---
title: "Molina Healthcare of Mississippi ABA coverage: the intake guide."
url: "https://carelu.com/payers/molina-healthcare-mississippi"
markdown_url: "https://carelu.com/payers/molina-healthcare-mississippi.md"
state: MS (Mississippi)
payer: Molina Healthcare of Mississippi (MississippiCAN / CHIP)
kind: Medicaid managed care plan (MCO)
parent_program: Mississippi Medicaid (MississippiCAN)
description: "How Molina Healthcare of Mississippi covers ABA for MississippiCAN members: ABA prior authorization, Molina’s MCP-482 criteria, the 3-day contract decision clock, timely filing, telehealth and appeals."
last_reviewed: October 2026
---

# Molina Healthcare of Mississippi ABA coverage: the intake guide.

_Payer Guide · Molina Healthcare · Mississippi · Last updated October 2026 · 15 primary sources_

> Molina’s MississippiCAN/CHIP plan: ABA requires PA (2026 Pre-Service Review Guide); MCP-482 criteria; BH auth 1-844-826-4335.

Molina Healthcare of Mississippi is one of the three MississippiCAN and CHIP coordinated care organizations. Its 2026 provider manual says nothing specific about ABA beyond listing autism among its clinical practice guidelines; what it does say is that Molina "follows state-specific criteria, if available, before applying Molina-specific criteria." Mississippi publishes no ABA medical-necessity criteria, so Molina’s national clinical policy MCP-482 (approved June 10, 2026) is the policy to prepare for.

This plan administers the **Mississippi Medicaid (MississippiCAN)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Mississippi Medicaid guide](https://carelu.com/payers/mississippi-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Molina Prior Authorization Look-Up Tool (Availity) or Healthcare Services, 1-844-826-4335: check 97151, 97152 and 0362T. [1][2]
- **Prior auth for treatment**: Required: "Applied Behavioral Analysis (ABA) – for treatment of Autism Spectrum Disorder (ASD)" is on Molina’s Medicaid Pre-Service Review Guide (eff. 1/1/2026); behavioral health non-inpatient fax 1-844-206-4006 [1]
- **Autism diagnosis required?**: Yes: a DSM-5/DSM-5-TR ASD diagnosis by a qualified provider or multidisciplinary team using at least one validated tool (Molina Clinical Policy MCP-482) [4][3]

## At a glance

- **Covers ABA?:** Yes, State Plan ASD services for members under 21
- **Prior auth:** ABA requires PA (2026 Pre-Service Review Guide); code detail in the look-up tool
- **BH authorization:** Phone 1-844-826-4335; non-inpatient fax 1-844-206-4006
- **Decision clock:** Contract: 3 calendar days or 2 business days; manual: expedited within 24 hours
- **Timely filing:** 180 days from DOS; 90 days to correct a denial
- **Licensure:** Mississippi Autism Board license; DOM centralized credentialing

## Prior authorization and Molina’s criteria

Molina’s Medicaid Pre-Service Review Guide (effective 01/01/2026) lists "Applied Behavioral Analysis (ABA) – for treatment of Autism Spectrum Disorder (ASD)" under behavioral health services requiring prior authorization and refers providers to the look-up tool for specific codes. Behavioral health authorizations are by phone at 1-844-826-4335 or fax at 1-844-206-4006 for non-inpatient requests; denials are communicated "within one business day of making the denial decision," and a Molina medical director is available for peer-to-peer review, which can be requested within five business days of an adverse determination. [1][3][4]

MCP-482 requires a diagnosis "in accordance with DSM-5 or DSM-5-TR criteria," made by "a multidisciplinary team with expertise in diagnosing ASD utilizing at least ONE clinically validated tool (e.g. ADI-R, ADOS-2, CARS-2, or DISCO)," an ASD initiation age of 18 months or older, documentation from the primary care physician of initial developmental concerns, and adaptive or functional assessments (Vineland, ABAS) for a baseline. If the standardized diagnostic assessment is more than 24 months old, updated documentation must describe current symptoms. The treatment plan is developed by a BCBA or BCBA-D, who "provides direct and consistent supervision" to BCaBAs or RBTs; reassessments occur at least every six months; plans above 25 direct hours a week need added justification. [1][3][4]

## Decision clock, claims and appeals

The MississippiCAN contract Molina signed requires standard authorization decisions "within three (3) calendar days and/or two (2) business days," and the manual commits to expedited decisions "no later than 24 hours" after the request. Claims are due within 180 calendar days of service; denied claims may be corrected and resubmitted within 90 days of the denial; as secondary payer, within 180 days of the primary’s final determination. Claim disputes go on the Claims Request for Reconsideration Form within 90 calendar days of the remittance advice, decided within 30 days. Provider appeals are due within 30 calendar days of the adverse determination; after exhausting them, a provider may request a Division of Medicaid administrative hearing within 30 calendar days of Molina’s final decision. [5][3]

## Licensure and out-of-state BCBAs

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. [10][11][12][13]

## Intake gates

The questions that decide whether a family can start with Molina Healthcare of Mississippi (MississippiCAN / CHIP), and what they have to bring.

- **Age limit**: Under 21 under the State Plan EPSDT benefit (ASD fee schedule ages 0–20); MCP-482 adds an ASD initiation age of 18 months or older. [7][4]
- **Diagnosis recency**: If the standardized diagnostic assessment is more than 24 months old, "updated documentation must describe current ASD symptoms and functional impact" (MCP-482). [4]
- **Who may diagnose**: A qualified provider or multidisciplinary team with ASD expertise, "e.g., clinical psychologists, developmental pediatrician, pediatric neurologist, psychiatrist, or other licensed clinicians permitted under applicable state law to diagnose ASD." [4]
- **Diagnostic tools required**: At least one clinically validated tool (ADI-R, ADOS-2, CARS-2 or DISCO, as examples); screening instruments "do not independently establish" the diagnosis; adaptive measures (Vineland, ABAS) for baseline. [4]
- **Referral required?**: MCP-482 requires documentation from the member’s primary care physician "noting initial developmental concerns, screenings, referrals, and treatments provided." [4]
- **Telehealth**: MCP-482 limits telehealth to "caregiver training, coaching and supervision, or other indirect service components," used with in-person ABA in a documented hybrid model. Molina’s manual says telehealth must come from a participating provider and points to Administrative Code Part 225, which lists BCBAs as telehealth providers with the home as an originating site. [4][3][8]
- **Prior-auth decision time**: Standard decisions within three calendar days and/or two business days (MississippiCAN contract § 4.3.3), extendable up to 14 days; expedited "no later than 24 hours" (Molina manual). [5][3]
- **Other insurance (who pays first)**: "Medicaid is always the payer of last resort": bill the primary and send its EOB. Molina "will pay claims for prenatal care and preventive pediatric care (EPSDT) and then seek reimbursement from third parties." Secondary claims are due within 180 days of the primary’s final determination. [3][9]

## Delivery and billing rules

Coverage decides whether Molina Healthcare of Mississippi (MississippiCAN / CHIP) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: MCP-482: the BCBA or BCBA-D who develops the plan "provides direct and consistent supervision to Board-Certified Assistant Behavior Analyst (BCaBA) or Registered Behavior Technicians (RBTs)," with no numeric ratio. The State Plan requires RBTs to work "under the direct supervision and direction of a BCBA or BCaBA." [4][6]
- **Daily limits / MUEs**: MCP-482 sets no daily cap; plans above 25 direct hours a week must meet added high-intensity criteria and be reassessed at least every six months. Daily units are also subject to the Medicaid MUE edits on the state fee schedule. [4][7]
- **Bill as provider**: Molina publishes no ABA rendering-provider rule. The State Plan rule applies: "licensed practitioners bill for the services provided by the unlicensed practitioners." [6][3]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Neither Molina’s Mississippi manual nor MCP-482 addresses billing 97153 and 97155 for the same time, and the state publishes no rule. [3][4]
  - Ask the plan: Molina Mississippi Provider Services, 1-844-826-4335, or your Molina provider agreement.
- **Session-note signature** _(ask the plan)_: Molina’s manual expects legible signatures and credentials of the provider and staff on paper records, but publishes no ABA-specific session-note rule. [3]
  - Ask the plan: Molina Mississippi Provider Services, 1-844-826-4335: ask for its ABA documentation standards.
- **Place of service** _(ask the plan)_: Molina’s Mississippi documents publish no ABA setting rule. [3][4]
  - Ask the plan: Molina Mississippi Provider Services, 1-844-826-4335: ask which POS codes it pays for ABA (home, clinic, school, community).

## What intake should collect for Molina Healthcare of Mississippi (MississippiCAN / CHIP)

- **Member ID:** Confirm Molina MississippiCAN or CHIP on the date of service.
- **Diagnostic report:** DSM-5/5-TR ASD diagnosis with at least one validated tool (ADOS-2, ADI-R, CARS-2, DISCO); updated symptom documentation if older than 24 months.
- **PCP documentation:** MCP-482 asks for the primary care physician’s notes on initial developmental concerns, screenings and referrals.
- **Adaptive baseline:** Vineland or ABAS results.
- **Other insurance:** Molina pays EPSDT claims and then seeks third-party reimbursement; still record every other coverage.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does Molina Healthcare of Mississippi cover ABA?

Yes, for MississippiCAN members under 21, with prior authorization; its 2026 Pre-Service Review Guide lists ABA for ASD.

### Which ABA criteria does Molina use in Mississippi?

Molina applies state-specific criteria first; Mississippi publishes none for ABA, so its national clinical policy MCP-482 applies.

### Can ABA be done by telehealth with Molina?

MCP-482 allows telehealth for caregiver training, coaching, supervision and other indirect parts of ABA, alongside in-person treatment.

### What is Molina’s timely filing limit in Mississippi?

180 calendar days from the date of service; corrected denied claims within 90 days of the denial.

## Primary sources

1. [Molina Healthcare Medicaid (Mississippi) — Pre-Service Review Guide, effective 01/01/2026](https://www.molinahealthcare.com/-/media/Project/PWS/Healthcare/PDF/PDF/Providers/MS/Prior-Auth/English/MHMS-PA-Guide-Request-Form-MSCAN-CHIP-2026.pdf)
2. [Molina Healthcare of Mississippi — Prior authorization (provider page)](https://www.molinahealthcare.com/providers/ms/prior-auth)
3. [Molina Healthcare of Mississippi — 2026 MSCAN and CHIP Provider Manual (clean version, 6/25/2026)](https://www.molinahealthcare.com/-/media/Project/PWS/Healthcare/PDF/PDF/Providers/MS/Manuals/PRMANMDMSEN0326-2026-MSCAN-and-CHIP-Provider-Manual-Clean-Version-final_remediated-6-25-26.pdf)
4. [Molina Clinical Policy MCP-482 — Applied Behavioral Analysis for Autism Spectrum Disorder (last approval 06/10/2026)](https://www.molinaclinicalpolicy.com/molinaclinicalpolicy/-/media/Molina/PublicWebsite/PDF/Common/Molina-Clinical-Policy/Applied-Behavioral-Analysis-for-Autism-Spectrum-Disorder_R.ashx)
5. [Mississippi Coordinated Care Contract — Molina Healthcare of Mississippi (Aug. 12, 2024 – Aug. 11, 2028)](https://medicaid.ms.gov/wp-content/uploads/2024/08/Molina-Healthcare-Coordinated-Care-Services-Contract_20240812.pdf)
6. [Mississippi State Plan, Attachment 3.1-A Exhibit 4b p.6 + Attachment 4.19-B p.4b(2) — Autism Spectrum Disorder (ASD) Services (SPA 16-0020, eff. 1/1/2017)](https://medicaid.ms.gov/wp-content/uploads/2017/05/SPA-16-0020-ASD-Services-Approved-Pages.pdf)
7. [Mississippi Division of Medicaid — Autism Spectrum Disorder Services Fee Schedule, July 2026 (.xlsx)](https://medicaid.ms.gov/wp-content/uploads/2026/07/ASD-FEE_SHEDULE-JULY-2026-fnl.xlsx)
8. [Miss. Admin. Code Title 23, Part 225 — Telemedicine (eff. 8/1/2026)](https://medicaid.ms.gov/wp-content/uploads/2026/07/Title-23-Part-225-Telemedicine-eff-8.1.26.pdf)
9. [Miss. Admin. Code Title 23, Part 306 — Third Party Recovery (eff. 9/1/2023)](https://medicaid.ms.gov/wp-content/uploads/2023/09/Title-23-Part-306-Third-Party-Recovery-eff.-9.1.23.pdf)
10. [BACB — U.S. Licensure of Behavior Analysts (Mississippi: 2015, MS Autism Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
11. [Miss. Code Ann. § 73-75-13 — eligibility for licensure as a behavior analyst or assistant behavior analyst (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-13/)
12. [Miss. Code Ann. § 73-75-5 — exemptions from the behavior analyst licensure chapter (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-5/)
13. [Mississippi Autism Board — Title 30 Part 3301, Licensure of Behavior Analysts and Assistant Behavior Analysts (rules final 3/13/2024)](https://www.msautismboard.ms.gov/sites/autism/files/UploadedDocuments/2024/MAB%20R&R%20(Final)%203.13.2024.pdf)
14. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
15. [Molina Healthcare of Mississippi — Provider announcements and Molina Matters newsletters](https://www.molinahealthcare.com/providers/ms/communications)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.