North Carolina Doubles ABA Reauthorization Work. Silna Says Technology Can Help

North Carolina doubles reauthorization work

RALEIGH, NORTH CAROLINA — North Carolina pulled back from a monthly approval rule that worried ABA providers. The final policy is less severe, but it still doubles the number of reauthorizations for intensive treatment plans.

Plans with more than 16 hours of services per week must now be updated and approved every three months. Plans at or below 16 hours stay on a six-month schedule.

The change took effect August 1. Existing approvals will not be cut short. NC Medicaid’s August 31 bulletin says the shorter schedule begins when each patient reaches the next reauthorization.

The policy also adds new credentialing, supervision, and telehealth rules. Technicians must earn an RBT or ABAT certification after a 120-day grace period. At least 10% of technician-delivered services must include observation and direction from a licensed supervisor, and technicians can no longer provide services by telehealth.

Those changes may improve oversight. They also add paperwork to a system already facing staff shortages and approval delays.

The paperwork adds up

Morelli said providers report spending 10 to 15 hours preparing one treatment plan. Moving from a six-month approval schedule to a three-month schedule results in two additional reauthorizations each year, by his estimate, which adds 20 to 30 hours of work for each affected patient.

The estimate makes the burden easy to understand; however, it is not a statewide average. Silna did not share how many providers were included, how time was measured, or how many North Carolina patients exceeded the 16-hour threshold.

Not every hour is automatically unpaid. Some treatment-plan work may be billable, while other administrative work may not be. The clearer point is that the new schedule takes more time from clinical and administrative teams.

Why smaller providers may feel it most

Large organizations can centralize prior-authorization work, assign specialized staff, and buy software. A BCBA opening a small practice must spread the same work across fewer employees and patients.

Morelli believes that difference could discourage independent clinicians from opening new practices. The result, he argues, may be a market with fewer small providers and more care concentrated among large organizations.

There is not enough data to confirm that prediction. North Carolina will need to track new provider enrollment, practice closures, approval times, denials, and treatment gaps.

Why the state tightened the rules

North Carolina’s changes followed rapid growth in Medicaid spending. NC DHHS reported that spending on research-based behavioral health treatment rose from $121.7 million in 2022 to about $544.4 million in 2025. The department projected spending of $1.14 billion by 2027.

The number of patients receiving services rose from 3,844 to 13,447 during the same period. NC DHHS said spending grew faster than enrollment and was concentrated among a small group of providers.

The state says it wants more individualized treatment plans, stronger documentation, and more sustainable spending. It has also promised to protect medically necessary care and rural access.

Providers worry the new schedule could create treatment gaps if health plans cannot process twice as many requests on time. NC Health News reported that some clinics were already seeing delays under the six-month schedule.

The first test will come when current approvals expire. Families will feel the change through approval times and interruptions, not through the policy language itself.

What technology can and cannot do

Prior authorization includes several steps: checking insurance coverage, identifying the required requirements, preparing documents, submitting the request, and tracking the response.

Silna’s platform brings those steps into one system. Its document-review tool looks for missing or inconsistent information before a provider submits a request to help providers avoid preventable denials

Prediction tools also need human review. A warning that a request may be denied should lead to a closer look at the paperwork. It should not become a reason to delay or deny care before the payer decides.

Technology can make the process easier. It cannot remove the extra approval cycles created by the state.

What comes next

Morelli supports a different approach known as gold-carding. Under that model, providers with a strong approval or compliance record can receive an exemption from some repeat reviews.

CMS uses a similar idea in federal programs. The goal is to spend less time reviewing providers with reliable records and more time on higher-risk cases.

North Carolina would need clear standards, consistent data across health plans, and a way to remove exemptions when a provider no longer qualifies.

The bigger picture is measurement. The state should publish approval times, denial rates, the number of patients above the 16-hour threshold, treatment interruptions, provider entry and exit, and patient outcomes.

Until those numbers are available, the clearest cost is time. An intensive plan that once needed approval twice a year may now need it four times. Large organizations may be able to absorb that work. A small practice may not.

North Carolina set out to strengthen oversight. The question is whether it can control spending without limiting care or making the market even harder for small providers.

AT A GLANCE

SOURCES & REFERENCES

Disclosure: Silna’s public-relations representative brought the North Carolina story to Breaking News ABA and arranged the interview with Morelli. Any prepublication review by Silna is limited to checking company-specific facts. The company does not have editorial approval.