NH Healthy Families is Centene’s New Hampshire Medicaid plan (underwritten by Granite State Health Plan, Inc.) and one of the three plans DHHS lists. Its ABA rules are spread across three documents: a 2019 payment policy that set the codes and kept prior authorization, a 2024 tip sheet that moved ABA onto the behavioral health platform, and the January 2026 provider manual that sets the decision clock.
Payment policy NH.PP.07 (effective May 1, 2019) ended the old bundled H2019 rate and pays ABA in "three (3) distinct components of ABA therapy: direct treatment, supervision, and parent training": 97153 direct treatment, 97155 supervision of a technician, 97156 parent training, plus 97151 for the initial assessment or reassessment, whose maximum rose "from 8 units (2 hours) to 32 units (8) hours." The same policy says "ABA treatment must be billed under the qualified rendering provider and will continue to require prior authorization."[1][2]
Since June 1, 2024, ABA is adjudicated on the behavioral health platform: Medicaid ABA claims go to payer ID 68068 (Ambetter marketplace ABA to 68069). Prior authorization goes on the Outpatient Treatment Request form or through the behavioral health portal, and new ABA providers enroll with the Behavioral Health Provider Specialty Profile. Existing authorizations were converted without re-authorization.[1][2]
InterQual, since June 1, 2026. In an April 28, 2026 notice NH Healthy Families said it "will retire Clinical Policy CP.BH.104, Applied Behavioral Analysis (ABA) Services," and that "Beginning on June 1, 2026, InterQual® criteria will be utilized to evaluate medical necessity determinations for all authorization requests related to Applied Behavioral Analysis (ABA) services, inclusive of all applicable ABA service codes" — for initial and concurrent reviews. InterQual is licensed criteria the plan does not publish. What did not change: prior-authorization requirements stay as they were, determinations still follow the NH Medicaid managed care contract and EPSDT, and "CP.BH.105 (ABA Clinical Documentation Requirements) is not affected by this change." CP.BH.105 requires the treatment record to be complete before the claim is submitted and a dated, credentialed signature from the rendering clinician or technician on every note.[10][11]
The questions that decide whether a family can start with NH Healthy Families, and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. The plan covers ABA within NH Medicaid’s EPSDT benefit, which covers members under 21 (He-W 546.02); it publishes no different age rule.[6][1]
The plan publishes nothing different from the state, where ABA must be "recommended by a licensed clinician who has experience in the diagnosis and treatment of autism spectrum disorder" (physician, psychologist, or developmental-medicine NP or PA; He-W 589.04(aj)).[1][6]
NH Healthy Families’ ABA documents (NH.PP.07, the provider manual) set no telehealth rule of their own, so the state rule applies. RSA 167:4-d requires the NH Medicaid program to “provide coverage and reimbursement for health care services provided through telemedicine on the same basis as the Medicaid program provides coverage and reimbursement for health care services provided in person,” with “no restriction on eligible originating or distant sites” (the child’s home counts) and reimbursement for “all modes of telehealth, including video and audio, audio-only, or other electronic media … for all medically necessary services.” Its list of providers who may use all modes names “Professionals certified by the national behavior analyst certification board or persons performing services under the supervision of a person certified by the national behavior analyst certification board.” So the BCBA assessment (97151/97152), supervision with protocol modification (97155) and technician and family services are inside the statute, subject to medical necessity; the statute names no in-person minimum for supervision. It is “conditioned upon review and approval of a state plan amendment,” and no NH Medicaid ABA document read publishes an ABA telehealth code list, POS or modifier.[9][1][3]
Standard requests: "the decision and notification will be made no more than seven (7) calendar days from receipt of the request (unless an extension is requested)." Urgent pre-service requests: 72 hours. Supply clinical information promptly: "Failure to submit necessary clinical information within forty-eight (48) hours of the request can result in an administrative denial." Routine requests should go in "at least five calendar days before the scheduled service delivery date"; out-of-network requests need 10 calendar days.[3][7]
"NH Healthy Families is always the payer of last resort." Providers must make reasonable efforts to identify other coverage (individual, group, employer, self-funded or commercial) and tell the plan if the family won’t cooperate. If other coverage is found after services, the plan "will coordinate with the provider to pay any claims that may have been denied for payment due to third party liability."[3][8]
Not stated by the plan or the state.[1]
Ask the plan: NH Healthy Families Utilization Management, 1-866-769-3085.
Not stated by the plan. The state rule names who must recommend ABA (physician, psychologist, or developmental-medicine NP or PA; He-W 589.04(aj)), not who may diagnose.[1][6]
Blocked on: NH Healthy Families Utilization Management, 1-866-769-3085.
Not stated by the plan or the state.[1]
Ask the plan: NH Healthy Families Utilization Management, 1-866-769-3085: ask which instruments it expects with the OTR.
Coverage decides whether NH Healthy Families 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.
NH.PP.07 treats 97155 as "Supervision of a Technician" but sets no ratio, and the plan publishes no other supervision rule. The state rule applies: a BCBA with BACB supervisory certification supervises BCaBAs, RBTs and rehabilitation assistants, with no numeric ratio (He-W 589.04(ah)).[1][6]
The only published unit limit is on the assessment: 97151 initial assessment or reassessment up to 32 units (8 hours), raised from 8 units in line with BACB guidance and CMS medically unlikely edits. Treatment units are set by the authorization.[1]
NH.PP.07 states "Documentation Requirements: Not Applicable," but the plan’s clinical policy CP.BH.105 (ABA Documentation Requirements, last revised 11/23) does set the rule, and NH Healthy Families said in April 2026 that CP.BH.105 "is not affected" by its move to InterQual. It requires "Completion of the treatment record prior to submission of a claim," and every note must show the provider organization, the member’s name on each page, date of service, time in and time out, pauses, location, the service code, and the "Rendering clinician/technician’s name, credentials, and dated signature." Addenda must reference the note they supplement and carry the date and a "Signature with credentials." Technician notes add target areas, techniques and barriers; QHP notes add protocol modifications and direction of technicians.[11][10][1]
"ABA treatment must be billed under the qualified rendering provider" (NH.PP.07). ABA claims go to the behavioral health platform, payer ID 68068 for Medicaid.[1][2]
Not addressed. NH.PP.07 lists 97153 and 97155 as separate components without saying whether they may be billed for the same clock time.[1]
Ask the plan: NH Healthy Families Provider Services, 1-866-769-3085, or your Provider Engagement Account Manager.
The plan publishes no ABA setting rule. At the state level, school-based ABA is billed by school districts under the Medicaid to Schools program (He-W 589).[1][6]
Ask the plan: NH Healthy Families Provider Services, 1-866-769-3085: ask which place-of-service codes it pays for ABA.
Yes, for New Hampshire Medicaid members. It pays 97151, 97153, 97155 and 97156 and requires prior authorization for ABA treatment.
To the behavioral health platform: payer ID 68068 for Medicaid, for dates of service on or after June 1, 2024.
Within 7 calendar days for standard requests and 72 hours for urgent ones, per its January 2026 provider manual.
Yes, under New Hampshire law. RSA 167:4-d requires NH Medicaid to cover telehealth on the same basis as in-person care, from any site including the home, and names BACB-certified professionals and the staff they supervise. That includes the 97151 assessment and 97155 supervision when medically necessary. The plan publishes no ABA-specific telehealth rule, so ask it which POS and modifier to bill.
InterQual Behavioral Health criteria, for initial and concurrent requests, since June 1, 2026; Centene’s CP.BH.104 was retired. Prior authorization requirements did not change, and the CP.BH.105 documentation rules (complete, signed notes before you bill) still apply.
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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