). For every other code the last public anchor is $17.50/15-minute unit for 97151 effective 1/1/2019, raised 4/1/2019 without published amounts; the 2022 BH increase skipped the 9715x codes. Pull current figures from the KMAP interactive fee-schedule lookup — the only source of truth for the rest.
Yes. KMAP Bulletin 21234 lists 97151, 97152, 97153, 97155 and 97156 as allowed with POS 10 (telehealth in the home), alongside POS 02 for other locations, from 1/1/2022. Group codes 97154, 97157 and 97158 are not on the list. K.S.A. 40-2,213 bars KMAP from excluding a covered service only because it is delivered by telemedicine. Confirm the modality with the member's MCO at authorization.
Kansas requires a Kansas license to practice ABA “in this state” (K.S.A. 65-7503). Confirm KMAP enrollment before treating KanCare members from another state.
180 days from the date of service at all three KanCare plans — Sunflower, Healthy Blue and UnitedHealthcare Community Plan (each plan’s 2026 provider manual). Corrected claims: 365 days at Sunflower (from notification of payment) and Healthy Blue (from the date of service).
KMAP’s autism bulletins name CPT codes only (97151, 97152, 97153, 97154, 97155, 97156 and 97158) and no H-codes. The full list is in the KMAP manuals’ Section 8400, so confirm any H-code with the MCO before billing it.
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.
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