Tufts Health RITogether is Tufts Health Public Plans’ Rhode Island Medicaid product, one of the three EOHHS managed care contracts. Its 2026 provider manual lists Home Based Therapeutic Services among the home and community based services for members under 21, and Point32Health publishes a Rhode Island ABA guideline, "Applied Behavior Analysis (ABA) Including Early Intervention for Tufts Health RITogether."
The headline for intake is administrative: RITogether requires neither prior authorization nor notification for HBTS or ABA. The guideline still states the criteria the plan applies, and the plan can review records.
The RITogether ABA guideline describes treatment planned "by a Licensed, Applied Behavior Analyst" and delivered by technicians "supervised by the Licensed, Applied Behavior Analyst," typically "in a home or community setting," with school-based services left to the IEP. Admission needs a comprehensive diagnostic and/or functional assessment (examples include ABLLS-R, Vineland-II, ADI-R, ADOS-G, CARS2, VB-MAPP) with medical history, physical examination and a detailed behavioral evaluation; "Screening scales such as the MCHAT-R are not sufficient to make a diagnosis." It also needs disruptive behavior that interferes with daily functioning or poses risk, and an initial evaluation from a licensed analyst. Continuation looks for "behavioral graphs, progress notes, and daily session notes," parent training and no duplication of IEP services. The codes are H2014 (-HO, -HP), H0046 (-HO, -HP), S9446, T1013, T1016 and T1024.[1][2][6]
One line needs care: the guideline says "The Plan may authorize ABA therapy visits, for Members <15 years of age," which echoes the commercial mandate’s age limit, while the behavioral health grid lists ABA for "Members < age 21" and the EOHHS contract requires HBTS for members under 21. Expect the under-21 contract rule to govern, and get any age question answered in writing.[1][2][6]
For first-time claims "the filing deadline is 90 calendar days from the date of service" for professional claims; claims after a primary carrier’s payment are due within 60 calendar days of that EOP. RITogether claims must carry "the attending/rendering physician’s name, NPI and Rhode Island license number." Tufts Health Public Plans is payer of last resort and wants the primary insurer’s EOP attached. Claim appeals "must be submitted within 60 calendar days of the date of the Explanation of Payment," with at most two levels, and appeals of timely-filing denials are considered only under narrow exceptions.[3]
Rhode Island licenses behavior analysts, so a BCBA licensed elsewhere cannot simply treat a Rhode Island child. Under R.I. Gen. Laws § 5-86-21(g), an analyst "licensed or certified in another state" may practice in Rhode Island without a Rhode Island license "for up to ten (10) calendar days per calendar year with no more than five (5) days of this activity occurring consecutively." Beyond that, the clinician needs a Rhode Island license (LBA) from the Department of Health board, which requires passing the BCBA exam and keeping active BACB status (§ 5-86-9). Chapter 5-86 has no telehealth exception and no reciprocity section. For Medicaid telehealth, EOHHS is explicit: an out-of-state provider may serve Medicaid members by telehealth only with "an active and unrestricted license in the state of Rhode Island" and Rhode Island Medicaid enrollment; "Out-of-state licensure alone does not confer eligibility."[9][10][8]
The questions that decide whether a family can start with Tufts Health RITogether (Tufts Health Public Plans), and what they have to bring. Each maps onto something intake should ask on the first call.
The plan sets no recency rule of its own; the state HBTS rule is a diagnosis "made within 3 years" and an evaluation within three years.[1][7]
The guideline names no diagnostician list; the diagnostic evaluation must include history, physical examination, formal test scores and medical screening. The state rule is a "qualified licensed health care professional."[1][7]
A comprehensive diagnostic and/or functional assessment (e.g., ABLLS-R, Vineland-II, ADI-R, ADOS-G, CARS2, VB-MAPP, Autism Behavior Checklist) with "the scores from the use of formal diagnostic tests and scales"; the MCHAT-R alone "will not be accepted."[1]
No plan authorization; the guideline applies "After a comprehensive evaluation and a referral (as needed)," and early intervention needs a PCP referral. The state HBTS rule requires a physician’s prescription, and R.I. Gen. Laws § 5-86-2(8) has a licensed analyst provide ABA only when prescribed by a child psychiatrist, behavioral developmental pediatrician, child neurologist or child-trained psychologist.[1][7][11]
Not applicable to ABA, which needs no authorization. For services that do, the 2026 manual says non-urgent RITogether requests "will be completed within 14 calendar days"; federal law caps standard Medicaid managed care decisions at 7 calendar days for rating periods starting on or after January 1, 2026.[2][4][12]
"Tufts Health Public Plans is payer of last resort for... Tufts Health RITogether." Submit to all known carriers first, then send the claim with "the primary insurer’s EOP," within 60 calendar days of the primary carrier’s EOP. "Do not take a cost-sharing amount up front."[3][13]
The behavioral health grid covers HBTS and ABA for "Members < age 21," as the EOHHS contract requires; the ABA guideline separately says the plan "may authorize ABA therapy visits, for Members <15 years of age." Early intervention covers children under 3.[2][1][6]
Ask the plan: Tufts Health Public Plans Provider Services (Rhode Island), 844-301-4093: confirm in writing that ABA is covered for members 15 to 20.
The RITogether ABA guideline and grid say nothing about telehealth. Under its EOHHS contract the plan may not exclude a service only because it is delivered by telemedicine, pay behavioral health providers less, or restrict originating sites, and EOHHS’s Telemedicine Billing Guidance applies.[1][6][8]
Ask the plan: Tufts Health Public Plans Provider Services (Rhode Island), 844-301-4093: ask which HBTS/ABA components may be billed by telehealth and the POS/modifier.
Coverage decides whether Tufts Health RITogether (Tufts Health Public Plans) 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.
The individual ABA treatment plan "is developed by a Licensed, Applied Behavior Analyst," sessions are "typically provided by behavioral technicians or paraprofessionals," and "The technician is supervised by the Licensed, Applied Behavior Analyst." No numeric ratio is published. The EOHHS contract adds monthly in-home observation by the clinical supervisor.[1][6]
No unit or hour cap is published; T1013 interpretation is limited to "up to 8 hours per month, 4 for supervision and 4 for parent training, not to be used with direct service." Hours follow severity and the treatment plan.[1]
ABA "may be provided in a variety of settings, such as at home and in the community"; "Services provided in a school setting are distinct and separate" and covered through the IEP. Services "primarily for school or educational purposes" are not medically necessary.[1]
RITogether claims must list "the attending/rendering physician’s name, NPI and Rhode Island license number on the claim form," so the rendering clinician is identified and Rhode Island-licensed.[3]
Not addressed for 97153 with 97155 in the RITogether ABA guideline or the claims chapter. Point32Health’s ABA payment policy (rev. 05/2026), which applies to Tufts Health RITogether, does not reimburse “Services provided concurrent with another treatment modality, such as occupational or speech therapy, where the ABA provider’s role is to escort/accompany the member to the appointment,” and says “Secondary ABA providers must submit procedure codes with the XP modifier.”[1][3][15]
Ask the plan: Tufts Health Public Plans Provider Services RI, 844-301-4093 — ask whether a BCBA’s supervision code pays for the same minutes as the technician’s direct-service code.
Progress must be shown in "behavioral graphs, progress notes, and daily session notes," and parent training documented. The plan does not say who signs a session note or when.[1]
Ask the plan: Tufts Health Public Plans Provider Services (Rhode Island), 844-301-4093.
No. Its behavioral health grid lists HBTS and ABA as "No PA or notification required. Providers just bill for this service."
90 calendar days from the date of service for in-state, in-network professional claims, and 60 days from a primary carrier’s EOP.
The plan removed the autism diagnosis code requirement at EOHHS’s direction, but the diagnostic report must still state the diagnosis and the evidence for it.
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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