Indiana Ends Peer-to-Peer Reviews for Fee-for-Service Prior Auths November 1

Indiana Health Coverage Programs bulletin BT2026161, issued September 29, says that beginning November 1, 2026, peer-to-peer reviews “will no longer be offered” for fee-for-service (Traditional Medicaid) prior authorization requests. “Peer-to-peer review scheduling will end effective Oct. 31, 2026” — 25 days from today. After that, “All authorization determinations will be completed through the administrative review and appeal processes.”

The turn: the fast fix goes away

A peer-to-peer call is where a BCBA can explain to a reviewer why a request for hours or an assessment makes sense, and often get a denial reversed without paper. That option ends for fee-for-service. Administrative review and appeal continue “following current policies and timelines,” and member appeals aren't affected. The bulletin also points to InterQual criteria now built into Acentra Health's submission workflow, and adds that completing them “does not guarantee approval.” The practical result: the request you submit has to carry the whole case, because there's no conversation afterward.

Same day: the referral rules, clarified

Bulletin BT2026160 says “statement of need” and “referral” now mean the same thing. A referral is required:

• at the start of ABA if the comprehensive diagnostic evaluation (CDE) is more than a year old;
• at reauthorization once the CDE passes a year old during treatment;
• with a new prior authorization after a six-month gap in ABA services, and again with each new PA if gaps continue.

It isn't required with every reauthorization or annually, and once submitted it doesn't need resubmitting. But “reassessment and an updated treatment plan must be completed at least every six months.” Referrals may come from an HSPP-endorsed doctoral psychologist, a physician, an APRN or a physician assistant. A BCaBA, BCBA, PT, SLP or OT can't write one.

The limits

BT2026161 is limited to fee-for-service. It doesn't say whether Indiana's managed care entities will follow. Neither bulletin changes the medical necessity standard itself. These are two of four ABA bulletins issued that day, including the FBA requirement that starts October 29.

What you must know or do

• Billers: list every pending or recently denied fee-for-service Indiana ABA authorization. Schedule any peer-to-peer you want before October 31.
• BCBAs: from November, write fee-for-service requests as if they'll be decided on paper alone, because they will. Answer the InterQual prompts in full.
• Intake: check each client's CDE date. If it's more than a year old at start or will pass a year before the next reauthorization, line up a referral from a physician, APRN, PA or HSPP psychologist, not the BCBA.