Molina Healthcare of Washington is one of the five Apple Health managed care plans HCA lists. It covers ABA under the state’s chapter 182-531A WAC pathway. What we could confirm about Molina’s own process comes from its slides in HCA’s February 2025 ABA technical assistance session; Molina’s Washington Medicaid provider pages and documents now return the company’s new-site "Page Not Found" page, so anything Molina-specific beyond that is marked "confirm with Molina."
At HCA’s February 27, 2025 ABA technical assistance session, Molina said: "Prior Authorization (PA) is typically required for ABA services. Please utilize Molina’s Prior Auth Look-up Tool to determine if PA is needed. PA is generally granted at the Group level, so anyone affiliated under the group can render the service." "BCBAs must be individually credentialed with Molina of Washington," while "CBTs and LABAs DO NOT need to be individually credentialed" and are added to the group by a mini-application or a roster sent to mhwproviderinfo@molinahealthcare.com. Contracting requests go to MHWProviderContracting@MolinaHealthcare.com with a W-9; claims go through Availity or a clearinghouse, and claim disputes through Availity. Molina’s autism case management team (four BCBA case managers) takes referrals at MHWCMReferrals@molinahealthcare.com, and general ABA questions go to aba@molinahealthcare.com or 1-800-869-7175.[3][5][6]
The rest of the pathway is the state’s: a Center of Excellence evaluation and prescription, an LBAT assessment and treatment plan, and prior authorization before treatment (WAC 182-531A-0500 to -0700). For MCO members the WAC says to "follow the managed care organization (MCO) process," and HCA requires every LBA, LABA and CBT to be enrolled as a servicing provider and listed on the group’s roster with each MCO.[3][5][6]
Federal Medicaid rules set the payment floor for every managed care plan: a state’s contract with an MCO "must provide that the organization will meet the requirements of § 447.45(d)(2) and (d)(3)" (42 CFR 447.46) — pay 90 percent of clean claims from practitioners within 30 days of receipt and 99 percent within 90 days — unless the plan and the provider agree in writing to an alternative schedule stipulated in the contract. A "clean claim" is one that "can be processed without obtaining additional information from the provider of the service or from a third party" (42 CFR 447.45(b)). Molina’s own Washington timely-filing, corrected-claim and secondary-claim limits sit in its Apple Health provider manual claims chapter, which returned a "Page Not Found" page when fetched for this guide; take them from your Molina agreement or Provider Services until it can be read.[1][2]
The questions that decide whether a family can start with Molina Healthcare of Washington, and what they have to bring. Each maps onto something intake should ask on the first call.
A Center of Excellence, by state rule for all Apple Health members (WAC 182-531A-0800); a COE serving Molina members must also be contracted with Molina. A Center of Excellence: an individual provider, not a facility. Licensed under Title 18 RCW and experienced in diagnosing and treating ASD, a developmental pediatrician, neurologist, pediatric neurologist, pediatric psychiatrist, psychiatrist or psychologist qualifies whether or not they are on HCA’s COE list. ARNPs (including psychiatric mental health nurse practitioners), physicians, physician assistants and naturopaths qualify only after HCA’s COE training and designation, on a signed COE Attestation form HCA 13-0009 (WAC 182-531A-0800). HCA may, at its discretion, accept a non-COE evaluation, for example a recent evaluation paid by the child’s primary insurance. A COE serving an MCO member must also be contracted with that MCO.[5][6]
By state rule: The COE documents "Results of formal diagnostic procedures performed by a provider, including name of measure, dates, and results, as available," or the clinical findings and observations used to confirm the diagnosis (WAC 182-531A-0500). The rule’s examples of ASD diagnostic tools are the ADI and the ADOS. If the COE has them, the evaluation must also include the ASD screening tool and date, a formal cognitive or developmental assessment with verbal, nonverbal and full-scale scores (examples: Mullen, Bayley, Wechsler) and a formal adaptive behavior assessment with domain scores (Vineland, ABAS), plus vision and hearing results.[5][6]
By state rule, a COE prescription is required for every Apple Health member. Yes: a COE prescription. "Any person may refer a client" to a COE for an evaluation, including the PCP, a school or early intervention professional, the family or the MCO, though many COEs require a PCP referral and an MCO may require prior authorization for the COE evaluation. If the COE concludes ABA is appropriate it writes "a prescription for ABA services" and sends the evaluation and prescription to the chosen ABA provider or the family (WAC 182-531A-0500). The COE evaluation and order go in with the first PA request.[5][6]
No Molina ABA timeframe could be read. Federal managed care rules apply: standard decisions "may not exceed 7 calendar days after receiving the request for service" for rating periods starting on or after January 1, 2026 (42 CFR 438.210(d)).[9]
Ask the plan: Molina behavioral health UM.
No Molina age rule could be read. The state rule sets none: No upper age limit. Chapter 182-531A WAC sets no age bound for ABA, and EPSDT (age 20 and younger) lets published limits be exceeded on medical necessity review. For a client first diagnosed at 21 or older, the COE who evaluates and orders ABA must be a psychiatric mental health nurse practitioner or a general practitioner designated by HCA as a COE, or a neurologist, psychiatrist or psychologist; ARNPs, physicians, PAs and naturopaths need additional COE training to prescribe ABA for adults.[5]
Blocked on: Molina behavioral health UM or aba@molinahealthcare.com.
Not confirmed for Molina. The state rule has no fixed expiry on the COE evaluation; the PA request is due within 60 days of the LBAT assessment.[5][6]
Blocked on: Molina behavioral health UM: ask how recent the COE evaluation must be.
No Molina telehealth rule could be read. The state rule: HCA’s ABA billing guide (January 1, 2026) lists the ABA codes allowed by telemedicine. Allowed: 97155, 97156 and 97157, plus team conferences 99366 and 99368. Allowed with limits: 97151, but only for indirect work (caregiver interviews and rating scales, treatment plan development, record review, scoring); direct observation and direct assessment of the child may not be done remotely. In the day treatment program (H2020), direct ABA must be in person in the clinic, and CBT supervision may be by audio-visual telemedicine only while an LBAT stays on site. Not allowed by telemedicine: 0362T, 0373T, 97153, 97154 and 97158. For telemedicine the originating site is where the client is (where the caregiver is, for caregiver training). Bill POS 02, or POS 10 when the client is at home, and add modifier 95 when the distant site is a nonfacility; to bill for a client located in Washington the practitioner must be licensed in Washington or hold a compact license Washington recognizes, and no behavior analyst compact is on HCA’s list.[6][8]
Blocked on: Molina Provider Services, (855) 322-4082: confirm Molina follows HCA’s ABA telemedicine code list.
Coverage decides whether Molina Healthcare of Washington 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.
The rendering clinician. Molina authorizes at the group level, but HCA requires each LBA, LABA and CBT to be enrolled with HCA, on the group roster sent to the MCO, and in the servicing provider box on claims for dates of service from July 1, 2025, with taxonomy 103K00000X in both taxonomy fields.[3][6]
Molina’s own ABA policy could not be read. The state rule: The lead behavior analysis therapist (LBAT) must "Supervise a minimum of five percent of the total direct care per week provided by the CBT (e.g., one hour of supervision per twenty hours of care)," and a CBT must be "supervised directly by an LBAT for at least five percent of total direct care per week" (WAC 182-531A-0700) and review the client’s progress with the LBAT at least every two weeks. When a LABA fills the LBAT role, the LABA and the supervising LBA or licensed psychologist share those duties. DOH’s licensing rule layers on top: at least two face-to-face contacts a month with each CBT and direct supervision and observation of at least five percent of the CBT’s monthly hours, seeing the CBT with each client at least once every three months (WAC 246-805-330).[6][5]
Blocked on: Molina behavioral health UM or aba@molinahealthcare.com: confirm Molina applies the Apple Health 5 percent LBAT supervision floor.
Not addressed in any Molina source read; the state guide does not settle 97153/97155 overlap.[3][7]
Ask the plan: Molina Provider Services, (855) 322-4082, or your Molina provider agreement.
No Molina unit limit could be read; units are set per authorization.[3]
Ask the plan: Molina behavioral health UM: ask whether HCA’s fee-schedule unit limits apply.
No Molina documentation rule could be read.[3]
Blocked on: Molina Washington Apple Health provider manual (request from Provider Relations).
Molina’s setting rules could not be read. The state rule: Home, center, community (a school, daycare, inpatient unit or playground, for example) or an HCA-approved day treatment program, or a mix. Services in community settings such as a school or restaurant "must be included in the ABA therapy treatment plan" (WAC 182-531A-0600). Not covered unless prior authorized: "School-based health care services or early intervention program-based services" (WAC 182-531A-1000). Inpatient ABA is limited to short-term, focused treatment of severe harmful behavior that is preventing discharge, ordered by a COE. The day treatment program (H2020) is typically authorized once in a lifetime for 48 service days.[5][6]
Blocked on: Molina behavioral health UM: confirm which settings and POS codes Molina pays for ABA.
Its state contract must hold it to the federal Medicaid standard: 90% of clean practitioner claims paid within 30 days of receipt and 99% within 90 days (42 CFR 447.46, 447.45), unless the provider contract sets an alternative schedule. Its own filing limit comes from the provider manual or your agreement.
Molina says PA is typically required and to check each code in its Prior Auth Look-up Tool. Authorizations are generally issued to the group, so any clinician affiliated with the group can render the service.
No. Molina credentials BCBAs individually; CBTs and LABAs are added to the group by roster or mini-application. All must still be enrolled with HCA.
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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