Oakland Community Health Network (OCHN) is the PIHP for Oakland County (region 8). For an Oakland County child on Medicaid, OCHN owns the autism evaluation and the ABA benefit, delivered through core provider agencies (CPAs) for support coordination and a network of ABA agencies. The state rules in our Michigan Medicaid guide are the floor; this guide covers OCHN’s published process.
OCHN publishes its sequence. Children not already receiving CMH services are screened through OCHN Access (248-464-6363); children already in CMH services are screened for ABA by their core provider agency. "A full medical and physical examination is required prior to a referral to OCHN." The diagnostic evaluation is "Performed by OCHN clinical diagnostician" and combines a caregiver interview, input from doctors, teachers and other providers (with consent), a record review, developmental, cognitive and language testing, adaptive functioning rated on the DD-CGAS, and observation with the ADOS-2; the clinical report includes the structured parent interview and/or ADI-R information, the DD-CGAS rating, the ADOS-2 scoring and a diagnostic summary with treatment recommendations.[1][2]
OCHN then uploads the documentation to MDHHS through the Waiver Support Application; "MDHHS approves the documentation within 12-48 hours," and children found eligible "will be linked to a CPA/ABA provider to begin coordination of services within 7 days." Children found not eligible are told by phone and sent a due-process notice. OCHN’s eligibility summary restates the state rule: Medicaid eligible, younger than 21, with an ASD diagnosis.[1][2]
Families pick both an ABA provider (for therapy) and a CPA (for support coordination). OCHN’s provider info sheet asks families to name two or three preferred ABA agencies and lists each agency’s setting (center, in-home, telehealth), hours and ages served; many serve 18 months to 21 years. OCHN describes each ABA plan as averaging "five to twenty-five hours of direct interventions per week depending on medical necessity," delivered in the home or a clinic, with parent or guardian training and participation.[3][2][4][5][6]
Staffing, billing and telehealth follow the MDHHS rules: 1:10 supervision, code-chart modifiers and same-time rules, and telehealth only for 97155–97158.[3][2][4][5][6]
The federal managed care rule covers this PIHP. When the network “is unable to provide necessary services, covered under the contract, to a particular enrollee,” the PIHP “must adequately and timely cover these services out of network for the enrollee, for as long as” the network cannot provide them. It must require the out-of-network provider “to coordinate with the MCO, PIHP, or PAHP for payment,” and the family’s cost must be no greater than in network (42 CFR 438.206(b)(4)–(5)). Oakland Community Health Network’s own out-of-network or single-case-agreement procedure and rate were not reviewed for this guide. Ask its utilization management or provider network team for an out-of-network authorization and the rate before the first session.[12]
What changes on Jan. 1, 2027. CMS records that at its September 2025 meeting the AMA CPT Editorial Panel "deleted CPT codes 0362T" and "0373T," "revised eight existing CPT codes" (97151 through 97158) and "created six new CPT codes" for adaptive behavior services; the AMA released the CPT 2027 code set on Sept. 9, 2026, with changes in effect on January 1. The ABA Coding Coalition’s 2027 guidance gives the final numbers: 97148 and add-on +97149 (behavior identification supporting assessment of harmful behavior, delivered by two technicians, additional technicians on the add-on), 97159 and add-on +97160 (adaptive behavior treatment of harmful behavior, same two-technician structure), 97173 (adaptive behavior treatment with analysis by a physician or other QHP, face-to-face with one patient) and 97180 (non-face-to-face services personally performed by the QHP, such as data review and modifying protocols). "Protocol modification" becomes "analysis" in the descriptors, and "since there is no grace period, 0362T and 0373T are invalid for dates of service on or after January 1, 2027." No state "approves" the codes themselves: they are Category I CPT codes that HIPAA requires on electronic claims, but, as the Coalition notes, HIPAA "does not, however, govern whether a payer covers a code / service, what a payer pays for a code / service, or what a payer requires to authorize" it, so each payer has to load them, price them and say how authorizations that list 0362T or 0373T carry over.[13][14][15][16][5][11]
MDHHS had not announced how Michigan Medicaid will handle the 2027 adaptive-behavior codes as of Nov. 1, 2026. Its bulletins run to MMP 26-48 (issued Oct. 30, 2026); one of them, MMP 26-46, does apply a 2027 CPT change (maternity codes), but none addresses ABA. The SFY 2027 Behavioral Health Code Charts (updated Sept. 30, 2026), the code list for behavioral health encounters, still list 0362T and 0373T and none of the new codes, and none of the proposed policies posted for public comment concerns them. OCHN reports ABA encounters on those MDHHS code charts, and we found no OCHN notice on the 2027 codes (its news and information page, checked Nov. 1, 2026). Ask OCHN how it will load the new codes and whether authorizations that list 0362T or 0373T carry over to dates of service from Jan. 1, 2027.[13][14][15][16][5][11]
MDHHS publishes no ABA fee screen for the autism benefit; the rate floor is in the Medicaid Provider Manual, Section 18.13: “All PIHPs will reimburse BHT-ABA services at a minimum to the rate outlined with the most recent executed PIHP contract.” The rate a provider is actually paid is the one in its network contract, so the answer to “what does OCHN pay for 97153?” comes from the contract or rate sheet: ask OCHN (provider network / contracting) for the current ABA rates by code and credential before signing.[4]
The questions that decide whether a family can start with Oakland Community Health Network (OCHN), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21. OCHN: ABA is offered to individuals who "Are Medicaid eligible," "Are younger than 21 years of age" and "Have an Autism Spectrum Disorder (ASD) Diagnosis," matching the manual.[2][4]
OCHN applies the state rule; its published autism material sets nothing different. No expiry on the diagnosis itself. "Comprehensive diagnostic re-evaluations are required no more than once every three years, unless determined medically necessary more frequently" by a physician or other licensed practitioner, with frequency based on age, developmental level, comorbidities, severity and adaptive deficits. The level of service is re-determined at least every six months, and BHT authorizations run up to 365 days.[4][2][1][3]
OCHN performs the evaluation with its own clinical diagnostician. The manual defines who may diagnose: a psychiatry or neurology physician; a developmental or developmental-behavioral pediatrician; a pediatrician or other physician with ASD expertise; a psychologist; an APRN or PA with ASD or behavioral-health training; or a fully licensed master’s clinical social worker experienced in diagnosing ASD.[1][4]
OCHN’s evaluation combines a caregiver interview, collateral input and records with developmental, cognitive and language testing, adaptive functioning on the DD-CGAS, and observation on the ADOS-2; the report includes a structured parent interview and/or ADI-R information, the DD-CGAS rating, ADOS-2 scoring, and a diagnostic summary with treatment recommendations.[1][4]
Children not receiving CMH services are screened via OCHN Access at (248) 464-6363 (Mon–Fri 8 a.m.–8 p.m.); children already in CMH services are screened for ABA by their core provider agency. "A full medical and physical examination is required prior to a referral to OCHN," matching the manual’s PCP screening-and-exam requirement.[1][2][4]
OCHN applies the state rule; its published autism material sets nothing different. Only the analyst-level codes. The MDHHS Bureau of Specialty Behavioral Health Services Telemedicine Database lists 97155, 97156, 97157 and 97158 as allowed via simultaneous audio/visual telemedicine (reported with POS 02 or POS 10, no modifier), and its revision log records that 0362T, 97151, 97153 and 97154 were removed from the database on 4/28/23 — so technician-delivered direct treatment and the behavior identification assessment are in-person. The diagnostic-evaluation codes 96112/96113 and 96116 remain allowed via audio/visual "for reporting BHT/ABA eligibility assessments and re-evaluation assessments related to Autism." The SFY 2027 code charts note on 97155 and 97156 to use POS 02 "if MDHHS has authorized tele-practice for an individual."[6][5][2][1][3]
OCHN applies the state rule; its published autism material sets nothing different. The PIHP decides, under the federal managed-care clock. Section 18 says "The PIHP’s Utilization Management will authorize the level of services prior to the delivery of services," and the manual requires determinations "Made within federal and state standards for timeliness." Under 42 CFR 438.210(d) a PIHP must decide a standard request within state-set timeframes that "may not exceed 14 calendar days" for rating periods that start before January 1, 2026 and "may not exceed 7 calendar days" for rating periods starting on or after that date, extendable by up to 14 calendar days at the enrollee’s or provider’s request or with justification; expedited decisions are due within 72 hours. Which cap binds depends on the PIHP contract’s rating-period start date. BHT authorizations run for up to 365 days and are re-authorized annually.[4][4][8][2][1][3]
OCHN applies the state rule; its published autism material sets nothing different. Medicaid pays last. "Medicaid is considered the payer of last resort. If a beneficiary with Medicare or Other Insurance coverage is enrolled in a Medicaid Health Plan (MHP), or is receiving services under a Prepaid Inpatient Health Plan (PIHP) or Community Mental Health Services Program (CMHSP), that entity is responsible for the Medicaid payment liability." Providers "must utilize other payment sources to their fullest extent" before billing Medicaid, and "Medicaid is not liable for payment of services denied because coverage rules of the primary health insurance were not followed" — so get the commercial plan’s prior authorization and use its network. The ABA section adds that the IPOS must not duplicate services that are the responsibility of "a private insurance or other funding authority." Nothing in Section 18 exempts a child with other coverage from the PIHP’s own eligibility determination and pre-service authorization. Federally, the agency rejects a claim when third-party liability is established and pays only the amount its schedule exceeds the third party’s payment (42 CFR 433.139).[4][4][10][2][1][3]
Coverage decides whether Oakland Community Health Network (OCHN) 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.
OCHN applies the state rule; its published autism material sets nothing different. The behavior technician works under the supervision of the BCBA/LBA or other professional (BCaBA or QBHP) overseeing the behavioral plan of care, "with minimally one hour of clinical observation and direction for every 10 hours of direct treatment." BHT services "must be provided under the direction of a BCBA/LBA or a Master’s prepared QBHP," and the BCBA/LBA is responsible for clinical skill development and supervision of BCaBAs, QBHPs and technicians and for communicating progress on goals to parents or guardians at least every three to six months. The manual gave licensed psychologists (LP/LLP) and QBHPs a deadline to be certified and licensed as a BCBA/LBA by September 30, 2025, and the SFY 2027 code charts (for the state fiscal year that began October 1, 2026) list the ABA codes for the Licensed Behavior Analyst (HO) and Licensed Assistant Behavior Analyst (HN), plus the behavior technician (HM) on 97153, 97154 and 0373T, with no separate QBHP row.[4][5][2][1][3]
OCHN applies the state rule; its published autism material sets nothing different. Allowed for the pairs MDHHS names. The SFY 2027 code charts (from October 1, 2026) say 97155 reported by a licensed behavior analyst "May co-occur with 97153 & 97154," and 97155 reported by a licensed assistant behavior analyst "Must co-occur with 97153, 97154, and 0373T in order to be reported," and the same-time reporting rules state that 97153 and 97155 "can occur at the same time, just not by the same person" (the technician delivers 97153 while the BCBA/LBA supervising delivers 97155); 97156 may be delivered by the BCBA/LBA to the caregiver while a technician delivers 97153 to the child; a 97151 reassessment may be reported at the same time as 97153, 97154, 0373T (and potentially 97157/97158) "IF there are two separate providers"; and 0362T may be reported at the same time as 0373T. Targeted case management may also run at the same time as a direct ABA service.[5][2][1][3]
OCHN applies the state rule; its published autism material sets nothing different. No per-day or per-week unit cap is published. The manual sets planning averages, not ceilings: focused behavioral intervention averages 5–15 hours a week and comprehensive behavioral intervention 16–25 hours a week, with actual hours set by the behavioral plan of care. A PIHP "may not deny services based solely on preset limits of the cost, amount, scope, and duration of services," and the level of service is re-determined at least every six months on measurable progress. Authorizations may run up to 365 days.[4][4][2][1][3]
OCHN: ABA plans average five to twenty-five hours a week and "can be provided either in the home or in a clinic setting," with parent or guardian training; its provider sheet also lists agencies offering telehealth. The state rule adds community settings and bars billing IDEA school services as BHT.[2][3][4]
OCHN applies the state rule; its published autism material sets nothing different. Services are reported to the PIHP/CMHSP under the provider’s network contract, with a modifier naming the rendering staff level. The SFY 2027 code charts list the qualifying provider types and modifiers for each ABA code: HO for a licensed behavior analyst (master’s level), HN for a licensed assistant behavior analyst (bachelor’s level), and HM for a behavior technician on the technician codes (97153, 97154, 0373T); group codes carry the UN–US group-size modifiers. (The U5 autism modifier the SFY 2026 charts put on 97151 is not in the SFY 2027 modifier list.) Which codes: ABA is billed with CPT codes, not H-codes. The SFY 2027 code charts list 97151, 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T for ABA (97152 does not appear); the diagnostic evaluation behind eligibility is reported with 96112, 96113 or 96116 “For reporting BHT/ABA eligibility assessments and re-evaluation assessments related to Autism”; and H0031 with the 6Y modifier is the behavior identification assessment for people outside the ABA benefit (“97151 for non-ABA was removed effective 10/1/24 so the H0031 with the 6Y is for these individuals”). A technician does not need a license or BACB registration, but must complete BACB-approved RBT training and work under the BCBA/LBA’s supervision.[5][4][2][1][3]
OCHN applies the state rule; its published autism material sets nothing different. Section 18 of the Medicaid Provider Manual and the SFY 2027 code charts do not state who signs an ABA session note or by when. The manual requires the individual plan of service (IPOS) to specify amount, scope and duration of each authorized service and permits electronic signatures for the beneficiary on the plan of service and consents; session-note signature standards sit in each PIHP’s provider contract and documentation standards.[4][4][5][2][1][3]
Blocked on: OCHN (or its CMHSP) provider manual / documentation standards (ask the PIHP’s autism benefit or provider network office for the ABA progress-note requirements).
There is no public state fee screen. The Medicaid Provider Manual (Section 18.13) says PIHPs reimburse BHT-ABA “at a minimum to the rate outlined with the most recent executed PIHP contract”; your rate is in your network contract, so ask OCHN for the current ABA rate sheet.
An OCHN clinical diagnostician, using a caregiver interview, records, developmental and cognitive testing, the DD-CGAS and the ADOS-2. OCHN then sends the documentation to MDHHS for approval.
OCHN says MDHHS approves the documentation within 12–48 hours and eligible children are linked to a CPA/ABA provider within 7 days to begin coordination.
Medicaid eligible, younger than 21, with an autism spectrum disorder diagnosis, plus the state manual’s medical-necessity criteria.
Not yet, as of Nov. 1, 2026. MDHHS has not announced the 2027 ABA codes (its SFY 2027 code charts still list 0362T and 0373T), and we found no OCHN notice. CPT 2027 deletes 0362T and 0373T and adds 97148/97149, 97159/97160, 97173 and 97180 from Jan. 1, 2027; ask OCHN how authorizations carry over.
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.
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