Regence BlueShield of Idaho is Idaho’s second Blue plan, and unlike Blue Cross of Idaho it publishes a full ABA rulebook. There are two medical policies, BH18 for treatment and BH33 for the initial assessment, and they name Idaho’s Bulletin 18-02 as their Idaho legal basis. There is also an Idaho-specific request form (5385ID, effective May 2026). The short version: no authorization for the assessment unless the member is on the Federal Employee Program, a documented prescription and at least one standardized assessment for treatment, and six-month authorizations.
BH18 applies to "member contracts with applicable benefits" subject to named state laws, including "Idaho’s Clarification Regarding Coverage of Treatments for Autism Spectrum Disorder (Bulletin No. 18-02)." It says a certified treating provider "in Idaho" is "a credentialed provider with a Board-Certified Behavioral Analysis (BCBA) certification issued by the Behavioral Analyst Certification Board." Initiation requires a documented ABA assessment, an ASD diagnosis "by a qualified treating health care professional, as defined by state law," symptoms that make the member "a safety risk to self or others and/or" unable "to participate in age-appropriate home or community activities," and ABA "recommended or prescribed by a qualified treating health care professional experienced in the diagnosis and treatment of ASD." It also requires an eight-part individualized treatment plan with at least one standardized assessment per targeted behavior. Continuation requires measured progress, objective measurement at least every six months and standardized assessments annually. ABA "used for educational, vocational or custodial purposes" is not medically necessary.[1][2][3]
The Idaho form 5385ID turns this into a checklist. The assessment request box is "only required for (FEP) Federal Employee Program." "Authorizations are for 6 months (26 weeks)," units are requested per six months, and "≥1 standardized assessment (required; curriculum-based alone is insufficient)." The form also flags that "there is very little evidence to support the efficacy of ABA for people 13 years and older," so requests for a member 13 or older need extra justification. Submissions go through Availity, by email to FAXBHRepository@regence.com, or by fax to 888-496-1540. Regence has announced a revised BH18 effective November 1, 2026. We could not retrieve the revised text, so re-check the policy for requests starting on or after that date.[1][2][3]
Idaho is one of the few states with no autism insurance statute, and intake should say so plainly. What Idaho has instead is Department of Insurance Bulletin No. 18-02 (April 2, 2018). Reading the federal Mental Health Parity and Addiction Equity Act, ACA § 1557 and the state’s Essential Health Benefits together, the Department declared that it "will consider an exclusion of treatments for autism spectrum disorder as discriminatory and prohibited when a plan includes coverage of rehabilitative or habilitative services, such as coverage of occupational therapy or speech therapy." It applies to the individual, small-group and large-group insured markets, and to self-funded plans subject to Idaho Code title 41, chapters 40 or 41, for plan years starting on or after January 1, 2019. Covered treatment must be "consistent with other mental health services (including applicable deductibles, copayments, or coinsurance), not subject to any separate dollar limits or visit limits, and in parity with medical and surgical benefits." The bulletin defines treatment as "evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including but not limited to behavioral health treatment" — it does not name ABA by name, and it sets no age limit. Carriers may still review medical necessity and "periodically review the medical necessity of continuing" treatment. Two practical limits: a bulletin is weaker than a statute, and a self-funded employer plan the Department does not regulate (most ERISA plans) sits outside it entirely — plan funding type is the first fact to establish.[4]
Idaho has no behavior-analyst licensure law and is not on the BACB’s list of licensing states. That is why Regence’s policy defines the Idaho treating provider by BACB certification rather than a state license. Regence publishes no ABA fee schedule, and rates are negotiated in the provider agreement.[5][1]
The questions that decide whether a family can start with Regence BlueShield of Idaho, and what they have to bring. Each maps onto something intake should ask on the first call.
No age cap in BH18 or BH33. Form 5385ID warns that "there is very little evidence to support the efficacy of ABA for people 13 years and older" and asks for added justification for members 13 or older, such as severe risk of injury related to ASD. Bulletin 18-02 sets no age limit.[3][1][4]
No recency window for the diagnosis. The clocks run on the data: objective measurement of treatment goals at least every six months, standardized assessments of treatment goals annually, and baseline and current data dated on the treatment plan.[1][3]
A "qualified treating health care professional (e.g. pediatrician, pediatric neurologist, developmental pediatrician, psychologist), as defined by state law." The same category must recommend or prescribe ABA, and must be "experienced in the diagnosis and treatment of autism."[2][1]
No diagnostic instrument is named. For treatment, each targeted behavior needs objective measurement and "at least one standardized assessment," with examples of SRS-2, Vineland-3, ABAS-3, SSIS, BRIEF-2 and PDDBI. Curriculum or criterion-referenced tools (VB-MAPP, PEAK, ABLLS-R, AFLS, MOTAS) are encouraged for planning, but form 5385ID says they do not replace the standardized requirement.[1][3]
Yes. BH18 and BH33 require a "written recommendation, clinical order, or prescription for ABA services" from a qualified treating health care professional. Bulletin 18-02 separately frames covered treatment as care "prescribed or ordered" by a licensed physician or psychologist.[1][2][4]
Form 5385ID lists "Telehealth" as a place of service for ABA requests, but neither BH18 nor BH33 says which ABA codes may be delivered remotely.[3]
Ask the plan: Regence behavioral health UM (via Availity) — ask which ABA codes are payable by telehealth for this contract and with which POS/modifier.
Turns on how the plan is funded. Idaho’s Managed Care Reform Act requires a managed care organization to answer a nonemergency prior-authorization request "within two (2) business days after complete member medical information is provided," "unless exceptional circumstances warrant a longer period" (Idaho Code § 41-3930). Self-funded ERISA plans follow 29 CFR 2560.503-1: 15 days, one 15-day extension, and 72 hours for urgent claims. Regence’s own lead time for continuations: submit "within five business days prior to the end of a current authorization (and no more than 30 days prior to the end of the authorization period)." The form carries an expedited box for cases where waiting "could place the member’s life, health, or ability to regain maximum function in serious jeopardy."[6][7][1][3]
Ask the plan: At benefits verification ask whether the plan is fully insured or self-funded, then confirm Regence’s decision timeframe for this contract.
For a child on two parents’ plans, Idaho’s rule (IDAPA 18.04.14.022) makes "the plan of the parent whose birthday falls earlier in the calendar year" primary, with separate rules for divorced or separated parents. Self-funded plans follow their own documents. If the child also has Idaho Medicaid, this plan pays first because Medicaid is the payer of last resort. Keep Regence’s authorization in place, and note that Medicaid pays CHIS on H-codes. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)), and CHAMPVA is the last payer (38 CFR 17.270).[8][9][10][11]
Ask the plan: Ask Regence at benefits verification for the coordination-of-benefits order on file, and record every other coverage the child has.
Coverage decides whether Regence BlueShield of Idaho 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.
BCBAs and BCBA-Ds "are considered independently qualified providers and may oversee all aspects of assessment, treatment planning, and supervision of support staff in accordance with BACB guidelines." BCaBAs "must work under the supervision of a BCBA or BCBA-D." Behavior analysts in training must be supervised by a BCBA or BCBA-D. Behavior Technicians and RBTs "must be under the ongoing supervision of a BCBA, BCBA-D, or qualified supervisor." "All supervision must be conducted in accordance with the Behavior Analyst Certification Board’s Professional and Ethical Compliance Code and current supervision standards." No numeric ratio is set, but the treatment plan must justify the "hours per week of direct face-to-face supervision," and "clinical justification is required for excessive hours" of supervision.[1]
No numeric cap. The treatment plan must give "clinical justification for the number of days per week and hours per day of direct ABA services," and requested intensity must rest on individual need. "Dosage recommendations must not be based solely on diagnosis, caregiver availability, or scheduling preferences." Excessive hours of supervision, assessment, social skills or parent training need clinical justification. Units are requested per 6-month authorization (the form’s example: 10 hours a week of 97153 is 40 units a week and 1,040 units per 26 weeks).[1][3]
Form 5385ID lists office, home, telehealth, community setting and other as places of service, and notes "School is not an eligible place of service for Federal Employee Program (FEP) policies." BH18 treats ABA "used for educational, vocational or custodial purposes" as not medically necessary.[3][1]
In Idaho the certified treating provider is "a credentialed provider with a Board-Certified Behavioral Analysis (BCBA) certification," and the individualized treatment plan must be "prepared by a treating provider who is certified to provide ABA therapy." BCaBAs "may not practice independently," and technicians "implement treatment protocols but do not design programs or perform independent assessments." Requests are submitted by the agency with a named BCBA or rendering provider (NPI and tax ID) on form 5385ID.[1][3]
Not addressed in BH18 (eff. 8/1/2025) or BH33. Regence’s revised BH18 takes effect November 1, 2026, and we could not retrieve its text to check for a concurrent-provider rule.[1]
Blocked on: The revised Regence BH18 (effective 11/1/2026) on regence.com medical policy, or Regence behavioral health UM — ask whether 97153 and 97155 may be billed for the same time and whether more than one ABA provider may hold an authorization at once.
BH18 and form 5385ID set treatment-plan content and require the requesting provider’s name, license information and signature on the request. Neither says who must sign session notes or by when.[1][3]
Ask the plan: The Regence provider manual and participating agreement (documentation standards).
Not unless the member is on the Federal Employee Program. The Idaho request form marks the assessment request "only required for (FEP)." Treatment requests need authorization where the contract carries ABA preauthorization, in 6-month periods.
At least one standardized assessment, such as Vineland-3 or ABAS-3. Curriculum-based tools like VB-MAPP or ABLLS-R are encouraged for planning, but on their own they are "insufficient" per form 5385ID.
There is no age cap, but the Idaho form says evidence for people 13 and older is limited and asks for added justification, such as severe risk of injury related to ASD.
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.
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