Note: Texas Medicaid managed care organizations (MCOs) must follow all aspects of the Applied Behavior Analysis (ABA) services policy as outlined in this draft notice. MCOs must provide all medically necessary, Medicaid-covered services to eligible clients. Providers should contact the client's specific MCO for details.
Effective for dates of service on or after February 1, 2022, Autism Services, to include Applied Behavior Analysis (ABA) evaluation and treatment, will be a benefit of the Texas Health Steps-Comprehensive Care Program (THSteps-CCP) for Texas Medicaid recipients who are 20 years of age and younger and who meet the criteria outlined in the Autism Services benefit description. Texas Health and Human Services Commission (HHSC) is releasing a draft of the Medicaid Autism Services benefit to providers.
The new Medicaid Autism Services benefit includes coverage of medically necessary ABA services for individuals with Autism Spectrum Disorder (ASD) and provides for coordination of the service array in interdisciplinary team meetings. The draft of the Medicaid Autism Services benefit includes the following topics:
- Applied Behavior Analysis (ABA) as a new benefit
- Requirements for prior authorization for ABA evaluation and treatment
- Clinical documentation requirements
- Licensed Behavior Analyst (LBA) as a new provider type and descriptions of Licensed assistant Behavior Analysts (LaBAs) and Behavior Technicians (BTs) who may work under supervision of an LBA. Note: LaBAs and BTs may not enroll in Medicaid.
- Requirements for interdisciplinary team meetings
- Prior authorization, billing, and reimbursement for procedure codes 97151, 97153, 97154, 97155, 97156, 97158, and 99366
- Medicaid Autism Services will be delivered in managed care as well as in fee-for-service.
The CCP Prior Authorization Request Form will be updated to enable requests for prior authorization of ABA services. Requests for prior authorization for new Autism Services benefits will be accepted on or after February 1, 2022. Claims may be submitted for dates of service beginning February 1, 2022.
Beginning July 30, 2021, Licensed Behavior Analyst Providers Can Submit Texas Medicaid Enrollment Applications. More information can be found at this link: TMHP’s Provider Enrollment on the Portal
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.
- Have a national provider identifier (NPI).
The draft of the Medicaid Autism Services benefit can be found at this link. The language in the Autism Services benefit draft is subject to change. A webinar is planned in the future for the public regarding the new benefit. Additional information will be provided in future articles on TMHP.com.
The provider rates associated with this benefit can be found at this link: Reimbursement Rate Updates for Autism Services Procedure Codes Effective February 1, 2022.
Email questions to MedicalBenefitRequest@hhsc.state.tx.us.