Pennsylvania's Community Care Now Authorizes IBHS Six Months at a Time

Since September 17, every new or renewed IBHS authorization, ABA included, runs six months at most instead of 12. The annual assessment doesn't change, so the extra request is a reassessment update. Magellan does the same in Somerset and Bedford on October 1.

Community Care Behavioral Health's Provider Alert 18, issued August 17, took effect on September 17: across all of its HealthChoices contracts, Intensive Behavioral Health Services authorizations “will be approved for a maximum of 6 months per authorization period.” Until now they could run up to 12 months within a waiver period.

It covers every IBHS level of care, including ABA, and Community and School-Based Behavioral Health. Only MST and FFT are unchanged.

The turn: twice the requests, not twice the assessments

The alert keeps the annual clock where it was. A Full Formal (Comprehensive) Assessment is still required “at least every 12 months,” and Written Orders “continue to be valid for up to 12 months.” So the new mid-year request doesn't need a new comprehensive assessment. It needs “a reassessment/update that documents the member's current clinical status, progress toward treatment goals, ongoing needs, and any recommended changes to services.”

That's the real workload change. For every IBHS-ABA client, one authorization packet a year becomes two, and the second one has to argue continued medical necessity from progress data.

What the alert says

  • Existing authorizations stand. Anything issued before September 17 “will remain in effect through their approved end date.”
  • New and renewal requests submitted on or after September 17 follow the six-month maximum. Requests for longer periods “will not be processed as submitted.”
  • Assessment units are capped in the ePortal: 100 units for Individual, Group and EBP “ASSESS” authorizations, and 200 units for “ASSESS-ABA.”
  • Community Care says there's “no change to documentation expectations, service definitions, or program eligibility requirements.”

The plans are converging on six months

  • Philadelphia's CBH has capped all IBHS authorizations at six months since February 23, 2025 (Provider Bulletin 25-05).
  • Magellan, with Behavioral Health Services of Somerset and Bedford Counties, received OMHSAS approval to move IBHS Individual, ABA and Group to a six-month maximum. Requests for Somerset and Bedford members with start dates of October 1, 2026 or later must reflect it.
  • PerformCare's policy CM-CAS-042, last reviewed April 3, 2026, still generates authorizations “for a maximum of 12 months.”

The limits

Community Care frames the change as supporting “timely reassessment of medical necessity and service intensity.” It doesn't say it will reduce hours, and it says medical necessity criteria haven't changed. Whether shorter authorizations lead to more reductions at renewal is something only your own denial data will show. Carelon's Pennsylvania contracts weren't checked for this piece.

What you must know or do

  • Intake and authorization staff: list every Community Care IBHS client with an authorization ending after September 17, and calendar the renewal packet six months from each new start date, not 12.
  • Clinical directors: build a reassessment/update template covering the four things the alert names: current clinical status, progress toward goals, ongoing needs, and recommended changes. Keep the comprehensive assessment on its annual cycle.
  • Check that no pending request asks for more than six months. Community Care won't process it as submitted.
  • Somerset and Bedford providers: any Magellan request starting October 1 or later should span six months at most.
  • Owners: estimate the extra BCBA time a second packet per client per year costs, and whether 200 ASSESS-ABA units covers your assessment practice.