Magnolia Health is Centene’s MississippiCAN and CHIP plan and one of the three coordinated care organizations the Division of Medicaid contracts with. For its members Magnolia, not the state, authorizes and pays for ABA, using Centene’s clinical policies CP.BH.104 (medical necessity) and CP.BH.105 (documentation), both last revised February 2026, and its own Autism Spectrum Disorders Treatment Form.
Magnolia’s prior-authorization list (CMS Final Rule 0057-F, effective 12/31/2025) lists "Applied Behavioral Analysis 0362T, 0373T, 97152, 97153, 97154, 97155, 97156, 97157, 97158"; 97151 is not on it. Requests go to Utilization Management on the Autism Spectrum Disorders Treatment Form with the treatment plan and SMART goals, the comprehensive diagnostic report (initial requests only), other services the child receives, a sample schedule and documentation of parent involvement; "Information older than 30 days will not be accepted for concurrent review."[1][3][5]
CP.BH.104 requires a confirmed DSM diagnosis by "a licensed physician, psychologist, or other licensed professional with specialized training in diagnosis and treatment of ASD," with severity level, and a comprehensive diagnostic evaluation (CDE). To start treatment the CDE must be from the past three years, or, if it is three to five years old, a diagnostic interview within 12 months must update it; to continue, the CDE must be within five years. The CDE must use at least one clinician tool (for example ADOS-2, ADI-R, CARS-2, STAT) and one parent tool (for example M-CHAT-R/F, SCQ, SRS-2). Treatment plans need the signature of the responsible BCBA and the parent. Hours must "not exceed six hours per day up to a total of 30 hours per week" unless documentation justifies more, and the policy expects less than 20 hours a week for a child attending school full time. Protocol modification (97155) should be at least two hours a week or 10% of direct hours, and no more than 20%; caregiver training ideally at least two hours a month. Updated behavior assessments and treatment plans are due at least every six months, and attendance below 80% of authorized hours triggers review.[1][3][5]
Magnolia’s 2026 manual repeats the MississippiCAN contract: standard outpatient decisions "within three (3) calendar days and/or two (2) business days following receipt of the request," with the same window for the provider to send missing information, extendable up to 14 days; expedited decisions within 24 hours. Claims are due within 180 days of service; secondary claims within 365 days of the primary payer’s EOP; reconsiderations and corrected claims within 90 days of the EOP. Claim appeals go on the Claim Appeal Form within 30 calendar days of the adverse determination. The contract requires CCOs to pay 90% of clean claims within 30 days and 99% within 90 days.[7][8][9]
Network entry runs through the Division: since July 1, 2022, providers "are now required to be enrolled, credentialed, and screened by DOM," selecting Magnolia on the Gainwell application. ABA rates follow the MississippiCAN ASD directed payment fee schedule written into the CCO contract.[7][8][9]
Mississippi licenses behavior analysts. The BACB’s licensure table lists Mississippi (2015) with the Mississippi Autism Board, which licenses Licensed Behavior Analysts and Licensed Assistant Behavior Analysts under Miss. Code Ann. § 73-75. To be licensed as a behavior analyst a person needs at least a master’s degree, "current and active certification" as a BCBA or BCBA-D, a fingerprint-based state and FBI background check, and the Board’s other requirements, which include an oral examination the Board gives at least quarterly (Rule 3.2); licenses run three years but never past the BACB certification. Assistant behavior analysts need a bachelor’s degree, BCaBA certification and proof of supervision by a licensed behavior analyst. Technicians are not licensed: the supervising licensee registers each Registered Behavior Technician with the Board, the technician "works solely under the license of the behavior analyst," and supervision follows the BACB’s policy (Rule 9). For a BCBA licensed in another state, the statute’s exemption list (§ 73-75-5: licensed psychologists, other licensed professionals within scope, supervised technicians, family members, trainees, school employees) does not include behavior analysts licensed elsewhere, and the Board’s rules contain no telehealth provision, so plan on a Mississippi license before treating a Mississippi patient in person or by telehealth. The route is licensure by reciprocity (Rule 3.4), which still requires meeting the Rule 3.1 and 3.2 requirements; a temporary license exists only for applicants awaiting exam scores or the next oral exam, restricts practice to Mississippi and requires supervision. The autism mandate ties into this: a "licensed behavior analyst" in § 83-9-26 is one licensed under § 73-75-13.[14][15][16][17]
The questions that decide whether a family can start with Magnolia Health (MississippiCAN / CHIP), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21: MississippiCAN ASD services follow the State Plan EPSDT benefit (ASD fee schedule ages 0–20), and the CCO contract’s ASD payment arrangement targets members "up to age 21."[11][8]
To start: CDE within the past three years, or a CDE three to five years old plus a diagnostic interview within 12 months of the request. To continue: CDE within five years (sooner for a provisional diagnosis or other listed reasons).[5]
A licensed physician, psychologist, or other licensed professional with specialized training in diagnosing and treating ASD, or a provider otherwise authorized by state law to diagnose autism.[5]
At least one primary clinician tool (STAT, ADI-R, CARS-2, ASRS, ADOS-2, EarliPoint, RITA-T, CSBS DP-ITC or other evidence-based tool) and one parent/caregiver tool (M-CHAT-R/F, SCQ, ASSQ, CAST, SRS-2, SWYC POSI, CSBS DP ITC). A Vineland used as the skills assessment needs an additional direct skills assessment (VB-MAPP, ABLLS-R, AFLS, PEAK, EFL and others).[5]
The recommendation for ABA must come from a licensed physician, psychologist or other licensed professional trained in ASD (it may be in the CDE), and is required whenever an initial or updated CDE is required.[5]
CP.BH.104 allows telehealth as a modality; CP.BH.105 requires a HIPAA-compliant platform with the rendering provider’s camera and audio on, and says the monthly one-on-one protocol work is not by telehealth "unless allowed by state guidelines." The state rule (Part 225) lists BCBAs as telehealth providers and the home as an originating site, live audiovisual only, billed with a telehealth modifier.[5][6][12]
Standard outpatient decisions within three calendar days and/or two business days of receipt, extendable up to 14 days; expedited within 24 hours (Magnolia 2026 manual; CCO contract § 4.3.3). Request outpatient services at least five calendar days ahead; concurrent requests need information less than 30 days old.[7][8][3]
Coverage decides whether Magnolia Health (MississippiCAN / CHIP) 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.
CP.BH.104 requires treatment to be "delivered or supervised by an ABA-credentialed professional," and protocol modification (97155) "for at least two hours per week or 10% of the direct service hours provided (whichever is greater), and no more than 20%." CP.BH.105 adds at least monthly one-on-one protocol work by the ABA supervisor, not by telehealth unless state guidelines allow. The State Plan requires RBTs to work "under the direct supervision and direction of a BCBA or BCaBA."[5][6][10]
CP.BH.104 screens at six hours a day and 30 hours a week, with more allowed when documentation shows clinical need; under 20 hours a week is expected for a child in school full time. 97153/97154 units not backed by the 10% protocol-modification standard over the six-month authorization are "subject to denial of payment or recoupment" (CP.BH.105).[5][6]
Session notes must be "completed prior to claim submission" and include the provider organization and rendering provider at the top, exact start and end times, pauses, location, service code, the "Signature of qualified rendering provider/technician," and, for 0373T/97155/97158, the protocol modifications made; caregiver signature is recommended on caregiver-training notes. Treatment-plan documents carry the signatures of the member or guardian, rendering clinician and supervising practitioner.[6]
CP.BH.104 says services "may be provided in various settings (e.g., home, clinic, school, community) and modalities (e.g., in-person, telehealth)," with a detailed school-based plan when ABA is delivered at school, and lists services "in lieu of school, respite care" as a reason to discontinue.[5]
Magnolia’s documents do not say whose NPI goes on an ABA claim. The State Plan rule applies: "licensed practitioners bill for the services provided by the unlicensed practitioners." Magnolia’s manual requires the rendering provider’s NPI in box 24J with rendering and group taxonomy codes.[10][7]
CP.BH.105 allows 97155 "to demonstrate new or modified protocol to a technician with the member/enrollee present," but says technician supervision alone and team meetings "do not constitute protocol modification." It does not state whether 97153 and 97155 may be billed for the same minutes.[6]
Ask the plan: Magnolia Provider Services, 1-877-236-0751: ask whether 97153 is payable for the same time as 97155 with the technician present.
Yes, for MississippiCAN members under 21, with prior authorization under clinical policy CP.BH.104.
Not for 97151, which is not on Magnolia’s PA list. 97152, 0362T and the treatment codes require PA.
Up to three years to start ABA, or three to five years with a diagnostic interview done within 12 months. For continued treatment the evaluation must be within five years.
Within three calendar days or two business days of receiving it, and 24 hours for an expedited request, with possible 14-day extensions.
CP.BH.104 screens at six hours a day and 30 hours a week, and fewer than 20 hours a week for a child in school full time; more is possible with documented clinical need.
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.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo