Molina Healthcare of Illinois is a statewide HealthChoice Illinois plan and has covered ABS since November 1, 2020. Of the Illinois plans, it went furthest in reading Public Act 104-0028: from January 1, 2026 ABA has no prior authorization at all, only concurrent review that starts once a child passes 48 therapy units in the calendar year.
Molina’s January 22, 2026 memo: “authorization is not required for an Applied Behavioral Analysis (ABA) initial assessment, evaluation, or the first 48 units per calendar year for ABA therapy (cumulative of 0373T, 97153, 97154, 97155, 97156, 97157, 97158). Due to Illinois Public Act 104-0028, ABA services are no longer eligible for prior authorization and require concurrent review only effective January 1, 2026. Note: Providers must submit concurrent clinical no later than 24 hours after the initiation of the 49th unit for concurrent review.” Forty-eight units is 12 hours, so for a typical intensive program the clock starts in the first week. “Availity Essentials is the exclusive provider portal for Molina Healthcare—and the only way to submit authorization requests,” and clinical documents must accompany every request.[12][13][2][14][15][16][17]
Illinois Public Act 104-0028 (HB 3019) changed behavioral health utilization management from January 1, 2026, and each HealthChoice Illinois plan has read it differently for ABA. Molina says ABA “services are no longer eligible for prior authorization and require concurrent review only” (no authorization for the initial assessment or the first 48 units of therapy a calendar year). Aetna Better Health approves 97151/97152 without medical-necessity review if notified within one business day, then runs concurrent review. Blue Cross Community Health Plans and YouthCare ask for notification within 24 hours of starting ABA services or the initial assessment. Meridian requires notice within 24 hours of 97151/97152 from May 1, 2026 and keeps prior authorization on treatment. CountyCare removed PA from 97151/97152 only. The Act itself added subsection (w) to 215 ILCS 5/370c: from January 1, 2026 “No policy shall require prior authorization for outpatient or partial hospitalization services for treatment of mental, emotional, or nervous disorders or conditions,” such coverage “may be subject to concurrent and retrospective review,” and “A Medicaid managed care organization may set a deadline of 24 hours after the initiation of treatment” for notification (one more business day if it cannot accept the notice). It also lets HFS “adopt rules to implement the applicable provisions” for managed care organizations “and the medical assistance fee-for-service program” (new 305 ILCS 5/5-5.28). The statute does not name ABA, which is why the plans differ; this guide reports each plan’s own written rule.[12][13][2][14][15][16][17]
Molina’s 2026 Medicaid provider manual (updated 09/2026): “Standard timely filing is 180 days for Medicaid.” Standard authorization decisions and notice come “within five (5) calendar days,” expedited within 48 hours. Members may appeal within 60 calendar days of the adverse benefit determination. Molina is the payer of last resort. Molina’s ABS memo tells providers to “refer to the HFS fee schedules for correct codes and rates” and that RBT services are submitted by the supervising provider with the RBT as rendering provider in Loop 2310B; HFS’s current rule adds the supervising BCBA in Loop 2310D. On payment, the manual says “Typically, claims are processed within 30 days,” and that unless otherwise agreed in writing Molina “will process the claim for service within 30 days after receipt of clean claims.” Illinois law sets the payment clock for every HealthChoice Illinois plan: under 305 ILCS 5/5-30.1(g), “The MCO shall pay a claim within 30 days of receiving a claim that contains all the essential information needed to adjudicate the claim,” must notify the billing party within 30 days when it cannot adjudicate a claim, and owes a late-payment penalty at least equal to the Insurance Code’s timely-payment interest, calculated and paid within 30 days after the claim is paid, without the provider having to ask for it. No plan document we read publishes a weekly submission cutoff or check-run day; ask the plan’s provider services for its payment cycle.[3][4][5][1]
The questions that decide whether a family can start with Molina Healthcare of Illinois, and what they have to bring. Each maps onto something intake should ask on the first call.
Molina publishes nothing of its own. HFS: a CDE more than 24 months old needs current functional-impairment documentation.[4][5]
Molina requires ASD “as indicated by a Comprehensive Diagnostic Evaluation”; HFS: the CDE is performed by a physician or clinical psychologist.[4][5]
Yes: services for members “who have been referred for ABS services by a physician,” with ongoing services recommended by a BCBA on a BATP. HFS’s physician order is valid one year.[4][5]
Molina’s manual follows CMS and state telehealth requirements and has no ABA-specific rule, so HFS’s applies. HFS’s ABS fee schedule (updated 05/14/2026) marks four codes for remote delivery: 97151 (assessment), 97155 (protocol modification), 97156 (family guidance) and 97157 (multiple-family group). The footnote reads: “Only use the GT or 93 modifier when providing allowable service remotely as a distant site telehealth service along with Place of Service (POS) 02 or 10, as applicable, on the specific service line of the claim.” 97152, 97153, 97154, 97158, 0362T and 0373T carry no telehealth modifier, so technician-delivered treatment is billed as in-person.[3][7]
Coverage decides whether Molina Healthcare of Illinois 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.
Molina publishes no ABA ratio of its own in the documents read (its 2022 memo’s collaborative-agreement language predates HFS’s 2023 change). HFS’s rule applies: RBTs “must receive supervision from a BCBA,” with Case Leadership of 5% or more of direct services in HFS’s ABS guidance.[4][6][5]
The only Molina unit rule is the 48-unit annual threshold before concurrent review. Molina points to the HFS fee schedule for codes and rates, whose daily maximums are 97153 32 units, 97155 24, 0373T 24.[2][4][7]
Molina’s memo: RBT services are “submitted by the collaborating BCBA (supervising Provider) with the RBT identified as the Rendering Provider in Loop 2310B of the 837P.” HFS’s ABS rule also requires the supervising BCBA’s name and NPI in Loop 2310D when an RBT renders.[4][5]
Not addressed in Molina’s memo or manual; HFS publishes no rule beyond NCCI edits.[2][3]
Ask the plan: Molina Provider Relations (MHILProviderNetworkManagement@MolinaHealthcare.com).
Not addressed in the Molina documents read.[3]
Ask the plan: Molina Provider Relations or the documentation standards in your Molina agreement.
No. Since January 1, 2026 ABA has concurrent review only: no authorization for the initial assessment or the first 48 units of therapy per calendar year.
Submit concurrent clinical no later than 24 hours after starting the 49th unit of the year, counted across 0373T and 97153–97158.
Through Availity Essentials, which Molina calls the only way to submit authorization requests, with clinical documents attached.
Molina directs providers to the HFS ABS fee schedule (97153 $13.00, 97155 $20.39 per 15 minutes); contracted rates are in your agreement.
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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