ProviderMatters

Behavioral Health Policy Updates (September 2025)

Posted on September 4, 2025

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice.

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.

 

Behavioral Health Policy –  New Effective Date  Summary of Changes 
Intensive Outpatient Program (IOP); Partial Hospitalization Program (PHP)  8/14/2025 
  • Documents process already in place.
Applied Behavioral Analysis for Down Syndrome 1/1/2026 
  • Applies to Commercial and Self-Funded plans who have accepted the DOI requirements.

 

Behavioral Health Policy – Annual Effective Date  Summary of Changes 
Applied Behavioral Analysis for Autism Spectrum Disorder  9/1/2025 
  • Removed the following language: A minimum of one (1) hour treatment planning per month is required, up to one (1) hour for every 10 hours of direct service.
  • Removed from Prior Authorization section 11, A, 1: language related to the FBA for ASD.
  • Separated the PARF for ABA FBA and ABA services requirement.
  • Added language on requirements for ABA FBA testing tools.
Admission and Concurrent Review Criteria for ASAM 3.5 10/1/2025 
  • No changes
Inpatient Rehabilitation (ASAM Level 3.7) for Substance Abuse 10/1/2025 
  • No changes
Clinical Review Criteria Related to Community-Based Acute Treatment/Youth Clinical Crisis Stabilization (CBAT/YCCS) Program and Intensive Community-Based Acute Treatment (ICBAT) Program 10/1/2025 
  • No changes
Behavioral Health Day Treatment 10/1/2025 
  • No changes
Neuropsychological Testing, Psychological Testing, and Neurobehavioral Status Exam 10/1/2025 
  • No change
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