The state plan describes the services as "available to any individual under the age of 21 based on a determination of medical necessity" (KS SPA 20-0007, effective 04/03/20), and State Plan Amendment 23-0014 was "approved on June 1, 2023, with an effective date of May 3, 2023" (KS SPA 23-0014). The payment methodology amendment, SPA 25-0011, states a fee schedule rate "set as of April 1, 2025." The KMAP provider manuals and fee schedule could not be retrieved, so no per-code rate or MCO list is stated.
The KMAP portal timed out or failed the secure connection, and the KanCare and KDHE pages returned HTTP 403. The state plan text read shows methodology only. Confirm rates, procedure codes, and the KanCare plans with the state before submitting claims.
The reimbursement criteria at a glance
- Is ABA covered by Kansas Medicaid
- Who is eligible and who recommends
- Provider qualifications
- How Kansas pays: the method, not the rates
- Place of service
- Prior authorization and managed care
- The commercial mandate
- Practices with in-house diagnostics versus ABA-only practices
- How this connects to the rest of your compliance stack
- Getting set up to bill Kansas Medicaid: the sequence
- What this guide could not verify
- Kansas reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by Kansas Medicaid
Yes, through two EPSDT state plan services in Attachment 3.1-A, item 4.b. "The Consultative Clinical and Therapeutic Services (CCTS) (also known as Autism Specialist Services) are available to any individual under the age of 21 based on a determination of medical necessity," and "Intensive Individual Supports services (also known as Registered Behavior Services) are available to any individual under the age of 21 based on a determination of medical necessity" (KS SPA 20-0007). A separate 1915(c) KS Autism Waiver is listed with approval 06/07/2023, effective 04/01/2022, and expiration 03/31/2027 (medicaid.gov waiver list).
Who is eligible and who recommends
"CCTS services are recommended by a physician or other licensed practitioner (e.g., licensed clinical social worker or psychologist)," and IIS services are recommended the same way "with the service plan subsequently developed by the Consultative Clinical and Therapeutic Services (CCTS) provider." The plan also states that "Children under 21 years will receive all medically necessary services" (KS SPA 20-0007; KS SPA 23-0014). The eligibility sentences name age and medical necessity and do not state an ASD diagnosis requirement.
Provider qualifications
For CCTS, the provider "will be a Board Certified Behavior Analyst (BCBA) or Assistant Behavior Analyst licensed through the Kansas Behavioral Sciences Regulatory Board," or a BCBA-D, BCBA, or BCaBA, or "an individual with a Master's degree, preference in Human Services or Education with documented experience working with a child with an Autism Spectrum Disorder and completion of state approved training curriculum." For IIS, the provider has "certification as a Registered Behavior Technician (RBT) under the supervision of a BCBA" or is "an individual of eighteen years of age or older with a high school diploma or equivalent and 40 hours of successfully applied behavioral analysis training," with clean background checks from the Kansas Bureau of Investigation, Adult Protective Services, Child Protective Services, and the Nurse Aide Registry (KS SPA 23-0014). KMAP enrollment steps and provider type or specialty were not read.
How Kansas pays: the method, not the rates
"Reimbursement for positive behavior support services, Consultative Clinical and Therapeutic Services, and Intensive Individual Supports are based upon a Medicaid fee schedule established by the State of Kansas," and "the agency's fee schedule rate was set as of April 1, 2025 and is effective for services provided on or after that date" (KS SPA 25-0011, Attachment 4.19-B). The fee schedule is published through KMAP, which could not be reached, so no per-unit rate is stated.
Place of service
CCTS services "are designed to be delivered primarily in the home and in other community settings" and "may be provided in all customary and usual community locations (which could include home)." For IIS, "the majority of these contacts must occur in customary and usual community setting (which included home)," and services to an individual who is an inpatient or resident of a hospital, nursing facility, intermediate care facility for intellectual or developmental disabilities, or an institution for mental disease are non-covered (KS SPA 20-0007; KS SPA 23-0014). School and telehealth rules were not found.
Prior authorization and managed care
"Under EPSDT these services require prior authorization. The Managed Care Organization (MCO) prior authorization process is not unduly burdensome and the MCO must provide notification of approved services within a reasonable timeframe" (KS SPA 20-0007). The names of the KanCare managed care organizations and any weekly hour limits were not verified.
The commercial mandate
K.S.A. 40-2,194 requires large-group and grandfathered plans to "provide coverage for the diagnosis and treatment of autism spectrum disorder in any covered individual whose age is less than 12 years." Applied behavior analysis is capped by hours, not dollars: "1,300 hours per calendar year for four years" for an individual diagnosed between birth and five years of age, and otherwise "520 hours per calendar year" for any covered individual less than 12, and the limit "may be exceeded" upon prior approval by the plan if it is medically necessary. "On or after July 1, 2016, reimbursement shall be allowed only for services provided by an autism service provider licensed or exempt from licensure under the applied behavior analysis licensure act" (K.S.A. 40-2,194, history L. 2014, ch. 62; L. 2015, ch. 83; L. 2023, ch. 3).
Practices with in-house diagnostics versus ABA-only practices
The Medicaid recommendation can come from a physician or other licensed practitioner such as a licensed clinical social worker or psychologist, so a practice with one on staff can keep the recommendation in-house, and an ABA-only practice depends on outside recommenders. The commercial mandate also ties reimbursement to licensure or exemption under the applied behavior analysis licensure act.
How this connects to the rest of your compliance stack
The credentials the state plan relies on are covered on the Kansas Licensing page, and the entity analysis is on the Kansas entity page.
Getting set up to bill Kansas Medicaid: the sequence
- Decide which service you provide. CCTS for the clinical and consultative tier, IIS for the intensive individual tier.
- Meet the provider qualifications. Licensed or board-certified analysts for CCTS, RBT or the training pathway for IIS, with background checks.
- Enroll through KMAP. Confirm provider type and specialty with the state, since the manual could not be read.
- Obtain prior authorization from the MCO. Under EPSDT these services require it.
What this guide could not verify
- Per-unit rates for 97151 to 97158 or any Kansas-specific codes.
- The KMAP Mental Health provider manual, including procedure codes, provider type and specialty, and any weekly hour soft limit.
- School and telehealth rules for CCTS and IIS.
- The KanCare managed care organizations and any hour limits.
- An ASD diagnosis requirement in the state plan text retrieved.
Kansas reimbursement variables at a glance
| Variable | Kansas value |
|---|---|
| ABA covered by Medicaid? | Yes, EPSDT CCTS and IIS (SPA 20-0007; SPA 23-0014 effective May 3, 2023) |
| Age | Under 21; medical necessity |
| Payment method | State fee schedule; rate set April 1, 2025 (SPA 25-0011) |
| Rates | Not verified |
| Prior authorization | Required under EPSDT through the MCO |
| Commercial mandate | K.S.A. 40-2,194: under 12; 1,300 hours a year for four years if diagnosed by age 5, otherwise 520; no dollar cap |
Frequently asked questions
Does Kansas Medicaid cover ABA?
Is prior authorization required?
Can a technician provide IIS?
What does the commercial mandate cap?
Where professional advice is essential, not optional
Kansas's state plan is detailed on who recommends and who provides services, and the rates sit behind the KMAP portal that could not be reached. Bring in a billing specialist to work from the current fee schedule, procedure codes, and the managed care organizations' authorization rules.
The governing authorities to know are Kansas SPAs 20-0007, 23-0014, and 25-0011 and K.S.A. 40-2,194.
This page describes rules read from CMS-hosted state plan amendments, the 1915(c) waiver listing, and the Kansas Revisor of Statutes. The KMAP provider manuals and fee schedule could not be read. KDHE, KanCare, the state insurance regulator, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.