This article has been updated. For the updated information, click here.
Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.
Beginning July 30, 2021, Licensed Behavior Analyst (LBA) providers can submit provider enrollment applications for Texas Medicaid through Texas Medicaid & Healthcare Partnership (TMHP). Provider Enrollment on the Portal (PEP) and the paper Texas Medicaid Provider Enrollment Application for Individuals will include LBA providers beginning July 30, 2021.
A checkbox for the LBA provider type and the requirements for LBA will be added to PEP and the updated version of the paper application.
Provider enrollment in Medicaid does not mean that an LBA may begin providing ABA services at that time. The benefit implementation date is February 1, 2022, and no LBA ABA services provided prior to that date are eligible for Medicaid reimbursement.
National Provider Identifier
LBA providers will be required to have a national provider identifier (NPI) before enrolling in Texas Medicaid.
Required Licenses and Certifications
To enroll in Texas Medicaid, LBA providers must be licensed as a Licensed Behavior Analyst (LBA) by the Texas Department of Licensing and Regulation (TDLR) or the appropriate state board where services are rendered.
Note: Providers cannot enroll if their licenses are due to expire within the next 30 days.
Important: Board Certified Assistant Behavior Analysts (BCaBA) and Registered Behavior Technicians (RBT) are not eligible for enrollment.
Enrollment in Texas Medicaid Using Provider Enrollment on the Portal
LBA providers are encouraged to enroll on TMHP’s Provider Enrollment on the Portal.
Online enrollment includes the following advantages:
- Applications are validated immediately to ensure that all fields have been completed.
- Most of the application can be completed online so that only a few attachments may need to be uploaded.
- Applicants can view real time status of both complete and incomplete applications submitted through PEP.
Texas Medicaid Enrollment Application
The paper Texas Medicaid Enrollment Application for Individuals will include LBA beginning July 30, 2021.
A checkbox for the LBA provider type and the requirements for LBA will be added to the updated version V.IV of the paper application.
For paper applications submitted to TMHP, the TMHP Provider Enrollment Department will accept the previous version V.III of the application through September 1, 2021. As of September 1, 2021, TMHP will only accept the most current version of the application as posted on the website. Previous versions of the application submitted on or after September 2, 2021, will be returned to the provider with a request that the correct version of the application be submitted with all required documentation.
Claims for services may not be submitted before February 1, 2022.
For more information, call the TMHP Contact Center at 800-925-9126.