---
title: "TrueCare ABA coverage in Mississippi: the intake guide."
url: "https://carelu.com/payers/truecare-mississippi"
markdown_url: "https://carelu.com/payers/truecare-mississippi.md"
state: MS (Mississippi)
payer: TrueCare (MississippiCAN / CHIP)
kind: Medicaid managed care plan (MCO)
parent_program: Mississippi Medicaid (MississippiCAN)
description: "How TrueCare (Mississippi True, a CareSource plan) covers ABA for MississippiCAN members: MM-1477 criteria, who may diagnose, PY-1639 billing and RBT rules, the 3-day decision clock, timely filing and appeals."
last_reviewed: October 2026
---

# TrueCare ABA coverage in Mississippi: the intake guide.

_Payer Guide · TrueCare · Mississippi · Last updated October 2026 · 17 primary sources_

> CareSource’s MississippiCAN/CHIP plan since 7/1/2025: MM-1477 ABA criteria, 6-month reviews, PY-1639 billing rules; LBA required.

TrueCare, licensed as Mississippi True and run with CareSource, joined MississippiCAN and CHIP on July 1, 2025. It is the only Mississippi plan with a Mississippi-specific ABA medical policy (MM-1477, effective May 1, 2026, marked DOM approved) and a Mississippi-specific ABA reimbursement policy (PY-1639, effective August 1, 2026). Both say state sources supersede them.

This plan administers the **Mississippi Medicaid (MississippiCAN)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Mississippi Medicaid guide](https://carelu.com/payers/mississippi-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: No for 97151: TrueCare’s Procedure Code Lookup Tool (Mississippi Medicaid, outpatient) returns "Auth is required? No" for 97151, and the 2026 PA list says "No prior authorization required for assessments/evaluations" under behavioral health. The same tool returns PA required for the technician-assisted assessment 97152 and for 0362T. MM-1477 limits behavioral assessments to 8 hours every 6 months without added justification [5][4][1]
- **Prior auth for treatment**: Yes: TrueCare’s Procedure Code Lookup Tool (Mississippi Medicaid, outpatient, any place of service) returns "Auth is required? Yes" for 97153, 97154, 97155, 97156, 97157, 97158 and 0373T (UM review, rule effective 7/1/2025), matching MM-1477 and PY-1639, which require medical-necessity review before ABA starts and every 6 months. The 2026 PA list’s narrower line ("PA required in Outpatient Hospital setting (POS 19, 22)") is not the whole rule [5][1][2][4]
- **Autism diagnosis required?**: Yes: a definitive primary ASD diagnosis by a child and adolescent psychiatrist, psychologist, child neurologist or developmental pediatrician, independent of the ABA provider, with a standardized tool (MM-1477) [1]

## At a glance

- **Covers ABA?:** Yes, for members under 21 (MM-1477)
- **Review:** PA for 97152–97158, 0362T, 0373T (Lookup Tool); 97151 no PA; medical-necessity review every 6 months
- **Assessment:** No PA for BH assessments/evaluations; 8 hours per 6 months (MM-1477), 6–10 hours (PY-1639)
- **Decision clock:** 3 calendar days or 2 business days, whichever is less; urgent 24 hours
- **Timely filing:** 180 days from DOS
- **Practitioners:** Mississippi LBA, LABA under LBA; RBTs listed with the Board

## Medical policy MM-1477: who diagnoses, what to send, how often

MM-1477 says "Medical necessity review is required for all ABA services initially with a baseline and then, again, every 6 months," and that "ABA services will be provided for members under the age of 21." The diagnosis must be "definitive, primary" and made "upon evaluation independent of the ABA provider and with a relationship with the member" by a child and adolescent psychiatrist, psychologist, child neurologist or developmental pediatrician, using standardized tools (ADOS, ADI-R, CARS-2); if the evaluation is more than 24 months old, a provider letter describing symptoms within the past year is required. A licensed practitioner performs the behavioral assessment, "generally not to exceed 8 hours every 6 months," and the initial plan must be signed by the parent and BCBA and include school placement and hours (IEP/504 information "must be provided to TrueCare"), prior ABA history, coordination with other therapies, a skills assessment (VB-MAPP, ABLLS-R), hours per week and a discharge plan. Continuation requests come every 6 months with updated scores and utilization of approved hours. [1][4][5]

The 2026 PA list reads narrower: it says "No prior authorization required for assessments/evaluations" and lists "Applied Behavior Analysis Treatment (ABA): PA required in Outpatient Hospital setting (POS 19, 22)." TrueCare’s Procedure Code Lookup Tool settles it for outpatient services in any setting: on a 10/18/2026 service date, Mississippi Medicaid, it returns "Auth is required? No" for 97151 and "Yes" for 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T (review group UM, rules effective 7/1/2025). [1][4][5]

## Reimbursement policy PY-1639: billing, RBTs and telemedicine

PY-1639 requires the treatment record (plans of care, treatment plans, behavior plans, functional assessments) to be submitted to TrueCare "prior to claim submission. Claims will not be accepted without accompanying treatment documentation." Behavior identification assessments must be performed by a BCBA and are "generally, not to exceed 6-10 hours every 6 months." Protocol modification counts only face-to-face time "supervising, observing and interacting in-person" with the member and technician. An RBT may provide ABA only under the supervision of an independent practitioner enrolled in Medicaid and affiliated with the RBT’s organization; if either leaves, the RBT may not continue under that supervisor. Concurrent billing (for example with OT, PT or speech), preparation, cleaning and break time are not billable unless state rules say otherwise. Telemedicine is "reimbursed in the same manner and subject to the same limits as in-person." Units follow 15-minute increments, "attained when the mid-point is passed," with each claim line limited to one date of service and CMS MUEs applied. [2][3]

TrueCare’s manual sets standard prior-authorization decisions at "no later than three calendar days or two business days, whichever is less," and urgent decisions within 24 hours. Claims are due within 180 days of service; provider appeals within 30 calendar days of the EOP or dispute letter, resolved within 30 days. Requests go through the provider portal, by phone at 1-833-230-2174, by fax at 937-396-3677 (toll-free 844-794-1584) or by email to UMMississippi@MSTrueCare.com. [2][3]

## Licensure and out-of-state BCBAs

MM-1477 requires that "All ABA services must be provided by providers licensed in Mississippi as a Licensed Behavior Analyst (LBA) or Licensed Assistant Behavior Analyst (LABA) under the supervision of an LBA," and that technicians be RBTs "listed with the respective State Licensure Board under a supervising LBA." Mississippi licenses behavior analysts. The BACB’s licensure table lists Mississippi (2015) with the Mississippi Autism Board, which licenses Licensed Behavior Analysts and Licensed Assistant Behavior Analysts under Miss. Code Ann. § 73-75. To be licensed as a behavior analyst a person needs at least a master’s degree, "current and active certification" as a BCBA or BCBA-D, a fingerprint-based state and FBI background check, and the Board’s other requirements, which include an oral examination the Board gives at least quarterly (Rule 3.2); licenses run three years but never past the BACB certification. Assistant behavior analysts need a bachelor’s degree, BCaBA certification and proof of supervision by a licensed behavior analyst. Technicians are not licensed: the supervising licensee registers each Registered Behavior Technician with the Board, the technician "works solely under the license of the behavior analyst," and supervision follows the BACB’s policy (Rule 9). For a BCBA licensed in another state, the statute’s exemption list (§ 73-75-5: licensed psychologists, other licensed professionals within scope, supervised technicians, family members, trainees, school employees) does not include behavior analysts licensed elsewhere, and the Board’s rules contain no telehealth provision, so plan on a Mississippi license before treating a Mississippi patient in person or by telehealth. The route is licensure by reciprocity (Rule 3.4), which still requires meeting the Rule 3.1 and 3.2 requirements; a temporary license exists only for applicants awaiting exam scores or the next oral exam, restricts practice to Mississippi and requires supervision. The autism mandate ties into this: a "licensed behavior analyst" in § 83-9-26 is one licensed under § 73-75-13. [1][12][13][14][15]

## Intake gates

The questions that decide whether a family can start with TrueCare (MississippiCAN / CHIP), and what they have to bring.

- **Age limit**: "ABA services will be provided for members under the age of 21" (MM-1477). [1]
- **Diagnosis recency**: If the diagnostic evaluation was completed more than 24 months before the request, a provider letter describing clinical symptoms within the past year is required (MM-1477). [1]
- **Who may diagnose**: A child and adolescent psychiatrist, psychologist, child neurologist or developmental pediatrician, evaluating "independent of the ABA provider and with a relationship with the member." [1]
- **Diagnostic tools required**: Standardized diagnostic tools as part of the referral, for example ADOS, ADI-R or CARS-2; goals built on a skills assessment such as VB-MAPP or ABLLS-R. [1]
- **Referral required?**: The diagnosis and standardized tools come "as part of a referral for services" from the independent diagnosing clinician (MM-1477); no separate PCP referral is named. [1]
- **Telehealth**: MM-1477: ABA "may be provided via telehealth in instances deemed medically necessary with supporting documentation that provides a plan for the provision of service delivery," but must "not [be] used as the primary method of treatment." PY-1639 reimburses telemedicine like in-person service. Part 225 lists BCBAs as telehealth providers and the home as an originating site. [1][2][10]
- **Prior-auth decision time**: Standard decisions "no later than three calendar days or two business days, whichever is less," extendable up to 14 days; urgent within 24 hours; retrospective within 20 business days (TrueCare manual; CCO contract § 4.3.3). [3][7]
- **Other insurance (who pays first)**: "When a member has other insurance, Medicaid is always the payer of last resort. TrueCare will not pay more than the Medicaid rate totals," and the primary payer’s determination must accompany the claim (PY-1639). Original claims with a primary EOB are due within 180 days of service or 90 days of the primary EOB (manual). [2][3]

## Delivery and billing rules

Coverage decides whether TrueCare (MississippiCAN / CHIP) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: ABA must be provided by a Mississippi LBA, or an LABA "under the supervision of an LBA"; RBTs must be listed with the Board under a supervising LBA (MM-1477). PY-1639 points to Mississippi and BACB supervision standards, requires supervision records kept at least 5 years, and lets an RBT work only under an enrolled independent practitioner affiliated with the same organization. No numeric ratio is published. [1][2]
- **Daily limits / MUEs**: TrueCare applies the CMS MUE table and bills one date of service per claim line in 15-minute units attained at the midpoint (PY-1639). Assessments are generally capped at 8 hours (MM-1477) or 6–10 hours (PY-1639) every 6 months. No weekly hour cap is published. [2][1]
- **Place of service**: The PA list requires ABA PA "in Outpatient Hospital setting (POS 19, 22)." MM-1477 excludes education-related services under IDEA, services duplicating an IEP, shadowing or para-professional services "in any setting," and recreational settings. PY-1639 says to bill place-of-service codes "as applicable." [4][1][2]
- **Bill as provider**: PY-1639: providers bill "only those services rendered by a qualified provider or by a provider under direct supervision," "at the appropriate practitioner level (ie, modifiers)," and may never bill for services rendered by another practitioner who is enrolled or eligible to enroll. The State Plan has licensed practitioners bill for BCaBAs and RBTs. [2][8]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: PY-1639: "Unless specifically stated in State rules, laws or other sources, concurrent billing (eg, occupational therapy, physical therapy, speech therapy)" is not billable, and protocol modification counts face-to-face time with the member and the BCaBA or RBT during a session. It does not say in so many words whether 97153 and 97155 may both be billed for the same minutes. [2]
  - Ask the plan: TrueCare Provider Services, 1-833-230-2174: ask whether the RBT’s 97153 is payable for minutes billed as 97155.

## What intake should collect for TrueCare (MississippiCAN / CHIP)

- **Member ID:** Confirm TrueCare MississippiCAN or CHIP on the date of service.
- **Independent diagnosis:** From a child psychiatrist, psychologist, child neurologist or developmental pediatrician not tied to the ABA provider, with ADOS, ADI-R or CARS-2.
- **Recent symptom letter:** Needed if the diagnostic evaluation is more than 24 months old.
- **IEP / 504 plan and school hours:** MM-1477 says IEP/504 information must be provided to TrueCare.
- **Treatment documentation before billing:** PY-1639: claims are not accepted without the treatment record.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does TrueCare cover ABA in Mississippi?

Yes, for MississippiCAN members under 21, under its Mississippi medical policy MM-1477.

### Who can diagnose autism for TrueCare ABA?

A child and adolescent psychiatrist, psychologist, child neurologist or developmental pediatrician, evaluating independently of the ABA provider, with a standardized tool such as the ADOS, ADI-R or CARS-2.

### Does TrueCare require prior authorization for ABA?

Yes for treatment. TrueCare’s Procedure Code Lookup Tool shows PA required for 97152–97158, 0362T and 0373T in any outpatient setting, and its policies require a medical-necessity review every 6 months. The 97151 assessment needs no PA.

### Can RBTs bill TrueCare directly?

No. RBTs work under the supervision of an enrolled independent practitioner in the same organization, and the supervising practitioner bills at the appropriate practitioner level.

### Does TrueCare pay for ABA by telehealth?

Yes when medically necessary and documented, but not as the primary method of treatment; telemedicine is paid the same as in person.

## Primary sources

1. [TrueCare Medical Policy MM-1477 — Applied Behavior Analysis for Autism Spectrum Disorders (eff. 05/01/2026; DOM approved)](https://www.caresource.com/documents/medicaid-ms-policy-medical-mm-1477-20260501)
2. [TrueCare Reimbursement Policy PY-1639 — Applied Behavior Analysis for Autism Spectrum Disorder (eff. 08/01/2026)](https://www.caresource.com/documents/medicaid-ms-policy-reimburse-py-1639-20260801)
3. [Mississippi TrueCare — Provider Manual, MississippiCAN and CHIP (Dec. 2025 posting)](https://www.mstruecare.com/wp-content/uploads/2025/12/MS-MED-P-1902951a-Mississippi-Provider-Manual_WEB.pdf)
4. [TrueCare — 2026 Mississippi Medicaid Prior Authorization List (Sept. 2026 posting)](https://www.mstruecare.com/wp-content/uploads/2026/09/MS-MED-M-4855859_2026-MS-MCD-TrueCare-PA-List.pdf)
5. [CareSource / TrueCare Procedure Code Prior Authorization Lookup Tool (Mississippi Medicaid, outpatient; ABA codes read 10/18/2026, rules effective 7/1/2025)](https://procedurelookup.caresource.com/)
6. [TrueCare — Prior authorization (MSCAN provider page)](https://www.mstruecare.com/ms/providers/provider-portal/prior-authorization/mscan/)
7. [Mississippi Coordinated Care Contract — Mississippi True d/b/a TrueCare (Aug. 12, 2024 – Aug. 11, 2028)](https://medicaid.ms.gov/wp-content/uploads/2024/08/Mississippi-True-dba-TrueCare-Coordinated-Care-Services-Contract_20240812.pdf)
8. [Mississippi State Plan, Attachment 3.1-A Exhibit 4b p.6 + Attachment 4.19-B p.4b(2) — Autism Spectrum Disorder (ASD) Services (SPA 16-0020, eff. 1/1/2017)](https://medicaid.ms.gov/wp-content/uploads/2017/05/SPA-16-0020-ASD-Services-Approved-Pages.pdf)
9. [Mississippi Division of Medicaid — Autism Spectrum Disorder Services Fee Schedule, July 2026 (.xlsx)](https://medicaid.ms.gov/wp-content/uploads/2026/07/ASD-FEE_SHEDULE-JULY-2026-fnl.xlsx)
10. [Miss. Admin. Code Title 23, Part 225 — Telemedicine (eff. 8/1/2026)](https://medicaid.ms.gov/wp-content/uploads/2026/07/Title-23-Part-225-Telemedicine-eff-8.1.26.pdf)
11. [Miss. Admin. Code Title 23, Part 306 — Third Party Recovery (eff. 9/1/2023)](https://medicaid.ms.gov/wp-content/uploads/2023/09/Title-23-Part-306-Third-Party-Recovery-eff.-9.1.23.pdf)
12. [BACB — U.S. Licensure of Behavior Analysts (Mississippi: 2015, MS Autism Board)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
13. [Miss. Code Ann. § 73-75-13 — eligibility for licensure as a behavior analyst or assistant behavior analyst (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-13/)
14. [Miss. Code Ann. § 73-75-5 — exemptions from the behavior analyst licensure chapter (FindLaw)](https://codes.findlaw.com/ms/title-73-professions-and-vocations/ms-code-sect-73-75-5/)
15. [Mississippi Autism Board — Title 30 Part 3301, Licensure of Behavior Analysts and Assistant Behavior Analysts (rules final 3/13/2024)](https://www.msautismboard.ms.gov/sites/autism/files/UploadedDocuments/2024/MAB%20R&R%20(Final)%203.13.2024.pdf)
16. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
17. [TrueCare — Updates & Announcements (MississippiCAN)](https://www.mstruecare.com/ms/providers/tools-resources/updates-announcements/mscan/)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.