Georgia Medicaid Gives Every ABA Request Over 30 Hours a Week an Enhanced Review

Georgia's Department of Community Health published a revised fee-for-service autism services manual dated July 1, 2026. It adds a new line below section 803.11: "Treatment services typically range from 10 to 30 hours per week… Requests exceeding 30 hours per week will undergo an enhanced authorization review."

The turn: not a cap, but a line on the page

Several states have set hard ceilings this year. Georgia hasn't. It still says hours "may be higher or lower when medically necessary." But a 30-hour threshold tells a reviewer where to look harder. Combined with the manual's two-month limit on data age, a request above 30 hours now needs fresh, specific justification to clear.

What else changed in the July and April revisions

• Rendering provider (new July 1): "For RBT or BCaBA rendered services, such as 97153, the supervising BCBA must be identified as the rendering provider on the claim." The RBT or BCaBA still writes and signs the session note.
• Enrollment: practitioners must "reside in Georgia or within 50 miles of the Georgia border and must hold an active license issued by the Georgia BCBA Licensure Board." Practices with two or more clinicians enroll as a group. "The Department does not provide a grace period for certification or enrollment."
• Submission window (July 1): prior auths "may be submitted up to 2 months before the PA's effective date." The April version allowed 90 days.
• No backdating: "PA effective dates cannot be made retroactive or backdated under any circumstance." A provider may set the effective date up to 30 days before submission.
• Data age: continued-treatment data "must not be more than two months older than the effective date of the requested prior authorization." Follow-up requests need a behavioral assessment from within two months.
• Turnaround (April 1): decisions within 7 calendar days, down from 45, plus 10 days when supplemental documentation is needed.

The limits

This is the fee-for-service manual. Most Georgia Medicaid children are in Georgia Families managed care, where each plan sets its own criteria. We covered CareSource Georgia's policy on September 7. The manual doesn't define what an "enhanced authorization review" involves. In April, DCH announced further July 1 fraud-prevention measures, including RBT oversight ratios and an annual abandoned-care report. We couldn't find either in the manual or in any final notice.

What you must know or do

• Clinical directors: list fee-for-service members authorized above 30 hours a week. For each renewal, attach assessment data under two months old that ties the hours to specific deficits.
• Billing: pull a sample of 97153 claims since July 1. Confirm the supervising BCBA, not the RBT and not the group alone, is in the rendering field.
• Authorization staff: reset renewal reminders to fall inside the two-month window. A request sent 75 days early no longer fits.
• Owners: check every billing clinician's Georgia license and address. The manual gives no grace period.