Inland Empire Health Plan (CA Medi-Cal)

MedicaidCA

ABA billing requirements · Source: Inland Empire Health Plan — Provider Resources (Behavioral Health)

High confidence

Verified 2026-03-16

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline14 days

Unit tracking cadenceTotal

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

BH carve-out managerCarelon

State licensure requiredBCBA state registration required via CA Board of Behavioral Sciences

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis, Functional Behavior Assessment, Baseline data, Measurable goals, Intervention strategies, Caregiver training plan

Progress summary cadenceEvery 6 months

Policy Notes

Inland Empire Health Plan (IEHP) is a not-for-profit Medi-Cal MCO serving San Bernardino and Riverside counties in CA, covering ~1.5M members. ABA prior auth required. Behavioral health managed through Carelon. BCBA must be enrolled with IEHP and California Medi-Cal.

CPT & Modifier Rules

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View H-codes, modifiers, unit limits, and billing restrictions for Inland Empire Health Plan (CA Medi-Cal).

Official policy source:Inland Empire Health Plan — Provider Resources (Behavioral Health)

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Data last verified: 2026-03-16 · Confidence: High · See our methodology

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