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]
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]
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]
"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.
NH.PP.07 states "Documentation Requirements: Not Applicable," and the provider manual publishes no ABA session-note rule.[1][3]
Ask the plan: NH Healthy Families Provider Services, 1-866-769-3085, or the documentation terms in your provider agreement.
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.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 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