Macomb County Community Mental Health (MCCMH) is the PIHP for Macomb County (region 9). It publishes one of the most detailed operational procedures of any Michigan PIHP, and two of its rules change intake timing: the medical exam must be recent, and authorizations cannot be backdated. The state rules in our Michigan Medicaid guide are the floor.
Families call MCCMH Customer Service at 855-99-MCCMH (855-996-2264); MCCMH registers the child, checks Medicaid, and a clinician does a phone screening, then schedules an intake with one of three autism case management programs (Easterseals MORC, Specialized Children & Family Services, Hope Network). "A child can access the ASD benefit only if they qualify for Medicaid." At intake the family must bring documentation of "a full medical and physical exam done by a doctor … within the past year" that shows more ASD testing is needed and confirms hearing and vision were checked and are not causing the symptoms; without it the evaluation is not scheduled.[1][2]
The case manager opens a pre-autism insurance layer for the evaluation, enters any third-party insurance, and refers for a comprehensive diagnostic evaluation and behavioral assessment. MCCMH recommends "gold standard tools such as the ADOS-2, ADI-R, CARS-2 and DD-CGAS." The report must state an ASD diagnosis and recommend ABA; the case manager uploads it and requests the autism enrollment insurance layer, which is opened "for three years based on the start date of the diagnostic evaluation." The case manager then refers to ABA providers and writes the ABA goals, amount, scope and duration into the IPOS, updated at least every six months.[1][2]
The behavioral assessment (VB-MAPP, ABLLS-R or AFLS) is completed before ABA starts and then at least every six months, and it sets the service level: focused (average 5–15 hours a week) or comprehensive (16–25). MCCMH’s worked example: an initial assessment on 2/10/26 opens a six-month window through 8/9/26; the case manager updates the IPOS and requests authorization "14 or more days before expected start date of services (no backdating)." The ABA provider completes the reassessment 4 to 6 weeks before the current authorization expires, and the next six-month authorization is again requested 14 or more days before its effective date. Comprehensive re-evaluations follow the manual’s once-in-three-years rule.[2][3][4][5]
MCCMH’s discharge criteria tighten one manual criterion: continued treatment is reviewed if the child has not shown measurable improvement "through a period of six months." Staffing, telehealth and billing rules follow the MDHHS floor.[2][3][4][5]
The questions that decide whether a family can start with Macomb County Community Mental Health (MCCMH), and what they have to bring. Each maps onto something intake should ask on the first call.
MCCMH applies the state rule; its published autism material sets nothing different. Under 21. BHT/ABA is covered "for children under 21 years of age diagnosed with Autism Spectrum Disorder" as an EPSDT benefit, and the first eligibility criterion is "Child is under 21 years of age." No minimum age is set; the manual stresses early screening at EPSDT well-child visits.[3][1][2]
Re-evaluations follow the manual: "no more than once every three years, unless determined medically necessary more frequently." MCCMH opens the autism enrollment insurance layer for three years from the start date of the diagnostic evaluation and can extend it if re-testing is scheduled outside that range. The behavioral assessment is repeated at least every six months.[2][3]
MCCMH applies the state rule; its published autism material sets nothing different. A qualified licensed practitioner "qualified and experienced in diagnosing ASD": a physician with a specialty in psychiatry or neurology; a physician with a subspecialty in developmental pediatrics, developmental-behavioral pediatrics or a related discipline; a physician with a specialty in pediatrics or other appropriate specialty with ASD training, experience or expertise; a psychologist; an advanced practice registered nurse or a physician assistant with ASD and/or behavioral health training; or a master’s-level, fully licensed clinical social worker qualified and experienced in diagnosing ASD. The PIHP is responsible for arranging the comprehensive diagnostic evaluation.[3][1][2]
MCCMH’s procedure recommends "the gold standard tools such as the ADOS-2, ADI-R, CARS-2 and DD-CGAS," with other tools if the clinician finds them necessary; behavioral assessments use VB-MAPP, ABLLS-R or AFLS at least every six months.[2]
MCCMH requires "a full medical and physical exam done by a doctor (such as a pediatrician or family doctor) within the past year" that shows more testing for ASD is needed and confirms hearing and vision were checked; "The exam must be provided before a child is scheduled for a diagnostic evaluation." The family then calls Managed Care Operations / Customer Service (855-996-2264), which refers for case management.[2][1]
MCCMH applies the state rule; its published autism material sets nothing different. Only the analyst-level codes. The MDHHS Bureau of Specialty Behavioral Health Services Telemedicine Database lists 97155, 97156, 97157 and 97158 as allowed via simultaneous audio/visual telemedicine (reported with POS 02 or POS 10, no modifier), and its revision log records that 0362T, 97151, 97153 and 97154 were removed from the database on 4/28/23 — so technician-delivered direct treatment and the behavior identification assessment are in-person. The diagnostic-evaluation codes 96112/96113 and 96116 remain allowed via audio/visual "for reporting BHT/ABA eligibility assessments and re-evaluation assessments related to Autism." The SFY 2026 code charts note on 97155 to use POS 02 "if MDHHS has authorized tele-practice for an individual."[5][4][1][2]
MCCMH sets the provider-side clock: authorization for each six-month assessment period is requested "14 or more days before expected start date of services (no backdating)," and reassessments are done 4 to 6 weeks before the current authorization expires. The PIHP decision clock is federal: standard decisions within state-set timeframes that "may not exceed 14 calendar days" (rating periods starting before January 1, 2026) or "7 calendar days" (on or after), extendable by 14 days; expedited within 72 hours.[2][7]
MCCMH: "private insurance is the primary payer, and Medicaid is considered the payer of last resort." If the child has both, the case manager helps obtain an Explanation of Benefits and follow the private plan’s steps for testing and ABA, and enters the third-party insurance layer in the record. The state rule applies on top: Medicaid is not liable for services denied because the primary plan’s rules were not followed.[1][2][3]
Coverage decides whether Macomb County Community Mental Health (MCCMH) 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.
MCCMH applies the state rule; its published autism material sets nothing different. The behavior technician works under the supervision of the BCBA/LBA or other professional (BCaBA or QBHP) overseeing the behavioral plan of care, "with minimally one hour of clinical observation and direction for every 10 hours of direct treatment." BHT services "must be provided under the direction of a BCBA/LBA or a Master’s prepared QBHP," and the BCBA/LBA is responsible for clinical skill development and supervision of BCaBAs, QBHPs and technicians and for communicating progress on goals to parents or guardians at least every three to six months. The manual gave licensed psychologists (LP/LLP) and QBHPs a deadline to be certified and licensed as a BCBA/LBA by September 30, 2025, and the SFY 2026 code charts now list QBHP as a qualifying provider only "until October 1, 2025."[3][4][1][2]
MCCMH applies the state rule; its published autism material sets nothing different. Allowed for the pairs MDHHS names. The SFY 2026 code charts say 97155 "Must co-occur with 97153, 97154, and 0373T in order to be reported," and the same-time reporting rules state that 97153 and 97155 "can occur at the same time, just not by the same person" (the technician delivers 97153 while the BCBA/LBA supervising delivers 97155); 97156 may be delivered by the BCBA/LBA to the caregiver while a technician delivers 97153 to the child; a 97151 reassessment may be reported at the same time as 97153, 97154, 0373T (and potentially 97157/97158) "IF there are two separate providers"; and 0362T may be reported at the same time as 0373T. Targeted case management may also run at the same time as a direct ABA service.[4][1][2]
MCCMH applies the state rule; its published autism material sets nothing different. No per-day or per-week unit cap is published. The manual sets planning averages, not ceilings: focused behavioral intervention averages 5–15 hours a week and comprehensive behavioral intervention 16–25 hours a week, with actual hours set by the behavioral plan of care. A PIHP "may not deny services based solely on preset limits of the cost, amount, scope, and duration of services," and the level of service is re-determined at least every six months on measurable progress. Authorizations may run up to 365 days.[3][3][1][2]
MCCMH applies the state rule; its published autism material sets nothing different. Home and community. Eligibility requires that "Services are able to be provided in the child’s home and community, including centers and clinics," and BHT is "designed to be delivered primarily in the home and in other community settings." Services "are not intended to supplant responsibilities of educational or other authorities," and the IPOS must not include special education and related services available through the local education agency under IDEA; coordination with the school or early intervention program (IEP/IFSP meetings, communication logs) is an eligibility element. For office or site-based services the primary provider must be within 30 minutes/30 miles in urban areas and 60 minutes/60 miles in rural areas of the beneficiary’s residence.[3][3][1][2]
MCCMH applies the state rule; its published autism material sets nothing different. Services are reported to the PIHP/CMHSP under the provider’s network contract, with a modifier naming the rendering staff level. The SFY 2026 code charts list the qualifying provider types and modifiers for each ABA code: HO for a licensed behavior analyst (master’s level) or QBHP, HN for a licensed assistant behavior analyst (bachelor’s level), and HM for a behavior technician on the technician codes (97153, 97154, 0373T); 97151 carries the state-defined U5 "Autism" modifier and group codes carry the UN–US group-size modifiers. A technician does not need a license or BACB registration, but must complete BACB-approved RBT training and work under the BCBA/LBA’s supervision.[4][3][1][2]
MCCMH applies the state rule; its published autism material sets nothing different. Section 18 of the Medicaid Provider Manual and the SFY 2026 code charts do not state who signs an ABA session note or by when. The manual requires the individual plan of service (IPOS) to specify amount, scope and duration of each authorized service and permits electronic signatures for the beneficiary on the plan of service and consents; session-note signature standards sit in each PIHP’s provider contract and documentation standards.[3][3][4][1][2]
Blocked on: MCCMH (or its CMHSP) provider manual / documentation standards (ask the PIHP’s autism benefit or provider network office for the ABA progress-note requirements).
Call MCCMH Customer Service at 855-99-MCCMH (855-996-2264). MCCMH screens by phone and schedules an intake with Easterseals MORC, Specialized Children & Family Services or Hope Network.
No. MCCMH’s procedure requires the authorization request 14 or more days before the expected start date, with no backdating.
Private insurance is the primary payer and Medicaid pays last; the MCCMH case manager helps get the EOB and follow the private plan’s steps for testing and ABA.
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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