CMS approved SPA MS 16-0020 on May 23, 2017, with an effective date of January 1, 2017 (CMS approval letter, SPA MS 16-0020). The Division of Medicaid's ASD administrative rule, its ASD fee schedule, and its provider pages could not be reached (DNS and SSL errors), so eligibility details beyond EPSDT, per-code rates, place of service, and provider credentials were not verified.
Mississippi's Division of Medicaid site was unreachable during research. This guide verifies the state plan authority, the payment method, and the commercial statute. It does not give per-code rates, place of service, or provider credentials.
The reimbursement criteria at a glance
- Is ABA covered by Mississippi Medicaid
- Who is eligible
- Rates and how they are set
- Place of service
- Prior authorization
- Provider qualifications
- The commercial mandate
- Practices with in-house diagnostics versus ABA-only practices
- How this connects to the rest of your compliance stack
- What this guide could not verify
- Mississippi reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by Mississippi Medicaid
Yes, for EPSDT-eligible beneficiaries. The state plan amendment was submitted "to allow the Mississippi Division of Medicaid to cover Autism Spectrum Disorder (ASD) services Early and Periodic Screening, Diagnosis and Treatment (EPSDT)-eligible beneficiaries when medically necessary, prior authorized and provided by certain qualified providers operating within their scope of practice, effective January 1, 2017" (CMS, SPA MS 16-0020).
Who is eligible
EPSDT services "are provided to beneficiaries under age twenty-one (21)," and treatment covers services "needed to correct or ameliorate physical or mental illnesses and conditions discovered by a screening" when the Division of Medicaid or its representative determines the service to be medically necessary (Miss. Admin. Code Title 23, Part 223, Rules 1.1 and 1.7). The ASD-specific diagnosis and referral requirements were not verified.
Rates and how they are set
The Division "reimburses Autism Spectrum Disorder (ASD) services in accordance with the most recent publication of the Current Procedural Terminology," and reimbursement "is the lesser of the usual and customary charge or a rate calculated by an actuarial firm" using wage and benefit data, overhead estimates, and billable-time assumptions. The rates "are the same for private and governmental providers and are published on the Division of Medicaid's website" (CMS, SPA MS 22-0022, approved November 4, 2022, effective 07/01/2022). No per-code rate for 97151 to 97158 was retrieved.
Place of service
Place of service, school, and telehealth rules for ASD services were not verified.
Prior authorization
ASD services must be "prior authorized," and a service not specifically covered by rule or the state plan requires a prior authorization request (SPA MS 16-0020; Part 223, Rule 1.7.C). Which entity performs the review, whether the managed care plans are involved, and any hour limits were not verified.
Provider qualifications
The state plan amendment refers to "certain qualified providers operating within their scope of practice." The Medicaid credential requirements for BCBAs, BCaBAs, and RBTs and the enrollment steps were not verified. The Mississippi licensure question is a separate matter covered on the Mississippi Licensing page.
The commercial mandate
Under Miss. Code Ann. 83-9-26, "a health insurance policy shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder" for policies on or after January 1, 2016. ABA coverage "shall be limited to twenty-five (25) hours per week, and shall not be required beyond the age of eight (8) years," with no more than ten hours per week for the services of a licensed behavior analyst, and all services under the supervision or direction of a licensed behavior analyst or licensed psychologist. Coverage under an ongoing treatment plan may be extended past those limits if medical necessity is determined. The section does not apply to nongrandfathered individual and small group plans that must include essential health benefits, and a small employer with 100 or fewer employees that offers a policy "will offer coverage" under it (Miss. Code Ann. 83-9-26, as posted by the Mississippi Insurance Department). The statute was enacted as HB 885 in the 2015 session. The text was read from the Insurance Department's posted copy, not the Legislature's code host.
Practices with in-house diagnostics versus ABA-only practices
The commercial statute allows supervision by a licensed behavior analyst or a licensed psychologist, so a practice with a psychologist on staff has a supervision route that an ABA-only practice does not. How the Medicaid ASD rule treats diagnosis, referral, and supervision was not verified.
How this connects to the rest of your compliance stack
See the Mississippi Licensing page for the credential posture and the Mississippi entity page for the structure analysis.
What this guide could not verify
- The ASD plan pages and the Division of Medicaid's ASD administrative rule, including diagnosis and referral requirements.
- Per-unit rates for 97151 to 97158.
- Place of service, school, and telehealth rules.
- Which entity performs prior authorization, managed care status, and hour limits.
- Medicaid provider qualifications and enrollment steps.
Mississippi reimbursement variables at a glance
| Variable | Mississippi value |
|---|---|
| ABA covered by Medicaid? | Yes, EPSDT ASD services, SPA MS 16-0020, effective January 1, 2017 |
| Payment method | Lesser of usual and customary charge or actuarial rate (SPA 22-0022) |
| Prior authorization | Required |
| Rates | Not verified |
| Commercial mandate | 83-9-26: 25 hours per week, not beyond age 8, extension on medical necessity |
Frequently asked questions
Does Mississippi Medicaid cover ABA?
How are rates set?
What does the commercial mandate limit?
Where professional advice is essential, not optional
The Division of Medicaid's own pages were unreachable during research, so Mississippi is a page to pair with a direct read of the ASD rule and fee schedule before you model revenue.
The governing authorities to know are SPA MS 16-0020, SPA MS 22-0022, and Miss. Code Ann. 83-9-26.
This page describes rules read from CMS state plan documents, the Mississippi Secretary of State's administrative code, and the Mississippi Insurance Department. The Division of Medicaid's ASD rule and fee schedule could not be read. The Division of Medicaid, the Insurance Department, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.