We’ll use updated ABA supplemental policy, starting April 22

For dates of service on or after April 22, 2025, Blue Cross Behavioral Health℠ will use the updated Applied Behavioral Analysis (ABA) Supplemental Policy when making determinations on prior authorization requests.

We made the following changes in the updated policy:

Section	Subsection	Significant changes
Initial Coverage Criteria	Diagnosis	Reformatted to make the diagnostic criteria easier to use and review. Updated the list of specific diagnostic instruments to be used to determine autism spectrum disorder, or ASD, diagnosis and level of severity.
	Initial Treatment	Reformatted the subsection (previously named Treatment) to make it easier to use and review initial treatment criteria. Added specific requirements for frequency and duration of caregiver involvement or parent or caregiver training (minimum two hours per month). Added specific requirements for supervision of direct treatment staff (minimum of 5% of direct hours).
Evaluation and Treatment Criteria	Treatment	Expanded to include: More detailed guidelines on continued ABA treatment Alternate services that may be more appropriate for members and their families who are making progress, such as individual outpatient psychotherapy or cognitive behavioral therapy or family therapy
	Continued Treatment	Expanded to: Include steps to assist pediatric members in transitioning to adulthood Outline expectations for adjustment of treatment plans in response to member improvement or lack thereof

Blue Cross Behavioral Health manages prior authorizations for behavioral health services for:

• Blue Cross Blue Shield of Michigan commercial members
• Medicare Plus Blue℠ members
• Blue Care Network Commercial members
• BCN Advantage℠ members

To view the updated policy, see the Behavioral Health Services section on either of the following webpages on bcbsm.com:

• For commercial members: Services That Need Prior Authorization
• For Medicare Advantage members: Medicare Advantage Prior Authorization