Michigan Medicaid ABA access SPA MI-25-0020 was approved February 19, 2026 and is effective June 1, 2026. The approved state plan package says a confirmed ASD diagnosis does not require reevaluation for continued BHT eligibility unless reevaluation is medically necessary, permits authorization periods up to 365 days, and requires validated assessment methods and behavioral outcome tools.

Apply the confirmed-diagnosis rule narrowly

The approved text removes a routine reevaluation requirement for a child with a confirmed ASD diagnosis, but it does not prohibit a medically necessary reevaluation or eliminate current assessment, treatment planning, eligibility, provider, and authorization requirements. Record the diagnostic professional, date, method, confirmation, later clinical concern, and the exact reason any new diagnostic evaluation is requested. Avoid telling families that all evaluations have ended.

Separate diagnostic and behavior assessments

Michigan describes a comprehensive diagnostic evaluation and a later behavior assessment with different purposes and qualified professionals. The behavior assessment may include observation, record review, functional analysis, data collection, and validated instruments. Keep the diagnostic record, referral, behavior assessment, baseline, outcome tool, treatment plan, and reassessment as distinct artifacts. A prior diagnosis cannot substitute for current target definition or individualized measurement.

Treat 365 days as a ceiling

BHT services may be authorized for a period not exceeding 365 days and may be reauthorized annually on a licensed professional's medical-necessity recommendation. This is not a guaranteed one-year approval or a permission to delay clinically indicated review. Preserve request and approved dates, authorized services and amount, conditions, review milestones, progress evidence, change events, renewal due date, and payer response.

Use validated tools without turning them into treatment

The SPA names validated assessment and behavioral outcome tools as examples of how functioning and improvement may be measured. Tool scores inform judgment; they do not independently determine diagnosis, dosage, medical necessity, discharge, or success. Qualified clinicians should record why a tool fits the person, version and administration conditions, baseline, repeated measure, interpretation, limitations, and how results changed the plan.

A fictional Michigan access review

Imani locks 36 BHT access records. Twenty-seven distinguish confirmed diagnosis, current behavior assessment, selected outcome tool, medical-necessity recommendation, requested period, authorized period, progress review, and renewal owner. Completeness is 27 of 36, or 75%. Three files request unnecessary diagnostic repeats, two lack baseline evidence, two confuse a tool score with eligibility, one has an expired authorization, and one lacks the payer response.

Confirm implementation outside the SPA

An approved SPA establishes state-plan authority, not every current portal field, plan procedure, code edit, fee, or provider contract. Recheck the 2026 policy bulletin page, mental-health provider resources, behavioral-health billing guidance, and the responsible Medicaid health plan before submission. Escalate any conflict with the SPA package and later agency direction attached. Do not infer a payment rate or network status from the access amendment.

Michigan SPA checklist

Verify SPA MI-25-0020 approval and June 1 effective date, member age and eligibility, confirmed diagnosis and diagnostic professional, medical need for any reevaluation, referral, behavior assessment, validated instrument, baseline and outcome tool, qualified rendering and overseeing providers, individualized plan, requested services and period, authorization no longer than 365 days, approval conditions, progress review, renewal, current bulletin and payer route, claim result, continuity action, and source recheck.

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