Tufts Health Public Plans (ConnectorCare / Commonwealth Care Bridge)

CommercialMA

ABA billing requirements · Source: Tufts Health Public Plans / Point32Health — ABA Clinical Policy

High confidence

Verified 2026-03-17

Authorization Requirements

Requires prior auth Yes

Initial auth duration6 months

Renewal auth duration6 months

Submission deadline30 days

Unit tracking cadenceWeekly

Requires FBA Yes

Diagnostic eval validity36 months

Re-eval cadenceEvery 6 months

BH carve-out managerCarelon

State licensure requiredLABA (MA Board of Registration of Allied Mental Health Professionals)

Documentation Requirements

Parent signatures required Yes

Start/stop times required Yes

Treatment plan componentsASD diagnosis (DSM-5) with date, BCBA-signed treatment plan with measurable goals, Functional Behavior Assessment (FBA), Behavior Intervention Plan (BIP), Baseline data and target behaviors, Projected discharge criteria, Caregiver training plan with attendance records, Massachusetts LABA license number for supervising BCBA, Health Connector enrollment verification (for ConnectorCare members)

Progress summary cadenceEvery 1 months

Policy Notes

Tufts Health Public Plans is the third Point32Health entity, covering ConnectorCare (subsidized commercial via MA Health Connector) and Commonwealth Care Bridge members. Distinct from 32 Health Plan (commercial) and Tufts Health Together (MassHealth Medicaid). ABA auth managed by Carelon (AIM Specialty Health). Covers ABA for members with ASD diagnosis through age 21. Massachusetts LABA license required for supervising BCBA. Weekly hour caps align with MassHealth rate schedule for ConnectorCare members. Telehealth covered with modifier 95. Dual-eligible members may require coordination with MassHealth FFS.

CPT & Modifier Rules

CPT rules require a free account

View H-codes, modifiers, unit limits, and billing restrictions for Tufts Health Public Plans (ConnectorCare / Commonwealth Care Bridge).

Official policy source:Tufts Health Public Plans / Point32Health — ABA Clinical Policy

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Data last verified: 2026-03-17 · Confidence: High · See our methodology

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