Medicaid Manual Changes (Effective 7/1/2026)

The Georgia Department of Community Health (DCH) released the July 1, 2026 Autism Spectrum Disorder Provider Manual, which includes several policy clarifications and documentation updates affecting autism providers statewide.

While this quarter's update does not represent a major overhaul of the Autism benefit, several revisions may impact provider enrollment, prior authorization submissions, treatment requests, and documentation expectations.

Below are the changes providers should be aware of:

1. Greater Scrutiny for Treatment Requests Over 30 Hours/Week [Section 803.11]

Perhaps the most important clinical update is new language regarding intensive treatment requests.

The manual now explicitly states that:

“Treatment services generally range from 10–30 hours per week, and requests exceeding 30 hours/week will receive an enhanced authorization review.”

What this means —> This does not create a hard cap on services.

Providers may still request more than 30 hours when medically necessary.

However, providers should expect:

• Increased clinical review

• Greater scrutiny of medical necessity

• Stronger expectations that assessments clearly justify treatment intensity; and

• More comprehensive supporting documentation.

  
  

Practice Recommendation

Before submitting requests exceeding 30 hours:

• Clearly document why lower treatment intensity is insufficient

• Ensure assessment results directly support dosage recommendations

• Describe why the member cannot make adequate progress with fewer hours

• Be prepared for additional requests for information

2. Clarification on Billing for RBTs and BCaBAs [601.1.2]

The manual now clarifies that services delivered by RBTs and BCaBAs must continue to be billed under the supervising BCBA in accordance with Medicaid billing requirements.

Importantly, DCH also specifies:

• The technician providing the service is responsible for completing and signing the daily treatment documentation; and

• Clinical oversight remains the responsibility of the supervising BCBA

  
  

While this largely reflects existing practice, DCH has now incorporated this expectation directly into policy.

3. Group Enrollment Requirements Clarified [601.1.2]

The enrollment section has been reorganized and clarified.

The manual now explains that:

• Practices with two or more clinicians should enroll as group providers

• Individual clinicians enroll as rendering providers linked to the group

• Providers must meet Georgia residency/border requirements; and

• BCBAs must hold active Georgia licensure

  
  

Although much of this reflects existing enrollment policy, the language is clearer than in previous manuals.

4. Prior Authorization Guidance Updated [Appendix D; Appendix E, Section B]

Several revisions were made to Appendix E regarding prior authorizations, including:

• Revised guidance for retroactive PAs

• Updated instructions regarding how far in advance PAs may be submitted; and

• Updates related to consolidated authorizations

  
  

Providers should carefully review Appendix E before submitting future authorization requests.

5. Treatment Plans Should Better Justify Intensity [Appendix E Section B; Appendix F]

Although the treatment plan template remains optional, DCH continues to emphasize that treatment plans should demonstrate a direct relationship between:

• Assessment findings

• Identified deficits

• Individualized goals; and

• Requested treatment intensity

  
  

The manual reiterates that the template itself is not required, but the guidance within it reflects DCH's expectations for high-quality documentation. 

6. School-Based Documentation Expectations Continue to Expand [Section 804.7-12]

Although most school-related changes occurred in previous quarterly manuals, DCH continues reinforcing expectations surrounding:

• Medically necessary school services

• Behavior reduction documentation

• Treatment in multiple environments when appropriate

• IEP/IFSP documentation; and

• School personnel training requests

  
  

Providers offering school-based ABA should continue reviewing these sections carefully when requesting authorization.

Key Takeaways

For most providers, this quarter's revisions should not require immediate operational changes.

However, organizations should:

✔ Review treatment planning procedures for requests exceeding 30 hours/week.

✔ Ensure technician documentation and supervising BCBA responsibilities align with the updated billing language.

✔ Review enrollment structure to confirm rendering providers and group enrollment remain compliant.

✔ Familiarize authorization staff with the revised Appendix E guidance before submitting future PAs.

Many of these revisions appear to be clarifications rather than entirely new policy. However, experience has shown that seemingly minor language changes often signal how DCH intends to review documentation during prior authorization and post-payment review.

Providers should view this update as an opportunity to strengthen documentation, particularly for higher-intensity treatment requests and complex cases.

Link to DCH Autism Provider Manual